One of the effects of organophosphate poisoning is inhibition of acetylcholinesterase leading to upregulation of nicotinic and muscarinic cholinergic neurotransmission. In warfare, sarin gasis a highly toxic synthetic organophosphorus compound that has similar effects.

Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)

• Salivation
• Lacrimation
• Urination
• Defecation/diarrhoea
• cardiovascular: hypotension, bradycardia
• also: small pupils, muscle fasciculation

'DUMBBELLS', which stands for Defecation, Urination, Miosis, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Lethargy and Salivation.

Management

• atropine
• the role of pralidoxime is still unclear - meta-analyses to date have failed to show any clear benefit