American Board of Psychiatry and Neurology (ABPN) Practice Exam

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What is the treatment of choice for organophosphate insecticide exposure and poisoning?

Pralidoxime and atropine
Flumazenil
Intravenous fluids and ventilation
Dimercaprol or penicillamine

The correct answer is: Pralidoxime and atropine

The treatment of choice for organophosphate insecticide exposure and poisoning is pralidoxime and atropine. Organophosphate compounds inhibit acetylcholinesterase, leading to an accumulation of acetylcholine at neuromuscular junctions and synapses. This hyperstimulation of the nervous system manifests as a range of symptoms, including muscarinic effects (like salivation, lacrimation, urination, diarrhea, gastrointestinal distress, and emesis) and nicotinic effects (which can cause muscle twitching, weakness, and respiratory distress). Atropine is an anticholinergic agent that counteracts the muscarinic effects of excess acetylcholine, helping to alleviate symptoms such as bradycardia, bronchorrhea, and increased secretions. Pralidoxime, on the other hand, works by reactivating acetylcholinesterase if given soon enough after exposure, thus helping to significantly reduce the symptoms related to the pesticide poisoning. While other treatments such as intravenous fluids and mechanical ventilation may be necessary to support the patient’s condition, they do not address the underlying biochemical issues caused by organophosphate poisoning. Flumazenil is a benzodiazepine antagonist and is not indicated for organophosphate