An organophosphate poisoning case responding the late application of Pralidoxime

Organophoshates are still widely used pesticides in agriculture, industry, the home, gardens and veterinarypractice. Organophosphates are efficiently absorbed by inhalation, ingestion and contact with the skin. Thesecompounds inhibit acetylcholinesterase and cause accumulation of acetylcholine in cholinergic receptors.Hyperstimulation of cholinergic synapses leads to the clinical manifestations of organophosphate poisoning.Medical treatment of organophosphate poisoning consists of intravenous atropine and oxime cholinesterase reactivators such as Pralidoxime. Pralidoxime regenerates acetylcholinesterase which is phosphorylated byorganophosphates and reverses both nicotinic and muscarinic effects of organophosphate toxicity. The enzyme should be given within 24 to 36 hours before its ‘‘aging’’ reaction. In this case we discuss the effectiveness of Pralidoxime administered 48 hours after organophosphate exposure with the review the literature.