Organophosphate Poisoning: A Comprehensive Review of Epidemiology, Mechanisms, Diagnosis, and Management

Organophosphate (OP) compounds constitute a category of extremely toxic substances that are commonly utilized as agricultural pesticides, household insecticides, and chemical nerve agents. Acute poisoning, occurring through occupational exposure, accidental ingestion, or intentional use, poses a considerable public health challenge worldwide, especially in developing countries like India, where it is a primary cause of suicide-related fatalities. The main mechanism of toxicity is the irreversible inhibition of acetylcholinesterase (AChE), causing a buildup of acetylcholine and resulting in a cholinergic crisis. Clinical symptoms include effects on the muscarinic and nicotinic systems, as well as central nervous system involvement, which collectively create a recognizable toxidrome. Diagnosis is based on clinical evaluation and the assessment of cholinesterase levels. Effective management requires immediate resuscitation, thorough decontamination, and the swift use of antidotes—atropine and oximes—along with comprehensive supportive care. Complications such as intermediate syndrome and delayed neuropathy increase the risk of morbidity and mortality.