In organophosphorus compound poisoning atropine can reverse all the following signs except -
Acute OP Poisoning A. Muscarinic effects :Due to muscarinic like action, following clinical features are observed 1. Bronchial tree -- cough, increased secretions, bronchoconstriction, wheezing, dyspnea, pulmonary edema. 2. Gastrointestinal -- nausea, vomiting, abdominal cramp, diarrhea. 3. Sweat glands -- increased sweating. 4. Salivary glands -- increased salivation. 5. Lacrimal glands -- increased lacrimation. 6. Eyes -- miosis, blurring of vision or dimness of vision. Miosis develops due to the inhibition of cholinesterase and marked parasympathomimetic stimulation of iris. However, dilatation of pupil in organophosphate intoxication have been recorded, therefore, it is essential not to rely only on pupillary size as diagnostic criteria for organophosphate compound poisoning. 7. Hea -- slow pulse, hypotension. 8. Urinary bladder -- frequency of micturation, urinary incontinence. {Muscarinic manifestation can be remembered with the mnemonic "DUMBELS" D = diarrhea, U = urination, M = miosis, B = Bronchospasm, bradycardia, E = emesis (vomiting), L = lacrimation, S = salivation} B. Nicotinic effects The nicotinic effects are as follows: 1. Striated muscles -- easy fatigue, weakness, muscular twitching, fasciculation, cramps 2. Sympathetic ganglia -- pallor, occasional elevation of blood pressure (hypeension), tachycardia 3. Increased adrenal medulla activity (Nicotinic manifestation can be remembered with the mnemonic "MATCH" M = muscle weakness and fasciculation, A = adrenal medulla activity increase, T = tachycardia, C = cramps in muscle, H = hypeension). C. CNS effects The CNS effects are: 1. Irritability 2. Apprehension 3. Restlessness 4. Fine fibrillary tremors of hands, eyelids, face or tongue 5. Muscular weakness 6. Convulsions -- the convulsions may be tonic (limbs stretched and rigid) or may be clonic (rapid repetitive movement). Clonic convulsions are more common. 7. Mental confusion progressing to stupor to coma 8. Depression of respiratory and circulatory centers REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 292
Lacrimation
Diaphoresis
Diarrhea
Muscle weakess
Poisoning