Organophosphorus compounds are one of the important insecticides and pesticides that have been used in chemical warfare as nerve agents. They are a major global clinical problem, with thousands of deaths occurring every year. Organophosphorus compounds inhibit acetylcholinesterase activity cause to the accumulation of acetylcholine at many synapses in the brain and different parts of neuromuscular junctions. In the cases of intoxication to organophosphours poisons four clinical syndromes have been described; cholinergic crisis, intermediate syndrome, delayed neuropathy and chronic organophosphate inducted neuropsychiatric disorder. Whichever stages has special signs and symptoms. The determination of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activity in whole blood and plasma, is a rapid, convenient and benefit screening method of Poisoning due to organophosphorus compounds but without high sensitivity and specificity, also assess their degradation products in plasma and urine will be feasible but is expensive and is limited to specialized laboratories. The conventional and standard management of poisoned patients include supportive care, detoxification and treatment with antidote atropine sulfate alone or with an oxime. Some of other drugs have been suggested for treatment, e.g. glycopyrrolate, sodium bicarbonate and magnesium sulfate which may in some cases necessary. But still there are many unanswered questions and controversies in the management of organophosphorus Poisoning. Patients with moderate to severe intoxication who receive first aid and emergency medical treatment may survive. However, the presence of either a cardiac arrhythmia or respiratory failure is associated with a poor prognosis. Finally, to reduce mortality rate, early diagnosis, precise monitoring and selection appropriate treatments are useful. This article presents a review of Poisoning with organophosphorus compounds.

Background: Cocaine Poisoning is known for causing severe clinical effects such as tachycardia, hypertension, agitation and confusion. Absence of clinical manifestations in cocaine Poisoning is unusual.Case report: A 26-year old man, known to be a cocaine addict, declared that he was forced by cocaine dealers to swallow many tablets of cocaine, six hours prior to admission to emergency department. Clinical examination, cardiac, hematological and biochemical checkups were unremarkable. The patient was clinically stable and left the hospital seven hours after admission by self-discharge. Blood and urine toxicological screening tests for benzodiazepines, barbiturates, tricyclic antidepressants and ethanol were negative. Patient’s blood sample was not sufficient for analysis of cocaine and its metabolites. Using high-performance liquid chromatography, urine and gastric lavage samples were positive for cocaine. Quantification of cocaine and its metabolites including benzoylecgonine (BZE) and ecgonine methyl ester (EME) in urine was done using gas chromatography-mass spectrometry. Results revealed high levels of cocaine and its metabolites (cocaine: 360 mg/L, BZE: 1350 mg/L, EME: 780 mg/L).Discussion: Cocaine Poisoning is generally accompanied by various clinical effects. In our case, despite the confirmed Poisoning, no clinical sign was noticed. Fatal Poisonings were reported with cocaine urinary concentrations of lower than that found in our patient.Conclusion: Asymptomatic cocaine Poisoning with high cocaine levels in urine is of note.

There are hundred thousands of deaths per annum from Poisoning in the World. Accidental Poisoning is most common in children and over 50 years old persons, but deliberate self-harm becomes predominant in teenage years and early adulthood. Understanding the patterns of Poisoning can assist in developing suicide prevention strategies and reducing the risks of accidental Poisoning. On the other hand, this could be helpful in reducing the accidental and occupational Poisoning cases. In some circumstances, many of these materials can potentially induce Poisoning. In excessive amounts, chemicals that are usually harmless, even apparently safe drugs can cause Poisoning. To reduce the morbidity and mortality and overall burden of Poisoning in the community, consideration should be given to developing education program as an effective tool and establishing poison information centers.