The Farmer Who Drank the Wrong Bottle — A Cholinergic Crisis Case

Case Scenario: A 35-year-old male farmer is brought to the emergency department by his relatives with complaints of excessive salivation, vomiting, and difficulty in breathing for the past 1 hour. According to his wife, he accidentally ingested a liquid pesticide while working in the fields, mistaking it for water. Shortly after ingestion, he developed abdominal cramps, sweating, and blurred vision. On examination, the patient is drowsy and restless. Vital signs: Temperature: 37°C Pulse: 48 beats/min (bradycardia) Blood pressure: 90/60 mmHg Respiratory rate: 32/min, shallow breathing SpO₂: 86% on room air General examination: Miosis (pinpoint pupils) Excessive lacrimation and salivation Profuse sweating Fasciculations noted over the chest and limbs Crepitations heard in both lung fields Investigations: ECG: sinus bradycardia Plasma pseudocholinesterase levels: markedly reduced Arterial blood gas: respiratory acidosis Diagnosis: Acute Organophosphate Poisoning Management Plan: 1. Emergency Stabilization (ABC approach): Airway: Ensure airway patency, suction secretions. Breathing: Administer oxygen; consider mechanical ventilation if respiratory failure. Circulation: IV fluids for hypotension. 2. Decontamination: Remove contaminated clothes. Wash skin with soap and water. Gastric lavage (if within 1 hour of ingestion and patient conscious). 3. Specific Antidotes: Atropine: 2 mg IV every 5–10 minutes until secretions dry and heart rate >80 bpm. Pralidoxime (2-PAM): 1 g IV over 5–10 min, may repeat in 1 hour, then every 8–12 hours.

The Farmer Who Drank the Wrong Bottle — A Cholinergic Crisis Case

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