RESPIRATORY FAILURE IN ACUTE ORGANOPHOSPHATE POISONING: MECHANISMS, RECOGNITION, AND MANAGEMENT

Authors

  • Dumpala Pramod Agasteen V Year Pharm.D, Ratnam institute of pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore 524346.
  • Magati Tejaswini V Year Pharm.D, Ratnam institute of pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore 524346.
  • Sadepalli Stella Sirisha V Year Pharm.D, Ratnam institute of pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore 524346.
  • Sangadala Thanvika V Year Pharm.D, Ratnam institute of pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore 524346.
  • M. Sowjanya Assistant Professor, Department of Pharmacy Practice, Ratnam institute of pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore 524346.
  • M. Bhargavi Department of Pharmacy Practice, Ratnam institute of pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore 524346.
  • Yadala Prapurna Chandra Principal And Professor, Department Of Pharmacology, Ratnam Institute Of Pharmacy, Pidathapolur, (V & P), Muthukur (M), Spsr Nellore District-524 346, Andhra Pradesh.

Keywords:

Organophosphate poisoning, Respiratory failure, cholinergic crisis, Intermediate syndrome, Mechanical ventilation, Atropine and oxime therapy

Abstract

Organophosphate (OP) poisoning is one of the serious health problems globally, especially in the agricultural regions of low, and middle, income countries, and respiratory failure has been identified as the principal cause of death. This review to summarize the main features of pathophysiology, diagnosis, and treatment of respiratory failure caused by OP poisoning. Respiratory failure is the result of the conjunction of multiple mechanisms, such as muscarinic, neuromuscular junction, and central depression. The clinical manifestations can be ranging from acute cholinergic crisis to intermediate syndrome so that the patient has to be carefully monitored and treated as soon as possible. The therapeutic approach involves immediate airway control, use of mechanical ventilation, and administration of atropine and oximes, which are antidotes. Although the pathophysiology of the disease has been well elucidated, the death rate is still high, so it is critical to make an early diagnosis and to administer intensive treatment without delay. This article presents a management protocol for this life-threatening condition currently supported by the existing scientific literature.

References

Eddleston M, et al. Respiratory failure in acute organophosphorus pesticide self-poisoning. QJM. 2006. doi:10.1093/qjmed/hcl065.

Tsao TC, et al. Respiratory failure of acute organophosphate and carbamate poisoning. Chest. 1990;98(3):631–6. doi:10.1378/chest.98.3.631.

Tong-qin, et al. Respiratory failure caused by acute organophosphorus pesticides poisoning: analysis of 56 cases. 2006. doi:10.3969/j.issn.1007-1326.2006.02.029.

Giyanwani PR, et al. Respiratory failure following organophosphate poisoning: a literature review. Cureus. 2017;9(9):e1651. doi:10.7759/cureus.1651.

Hulse EJ, et al. Respiratory complications of organophosphorus nerve agent and insecticide poisoning: implications for respiratory and critical care. Am J Respir Crit Care Med. 2014;190(12):1342–54. doi:10.1164/rccm.201406-1150CI.

Patil VP, et al. Contributing factors for morbidity and mortality in patients with organophosphate poisoning on mechanical ventilation: a retrospective study in a teaching hospital. J Clin Diagn Res. 2016;10(12):OC06–OC09. doi:10.7860/JCDR/2016/22116.9038.

Bryant S, et al. Organophosphate poisoning. Acad Emerg Med. 2008;15(5):497–8. doi:10.1197/S1069-6563(03)00378-6.

Sheng-yang, et al. Cause analysis and clinical countermeasure of respiratory failure in acute organophosphorus pesticide poisoning. 2002. doi:10.3969/j.issn.1671-301x.2002.02.007.

Baker DJ. The management of respiratory failure following organophosphate exposure. 1998.

Yang CC, Deng JF. Intermediate syndrome following organophosphate insecticide poisoning. J Chin Med Assoc. 2007;70(11):467–72. doi:10.1016/S1726-4901(08)70043-1.

Shin YH, et al. Respiratory failure of acute organophosphate insecticide intoxication. Tuberc Respir Dis. 1999;46(3):363–72. doi:10.4046/TRD.1999.46.3.363.

Carey JL, et al. Central respiratory failure during acute organophosphate poisoning. Respir Physiol Neurobiol. 2013;189(2):403–10. doi:10.1016/j.resp.2013.07.022.

Guo-biao, et al. Treatment by mechanical ventilation for respiratory failure caused by acute organophosphorus pesticide poisoning. 2005. doi:10.3969/j.issn.1672-3619.2005.03.023.

Trancart MM, et al. Identification of mechanisms underlying ventilatory dysfunction in organophosphorus chemical warfare agent-exposed mice. Chem Biol Interact. 2025;403:111713. doi:10.1016/j.cbi.2025.111713.

Yu JH, et al. Outcomes of elderly patients with organophosphate intoxication. Sci Rep. 2021;11:12431. doi:10.1038/s41598-021-91230-2.

Lü M, et al. Experience of the treatment on 35 cases of acute organophosphorus pesticide poisoning complicated with respiratory failure. 2008. doi:10.3969/j.issn.1002-221x.2008.06.009.

Lingyun, et al. Analysis of 42 cases of acute organophosphorus pesticide poisoning with respiratory failure. 2014. doi:10.3969/j.issn.1674-4500.2014.04.09.

Owobu AC, et al. Severe organophosphate poisoning and aspiration pneumonitis treated with exchange blood transfusion: a case report. Oxf Med Case Reports. 2025;2025(1):omaf031. doi:10.1093/omcr/omaf031.

Zellner T, et al. Severe pirimiphos-methyl intoxication: clinical findings and cholinesterase status. Front Pharmacol. 2022;13:1102160. doi:10.3389/fphar.2022.1102160.

Hulse EJ, et al. Organophosphorus nerve agent poisoning: managing the poisoned patient. Br J Anaesth. 2019;123(4):457–63. doi:10.1016/j.bja.2019.04.061.

Khan S, et al. Prolonged intermediate syndrome due to organophosphate poisoning. J Clin Toxicol. 2012;2(3):229. doi:10.4172/scientificreports.229.

Singh G, Khurana D. Neurology of acute organophosphate poisoning. Neurol India. 2009;57(2):119–25. doi:10.4103/0028-3886.51277.

Chong-tao. Analysis of acute organophosphorus pesticide poisoning complicated with respiratory failure: 69 cases. 2012. doi:10.3969/j.issn.1671-8194.2012.36.025.

Vamsi V, SomaSekhar K, Sandeep R, Meghana B, Sharmila S. Case Report on Pulmonary mucormycosis. International Journal of Health Care and Biological Sciences. 2023 Nov 25:7-9.

Azazh A. Severe organophosphate poisoning with delayed cholinergic crisis, intermediate syndrome and organophosphate-induced delayed polyneuropathy. Ethiop J Health Sci. 2011;21(3):203–8. doi:10.4314/ejhs.v21i3.

Ramadori G. Organophosphorus poisoning: acute respiratory distress syndrome and cardiac failure as cause of death in hospitalized patients. Int J Mol Sci. 2023;24(7):6658. doi:10.3390/ijms24076658.

Jokanović M, Kosanović M. Neurotoxic disorders and medical management of patients poisoned with organophosphorus pesticides. Scripta Med. 2012;43(2):91–7. doi:10.5937/scriptamed1202091j.

Anjana S, et al. Predictors of respiratory failure in acute organophosphorus compound poisoning. Int J Health Res Medico-Legal Pract. 2019;5(1):23–6. doi:10.31741/IJHRMLP.V5.I1.2019.5.

Abdollahi M, Karami-Mohajeri S. Intermediate syndrome caused by organophosphate poisoning: a comprehensive review. Toxicol Appl Pharmacol. 2012;258(3):309–14. doi:10.1016/j.taap.2011.11.014.

Peter JV, et al. Management of acute organophosphorus pesticide poisoning. Lancet. 2008;371(9612):597–607. doi:10.1016/S0140-6736(08)60947-2.

Published

14-02-2026

How to Cite

Agasteen, D. P., T. Magati, S. S. Sadepalli, T. Sangadala, S. M, B. M, and P. C. Yadala. “RESPIRATORY FAILURE IN ACUTE ORGANOPHOSPHATE POISONING: MECHANISMS, RECOGNITION, AND MANAGEMENT”. International Journal of Trends in OncoScience, vol. 4, no. 1, Feb. 2026, pp. 1-7, https://ijtos.com/index.php/journal/article/view/80.

Issue

Volume-4, Issue-1, 2026

Section

Review Articles
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