Poisoning with organophosphates is unfortunately relatively common. especially in developing countries. If the person survives the acute phase then organophosphate-induced delayed neurotoxicity (OPIDN) may develop with long-term disability.
Phase
Time Frame
Manifestations
acute cholinergic crisis
minutes to hours after ingestion
malfunction at muscarinic and nicotinic receptors due to inhibition of acetyl-cholinesterase
intermediate syndrome (IMS)
hours to days after ingestion
muscle weakness (proximal limb, neck, respiratory, cranial nerves) with defect at neuromuscular junction
OPIDN
two weeks or more after ingestion
central and peripheral distal axonopathy, neurodegeneration
Features of the chronic/delayed neuropathy"
(1) motor neuropathy with weakness, especially of the extremities
(2) numbness and tingling in the hands and feet
(3) ataxia
Some patients develop a progressive ascending weakness and paralysis.
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