Organophosphate Poisoning
                        =========================
See also <Gi-D-Dx.TXT>, <P-ChemWr.txt>

þ Symptoms:
 - acetylcholinesterase inhibitor; acetylcholine builds up in synapses of
   parasympathetic, sympathetic and somatic synapses:
   muscarinic, nicotinic, neuromuscular and CNS symptoms.
 - primary sx are muscarinic (SLUDGE): <Toxidrom.TXT -muscarinic>

þ Treatment
 - Atropine
  + The endpoint of atropine treatment is decrease of bronchial
    secretions.  Mere pupil dilation is not an endpoint.
    [Goldfrank's Toxicologic Emergencies p 1434.]
 - Glycopyrrolate
   another antimuscarinic agent.  If the patient does not have CNS symptoms it
   may be the drug of choice. Unlike atropine, it does not cross the blood
   brain barrier. For this reason, it will not cause the central
   anticholinergic symptoms that can be seen with atropine ("mad as a
   hatter"). [Goldfrank's Toxicologic Emergencies p 1434.]
 - PAM:
  + Pralidoxime counters organophosphates two ways.
    [Goldfrank's Toxicologic Emergencies p 1434.]
   - removes the organophosphate already bound to acetylcholinesterase;
     restores acetylcholinesterase to normal function.
   - prevents continued toxicity by scavenging free organophosphate.