A patient present to emergency with pinpoint Pupil,salivation, lacrimation, tremors and red tears. Plasma chlolinesterase level was 30% of normal. Most probable diagnosis is

These are characteristic features of anti-cholinestearse(organophosphate and carbamate) poisoning. Features of Organophosphate poisoning: Muscarinic symptoms: Pin point pupil, salivation,lacrimation, urination, defecation, gastrointestinal distress, vomiting, bronchospasm, bradycardia Nicotinic symptoms: Fasciculations and fibrillations of muscle, tachycardia, tachypnea CNS symptoms: Temors, giddiness, ataxia, coma Red tears: Due to accumulation of porphyrin in the lacrimal glands Ref-Katzung 12/e p110