Acetylcholinesterase inhibition by organophosphorus pesticides or nerve gases can cause acute parasympathetic system dysfunction, muscle weakness, seizures, coma, and respiratory failure.
Prognosis depends on the dose and relative toxicity of the specific compound, as well as pharmacokinetic factors.
Initial resuscitation, then atropine and oxygen, are considered to be the mainstays of treatment, although good quality studies to show benefit have not been found.
We don't know the optimum dose of atropine to give, but common clinical practice is to administer sufficient to keep the heart rate greater than 80 beats per minute, systolic blood pressure above 80mmHg, and the lungs clear.
Glycopyrronium bromide may be as effective as atropine in preventing death, with fewer adverse effects, although no adequately powered studies have been done.
Washing the poisoned person and removing contaminated clothes is a sensible approach, but no studies have been done to evaluate benefit.
Healthcare workers should ensure that washing does not distract them from other treatment priorities, and should protect themselves from contamination.
Benzodiazepines are considered to be standard treatment to control organophosphorus induced seizures, although no studies have been found.
We don't know whether activated charcoal, alpha2 adrenergic receptor agonists (clonidine), butyrylcholinesterase replacement therapy using fresh frozen plasma or plasmapheresis, magnesium sulphate, N-methyl-D-aspartate receptor antagonists, organophosphorus hydrolases, sodium bicarbonate, milk and other "home remedies" taken soon after ingestion, cathartics, or extracorporeal clearance improve outcomes.
Oximes have not been shown to improve outcomes, but studies have been of poor quality so a definite conclusion cannot be made.Potential benefits from gastric lavage or ipecacuanha are likely to be outweighed by the risks of harm, such as aspiration.