A farmer presents with excessive salivation, lacrimation, miosis, bradycardia, and profuse sweating after working with an organophosphate insecticide. The antidote that addresses BOTH the muscarinic and nicotinic effects of this poisoning is:
- A Atropine sulphate alone
- B Pralidoxime (2-PAM) alone
- C Diazepam alone
- D Atropine combined with pralidoxime (2-PAM) ✓
Explanation
Organophosphate poisoning inhibits acetylcholinesterase, causing accumulation of acetylcholine at both muscarinic and nicotinic synapses. Atropine is an antimuscarinic agent that reverses the SLUDGE/DUMBELS syndrome (salivation, lacrimation, urination, defaecation, bradycardia, bronchospasm) but has no effect on nicotinic features (muscle fasciculations, weakness, paralysis). Pralidoxime (2-PAM) reactivates the phosphorylated acetylcholinesterase enzyme if given early (before 'ageing'), counteracting both nicotinic and residual muscarinic effects. The combination is therefore the complete antidote regimen.
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.