Organophosphate Poisoning

What is organophosphate poisoning?

Organophosphate poisoning is when your body reacts to organophosphate exposure. Organophosphates are a group of chemical compounds found in the following:

• Pesticides (pest control).
• Insecticides (kills insects).
• Herbicides (destroys weeds and vegetation).
• Chemical warfare nerve agents (chemicals that affect your nervous system).

Organophosphates harm your body. They damage nerves and affect how your organs function. Short or long-term overexposure leads to respiratory failure and life-threatening outcomes.

What types of organophosphates cause poisoning?

The most common organophosphates that lead to poisoning include:

• Chlorpyrifos (also known as Dursban).
• Diazinon.
• Fenthion.
• Malathion.
• Parathion.

In chemical warfare, the organophosphate Sarin is commonly used.

How common is organophosphate poisoning?

A 2020 study found 2,079 cases of organophosphate exposure without any reported deaths. This is a significant decline from the peak of exposure in 1997, where there were 20,135 cases reported that year. The decline is due to increased awareness of the dangers of these chemical compounds.

Are organophosphates still available in the United States?

From 2000 to 2005, the U.S. Environmental Protection Agency (EPA) phased out the use of residential organophosphates. Some organophosphates are still in use as insecticides for food crops.

What are the symptoms of organophosphate poisoning?

The symptoms of organophosphate poisoning affect different parts of your body and could include:

• Cardiovascular system: Increased or decreased heart rate, high or low blood pressure, abnormal heartbeat.
• Central nervous system: A headache, restlessness, seizures, loss of consciousness, coma.
• Eyes: Tearing up, bloodshot eyes, small or constricted pupils.
• Gastrointestinal system: Abdominal pain, nausea and vomiting, diarrhea
• Genitourinary system: Peeing too often or less than usual.
• Musculoskeletal system: Muscle weakness, muscle cramps, involuntary muscle movements (fasciculations).
• Respiratory system: Runny nose, wheezing, shortness of breath, tight chest, breathing in more (hyperpnea) or less air (bradypnea) than usual, watery fluid with excessive mucus coming up from your lungs (bronchorrhea).
• Skin: Excessive sweating.

What causes organophosphate poisoning?

Exposure to organophosphates causes organophosphate poisoning. These chemical compounds can enter your body through your mouth and nose or are absorbed into your skin.

You’re more at risk of exposure to organophosphates if you:

• Regularly work with or use pesticides, insecticides or herbicides that contain the compounds.
• Live in an area undergoing war or terrorism.
• Ingest (swallow) organophosphates to self-harm or attempt suicide.

If you’re thinking about self-harm or suicide, call or text the Suicide and Crisis Lifeline at 988. Someone is available to talk with you 24/7.

What does organophosphate do to the body?

Your gastrointestinal tract (ingestion), lungs (breathing) or skin (physical contact) absorb the organophosphates. Once inside your body, these chemicals stop or block the activity of cholinesterase enzymes in your plasma and red blood cells.

A neurotransmitter (brain chemical) called acetylcholine plays a critical role in muscle movement all over your body, and it usually transmits signals to cell junctions to make muscles move. After acetylcholine does its job, cholinesterase breaks down acetylcholine. Breaking down acetylcholine resets your nervous system to prevent overstimulation of your muscles and nerves.

When acetylcholine doesn’t break down, it collects in the area where nerve cells connect and communicate (synapse). This prevents your nervous system from communicating with the rest of your body, which leads to life-threatening symptoms.

What are the complications of organophosphate poisoning?

If left untreated, symptoms of organophosphate poisoning are deadly. Respiratory failure (difficulty breathing) is the leading cause of death after organophosphate poisoning.

Other complications can include:

• Cranial nerve palsy.
• Memory loss.
• Myopathy.
• Peripheral neuropathy.
• Psychosis.

How is organophosphate poisoning diagnosed?

A healthcare provider often diagnoses organophosphate poisoning based on your symptoms, clinical history and, sometimes, with blood tests to check the acetylcholinesterase activity levels. If you’re exposed to chemicals or regularly use products that contain organophosphates, please let your provider know.

Since there are many other medical conditions that can present with similar symptoms as organophosphate poisoning, your provider may order the following to check your overall health and to determine the cause of your symptoms:

• Blood tests.
• Urine tests.
• Imaging tests (MRI or CT scans).
• Electroencephalogram (EEG).
• Nerve conduction study.

Since organophosphate poisoning is life-threatening, your healthcare provider may offer treatment before all test results are back from the lab.

How is organophosphate poisoning treated?

Immediate treatment with atropine and pralidoxime treats organophosphate poisoning. Atropine reduces overstimulation of your nervous system. Pralidoxime is the antidote that reactivates the enzyme that breaks down acetylcholine. You’ll receive these medications through an IV (a needle in your vein).

Decontamination is an essential part of treatment. You’ll need to remove all your clothing since it may contain trace amounts of organophosphates. Your care team will get rid of your clothing. Your providers will wash your skin thoroughly with soap and water at least three times to ensure the compounds are no longer on your skin. They’ll also give you a clean hospital gown to wear for the rest of your stay in a hospital.

If symptoms are severe and you have trouble breathing, you may need intubation to keep your airways open.

How soon after treatment will I feel better?

Depending on the extent of organophosphate poisoning, it could take several days to weeks before you feel better. Your provider will give you the best time estimate for your situation.

Can organophosphate poisoning be prevented?

You can’t prevent all cases of organophosphate poisoning, especially if you’re in an area that’s undergoing war or you’re not aware of organophosphate use.

If you handle or work with potentially hazardous materials, you can reduce your risk by wearing personal protective equipment (PPE), like gloves and a mask, for example. Remove any clothing or items that may have come into contact with the compounds before entering your home. Make sure you take a bath or shower after working with these products and wash your hands thoroughly before eating or drinking.

Can you recover from organophosphate poisoning?

Yes, it’s possible to recover from organophosphate poisoning. But there’s a risk that symptoms could come back, or you may have permanent damage to your nervous system as a result.

Your outlook can vary based on the following:

• The amount of organophosphate exposure.
• The type of organophosphate compound.
• How organophosphates entered your body.
• Your general health at the time of exposure.

For example, if you inhale certain organophosphates, you may experience symptoms faster and more severely than if you had exposure to the same amount on your skin.

Your healthcare provider will give you the most up-to-date information on your outlook.

What is the mortality (death) rate of organophosphate poisoning?

Globally, the organophosphate mortality rate is 2% to 25%. Prompt treatment reduces your risk of a life-threatening outcome.

When should I see a healthcare provider?

If you came into contact with or had exposure to organophosphates, contact the Poison Control Poison Helpline at 1.800.222.1222. This number will connect you to a local poison center, where a poison expert will discuss the next steps. They’ll stay on the line with you until emergency services arrive.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What type of treatment do you recommend?
• Are there side effects of treatment?
• How do I decontaminate after exposure?
• How do I know if organophosphates are present in my workplace?
• What safety precautions can I take to protect myself from poisoning if I work with organophosphates on the job?

A note from Cleveland Clinic

If you work in the agricultural industry, you may be in close contact with organophosphate compounds. These compounds are dangerous to humans and animals alike and require careful handling to prevent harm.

If you experience symptoms of organophosphate poisoning, don’t panic. Start by contacting Poison Control at 1.800.222.1222. A poison expert will talk to you to make sure you’re safe. They’ll connect you to emergency services to prevent life-threatening outcomes.