Vol 1:1 Answer

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The Question

The answer is c.
The patient drank insecticide, which is primarily composed of organophosphate compounds (i.e. Malathion). These compounds inhibit acetylcholinesterase, the enzyme responsible for the breakdown of acetylcholine. The patient is having a “cholinergic crisis”. Over stimulation of muscarinic and nicotinic receptors leads to his symptoms, commonly remembered by the mnemonics SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis) or DUMBBELS (Defecation, Urination, Miosis, Bronchospasm, Bronchorrhea, Emesis, Lacrimation, Salivation). The treatment for organophosphate toxicity is atropine and pralidoxime (2-PAM). Atropine is an anti-cholinergic, therefore it competitively inhibits the excess acetylcholine. Pralidoxime works to regenerate acetylcholinesterase, therefore also limiting the amount of acetylcholine.

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