Case 02 · Toxicology
Organophosphate poisoning
A 32-year-old farmer is brought in drowsy, frothing and drenched in sweat an hour after drinking chlorpyrifos. Protect your team, secure his airway, and titrate atropine to the bedside endpoints: fast enough to save him, careful enough not to tip him into atropine toxicity.
About this case
What you will practise
Learning objectives
- Recognise the cholinergic toxidrome: secretions, bradycardia, miosis, sweating and fasciculations.
- Protect staff and decontaminate the patient alongside resuscitation.
- Titrate atropine by doubling doses to a clear chest and the other endpoints, then maintain with an infusion.
- Recognise atropine toxicity and adjust.
- Decide when to intubate, and choose a safe paralytic.
- Avoid harmful interventions; plan ICU care and a self-harm safety plan.
Key decisions this case tests
- How fast to escalate atropine, and when to stop.
- What “atropinised” actually means at the bedside.
- Rocuronium or succinylcholine?
- Gastric lavage or activated charcoal?
- Pralidoxime: per local protocol, with honest uncertainty about benefit.
Reference basis
- Eddleston M, Chowdhury FR. Pharmacological treatment of organophosphorus insecticide poisoning. Br J Clin Pharmacol 2016;81:462–70.
- Eddleston M et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide: a treatment protocol for junior doctors. Crit Care 2004;8:R391–7.
- WHO-proposed pralidoxime regimen: 30 mg/kg, then 8 mg/kg/h.
Content version 1.0 · November 2026 · clinical review pending. See the Clinical content policy.
Before you start
This case involves intentional self-poisoning. If this topic affects you personally, you can talk to someone now: Tele-MANAS, India’s free 24×7 mental health helpline, on 14416 or 1800-89-14416.
Visle is for education only and is not medical advice. Real poisoned patients need local protocols and poisons-centre advice.
Ready for another emergency?
Case 01 puts you in front of an anterior STEMI with a hidden sildenafil trap.