What is the treatment for organophosphate poisoning?

• A. Atropine
• B. Pralidoxime
• C. Activated charcoal
• D. Morphine

Answer: (A)

Organophosphate poisoning causes an excess of acetylcholine at muscarinic and nicotinic receptors because acetylcholinesterase is inhibited. The immediate, life-saving focus is to block the dangerous muscarinic effects—bronchorrhea, bronchospasm, salivation, sweating, miosis, and bradycardia—with atropine. Atropine works by competing at muscarinic receptors, rapidly reducing airway secretions and improving breathing and heart rate, which is why it is the cornerstone of initial treatment.

Pralidoxime is another important antidote that reactivates acetylcholinesterase and helps with nicotinic symptoms like muscle weakness, but atropine is the first critical step to stabilize the patient’s airway and ventilation. Activated charcoal may be considered if the exposure was recent and the patient can protect their airway, but it does not reverse the cholinergic crisis. Morphine is not appropriate here because it can worsen respiratory depression and secretions.