Review Question - QID 109527

This patient is presenting with drooling, fasciculations, and loss of control of his bladder in the setting of being a seasonal farm worker suggesting a diagnosis of organophosphate intoxication. The best initial medical therapy is to administer atropine.

Organophosphate intoxication presents with bradycardia, miosis, bronchorrhea, fasiculations, urination, lacrimation, salivation, and defecation (diarrhea). Organophosphates inhibit acetylcholinesterase, leading to increased levels of acetylcholine which causes the underlying symptoms. The best initial step in management is to stabilize the patient and remove their clothing as this may be a source of continued exposure to this compound. The next best step in management is to administer atropine which has strong anticholinergic effects. Other therapies include 2-pralidoxime which binds to organophosphate-inactivated acetylcholinesterase to "reactivate" this enzyme.

Incorrect Answers:
Answer 2: Electroencephalography could be used to diagnose a patient's underlying seizure disorder; however, it would not be indicated in the acute management of a seizure.

Answer 3: Lorazepam could be appropriate management of a patient presenting with a seizure, in particular if they are presenting in status epilepticus. This patient is not presenting with observed tonic or clonic movements and does not demonstrate Todd paralysis.

Answer 4: Supportive therapy and monitoring would be appropriate management for intoxication with an illicit substance for which there is not an antidote such as MDMA, alcohol, or marijuana.

Answer 5: Urine toxicology could be indicated to determine the underlying cause of this patient's presentation if intoxication with an illicit substance was suspected.

Bullet Summary:
The best initial step in management for organophosphate intoxication is to remove the patient's clothing (limit exposure), stabilize their vitals, and administer atropine and 2-pralidoxime.