A farmer presented with confusion, increased salivation, fasiculations, miosis, tachycardia and hypeension. Poison that can cause these manifestations: FMGE 10; AIIMS 12; KCET 13; PGI 14; JIPMER 14
Organophosphates inhibit acetylcholinesterase, leading to accumulation of acetylcholine. The symptoms mentioned are classic for cholinergic toxicity: increased secretions (salivation), miosis (pinpoint pupils), fasciculations (muscle twitching), and autonomic symptoms like tachycardia and hypertension. But wait, isn't tachycardia more of an atropinic effect? Wait, maybe there's a mix here. Let me think. In organophosphate poisoning, the parasympathetic overstimulation can cause bradycardia, but in some cases, especially with high doses, the sympathetic nervous system might be affected, leading to tachycardia and hypertension. Or maybe the patient has a mixed presentation with some anticholinergic effects from another substance?
Wait, the options weren't listed, but the correct answer is supposed to be one of them. Since the question is from FMGE and AIIMS, maybe the answer is organophosphates. Let me cross-verify. The key symptoms are miosis, fasciculations, which are more cholinergic. Atropine is used in treatment, which is anticholinergic. So the poison here is likely an organophosphate insecticide. The other options might include things like anticholinergics, which would cause the opposite symptoms (dry mouth, dilated pupils), or maybe something else like nerve agents. But the farmer's context points more to organophosphates.
Wait, but tachycardia is a bit confusing because cholinergic overstimulation usually causes bradycardia. Maybe in later stages, the sympathetic system is overstimulated, leading to tachycardia. Or perhaps the patient is in a mixed state with some sympathetic activation. Alternatively, could it be another toxin? Maybe something like carbamates, which also inhibit acetylcholinesterase but with shorter duration. But the symptoms here are consistent with OP poisoning. Let me confirm. The key is the combination of muscarinic and nicotinic effects. Miosis is muscarinic, fasciculations are nicotinic. So organophosphates are the most likely answer here. The other options, like anticholinergics, would cause the opposite, so they can be ruled out. The correct answer is likely Organophosphate.
**Core Concept**
This question tests recognition of **cholinergic toxicity**, specifically **organophosphate poisoning**, which inhibits acetylcholinesterase, causing excessive acetylcholine accumulation. Key symptoms include **muscarinic** (salivation, miosis) and **nicotinic** (fasciculations) effects, along with **autonomic** (tachycardia, hypertension) manifestations.
**Why the Correct Answer is Right**
Organophosphates are **pesticides/insecticides** that irreversibly inhibit **acetylcholin