Dr. Manokaran.C, Dr. Sathiyanarayanan.J, Dr. Sravya Nadhella Department of General medicine

Guided by

1.Professor and unit chief 2.Assistant professor 3. Postgraduate resident


Organophosphorous poisoning is one of the most common poisonings worldwide. An estimated 3 millionor more people worldwide are exposed to organophosphates each year, accounting for 300,000 deaths. Diagnosis of oragnophosphorous poisoning is challenging if patient presents in a unconscious state or no history of exposure to the compound.

Case Report

A 18year old male who was intubated in outside a government hospital for poor GCS presented to the casualty in conscious state. No history was available from the family except for the confused state. Clinical examination showed GCS-E4VTM5 with miosis & fasciculations. with lack of history, many differential diagnosis was made with the findings present.All other differentials were ruled out with investigations day by day. He was treated with atropine infusion after which his tachycardia and secretions settled. serum cholinesterase levels were obtained after a week which showed very low levels confirming organophosphorus poisoning.


In this case, lack of history made it extremely challenging to make the final diagnosis of organophosphorus poisoning.Normal serum cholinesterase levels are 5320-12920. In our case, it was extremely low- 101( almost 80% below the baseline). The clinical spectrum along with the laboratory investigations helped us in coming to the diagnosis. Though the incidence of organophosphorus poisoning is high, the absence of typical symptoms of this poisoning like increased secretions which in our case was evident after few days of admission and lack of history posts a diagnostic difficulty .


With lack of history and denial of organophosphorous compound exposure, diagnosis of organophosphorous compound poisoning is challenging . clinical features plays a important role in such dilemma


organophosphorous poisoning, clinical spectrum