A 5 year old child presents with confusion, increased salivation, lacrimation, fasciculations, miosis, tachycardia and hypertension. Which of the following poisons can cause these manifestations ?

Ans. is 'b' ie Organophosphate insecticides. Out of the given option only Opium and Organophosphate insecticides can cause miosis. .Out of Opium and organophosphate the symptoms of this child are characteristic of organophosphate poisoning as described below:Organophosphate poisoningOrganophosphate compound irreversibly inhibit acetylcholinesterase and cause accumulation of acetylcholine at muscarinic and nicotinic receptors.Muscarinic effectsMiosis, blurred vision.Increased sweating, salivation, lacrimation.Increased bronchial secretions, bronchoconstriction.Abdominal cramps, diarrhoea, nausea, vomitting.Urinary frequency and incontinence.Nicotinic effects On Striated muscles - twitching, fasciculation, cramps, muscle paralysis On Sympathetic ganglia - hypertension, tachycardiaCNS EffectsAnxiety, restlessness, confusionSeizures & comaThis child presents with tachycardia and hypertension which are nicotinic manifestations. But one must also know that the muscarinic effect on C.V.S. causes bradycardia and hypotension (but this is seen in severe poisoning).Opium PoisoningOpium first stimulates, then depresses and finally paralyses the nerve centres.Characteristic features are:Pinpoint miotic pupils *Slow and stertorous respiration*Bradycardia and hypotension*All secretion dry up except sweatSkin in moist, perspiring and cold*