Key messages

• Organophosphates cause acute respiratory and circulatory failure due to cholinesterase inhibition. Atropine sulfate is effective for muscarinic signs due to all types of organophosphates. Pralidoxime is effective for most of the highly toxic organophosphates, but is less effective for those with moderate toxicity.

• Paraquat is highly toxic with delayed and refractory pulmonary fibrosis. No known therapies are significantly effective to improve prognosis. Blood paraquat concentration 4 to 24 h after ingestion has reliable prognostic value.

• Glufosinate causes central nervous system signs and circulatory failure after a latent period of 8 to 38 h. Respiratory support must be provided for all patients, particularly those who have ingested 100 ml or more.

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