A 28-year-old agricultural worker is brought unconscious with profuse secretions, miosis, and bradycardia. Atropine 4 mg IV is given but DUMBELS features persist. The next most critical pharmacological step is:

• A Pralidoxime 1–2 g IV within 24 hours of exposure
• B Diazepam 10 mg IV for seizure prophylaxis
• C Sodium bicarbonate to alkalinise urine
• D Repeat atropine until secretions dry and pupils mid-dilate ✓

Explanation

The endpoint of atropinisation is dryness of secretions and heart rate >80 bpm, NOT pupil size alone. Large doses (30–100 mg/day in severe cases) may be needed. Pralidoxime is essential for nicotinic (muscle) symptoms but atropinisation takes priority and must continue until secretions dry. Bicarbonate is used for carbamate poisoning with cardiac arrhythmia, not organophosphate.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.