For organophosphate poisoning, which treatment combination is indicated?

• A. Diazepam
• B. Activated charcoal
• C. Atropine and pralidoxime
• D. Supportive care only

Answer: (C)

Organophosphate poisoning creates a cholinergic crisis by blocking acetylcholinesterase, so acetylcholine piles up at muscarinic, nicotinic, and CNS receptors. The treatment targets both reversing the enzyme inhibition and blocking the muscarinic effects. Atropine blocks muscarinic receptors, relieving troublesome secretions, bronchospasm, bradycardia, and miosis. It doesn’t touch the nicotinic symptoms like muscle weakness. Pralidoxime reactivates acetylcholinesterase by removing the organophosphate from the enzyme, addressing both muscarinic and nicotinic effects, especially if given early before the enzyme-inhibitor complex ages. That combination directly tackles the underlying problem and improves outcomes, whereas relying on supportive care alone misses the antidotal intervention, and activated charcoal or benzodiazepines alone don’t reverse the cholinergic excess in the same way.