The pathophysiology of organophosphorus pesticide self-poisoning is not so simple.

The paper by Aardema and colleagues in this issue of the Netherlands Journal of Medicine illustrates well the problems that clinicians face with organophosphorus pesticide self-poisoning. Yet the toxicological literature’s image of this poisoning is beguilingly simple. Ingestion of an organophosphorus pesticide results in inhibition of acetylcholinesterase. The resulting build up of acetylcholine causes overstimulation of cholinergic synapses in the autonomic nervous system, central nervous system and neuromuscular junction, producing the acute cholinergic crisis. Patients die from respiratory failure during this crisis, or from a delayed respiratory failure called the intermediate syndrome. Atropine and oximes treat the poisoning.