# Case Report: 2-PAM or not 2-PAM

## TL;DR

A patient intentionally ingested acephate, a pesticide, and was successfully treated with atropine and pralidoxime.

## Contribution

This case report highlights the clinical management of acephate poisoning and discusses the role of oximes in its treatment.

## Key findings

- The patient required intubation due to severe symptoms from acephate poisoning.
- Treatment with atropine and pralidoxime led to successful recovery and extubation.
- Oximes may play a role in managing acephate toxicity despite its classification as a safer pesticide.

## Abstract

Organophosphates (OP) are used as pest control agents worldwide and have been seen in accidental and intentional poisonings.

A patient presented after intentional ingestion of the OP Orthene (50% acephate). Due to copious secretions, the patient was intubated and given atropine by the paramedic before transport. In the emergency department he displayed both muscarinic and nicotinic effects from OP ingestion. The patient was given multiple doses of atropine and a pralidoxime bolus. He was extubated and transferred to psychiatry two days later.

Acute OP exposure is a rare but complex presentation in the United States. In the United States there are bans on several organophosphate varieties, which have reduced the number and severity of OP toxicities. Acephate is generally considered a safer OP by United States regulators and the World Health Organization. In this case report, we describe an OP exposure with marked symptoms requiring intubation and successful treatment with atropine and pralidoxime. We also discuss the role of oximes in acephate toxicity.