Fasciculating toxicity

Am J Emerg Med. 2019 Apr;37(4):798.e1-798.e2. doi: 10.1016/j.ajem.2019.01.033. Epub 2019 Jan 21.


Organophosphorus (OP) compound poisoning with suicidal intent is common. It is one of the frequent cause for admission to hospital Emergencies and intensive care units in our region. We describe here a case of 19-year old girl who presented to the Emergency Department with atypical features of OP poisoning. She had perioral, tongue and lower limb fasciculations along with generalized muscle weakness with no or minimal muscarinic effects. OP poisoning with isolated nicotinic receptor mediated effect is often reported in children but in adult it is extremely rare. Based on history and clinical suspicion of nicotinic receptor mediated effect of OP, she was given intravenous atropine along with other supportive treatment. Patient got completely recovered from fasciculations and her motor weakness improved after 6 h of atropine therapy. Emergency physician should keep a high index of suspicion of isolated nicotinic and ganglionic mediated effect of OP and a trial of atropine should be given to the patient.

Keywords: Atropine; Fasciculations; Muscarinic; Nicotinic; Organophosphorus (OP).

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Administration, Intravenous
  • Atropine / administration & dosage
  • Atropine / therapeutic use*
  • Fasciculation / drug therapy
  • Fasciculation / etiology*
  • Female
  • Humans
  • Insecticides / poisoning
  • Muscarinic Antagonists / administration & dosage
  • Muscarinic Antagonists / therapeutic use*
  • Muscle Weakness / drug therapy
  • Muscle Weakness / etiology*
  • Organophosphate Poisoning / diagnosis*
  • Organophosphate Poisoning / drug therapy
  • Organophosphate Poisoning / urine
  • Suicide, Attempted
  • Young Adult


  • Insecticides
  • Muscarinic Antagonists
  • Atropine