• Poisoning can occur due to occupational or accidental exposure, deliberate ingestion, or chemical warfare with nerve gases.
  • Presentation is highly variable due to differences in dose, agent toxicity, and type of exposure.
  • Diagnosis is usually based on a history of exposure, with characteristic signs of cholinergic excess, but can be difficult when the patient is inadvertently exposed or is unconscious or confused.
  • Standard treatment is resuscitation, supportive care, decontamination, and use of atropine.
  • Accidental or occupational exposures nearly always have a favorable outcome.

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