Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM) 

Cholinesterase Inhibitors
Including Insecticides and Chemical Warfare Nerve Agents

Key Concepts

• Cholinesterase inhibitors are a class of compounds that includes chemical warfare nerve agents and certain insecticides.
• Fatalities occur mainly due to effects on respiration due depression of respiratory drive, paralysis of muscles of respiration, bronchoconstriction, and airway obstruction from profuse respiratory tract secretions.
• Treatment includes the use of atropine, 2-PAM, diazepam, and aggressive supportive care.

About This and Other Case Studies in Environmental Medicine

This educational case study document is one in a series of self-instructional publications designed to increase the primary care provider’s knowledge of hazardous substances in the environment and to promote the adoption of medical practices that aid in the evaluation and care of potentially exposed patients. The complete series of Case Studies in Environmental Medicine is located on the ATSDR Web site at www.atsdr.cdc.gov/csem/. In addition, the downloadable PDF version of this educational series and other environmental medicine materials provides content in an electronic, printable format, especially for those who may lack adequate Internet service.

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Acknowledgements

We gratefully acknowledge the work that the medical writers, editors, and reviewers have provided to produce this educational resource. Listed below are those who have contributed to development of this version of the Case Study in Environmental Medicine.

Please Note: Each content expert for this case study has indicated that there is no conflict of interest to disclose that would bias the case study content.

ATSDR Authors: Erik Auf Der Heide, MD

ATSDR Planners: Valerie J. Curry, MS; John Doyle, MPA; Bruce J. Fowler, Ph.D.; Kimberly Gehle, MD; Sharon L. Hall, Ph.D.; Michael Hatcher, DrPH; Kimberly Jenkins, BA; Ronald T. Jolly; Delene Roberts, MSA; Brian Tencza, MS.

ATSDR Commenters: Susan Gorman, PharmD, SB; Paul Joe, M.D.; Nickolette Roney, BA

Peer Reviewers: Alan H. Hall, M.D., Toxicology Consulting and Medical Translating Services, Inc. (TCMTS, Inc.), P.O. Box 184, Mile 5.0 Pass Creek Road, Elk Mountain, WY 82324; Sheldon L. Wagner, MD, Professor of Clinical Toxicology, Oregon State University, Emeritus, Corvallis, Oregon 97331-2106

Disclaimer

The state of knowledge regarding the treatment of patients potentially exposed to hazardous substances in the environment is constantly evolving and is often uncertain. In this educational monograph, ATSDR has made diligent effort to ensure the accuracy and currency of the information presented, but makes no claim that the document comprehensively addresses all possible situations related to this substance. This monograph is intended as an educational resource for physicians and other health professionals in assessing the condition and managing the treatment of patients potentially exposed to hazardous substances. It is not, however, a substitute for the professional judgment of a health care provider. The document must be interpreted in light of specific information regarding the patient and in conjunction with other sources of authority.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry or the U.S. Department of Health and Human Services.

U.S. Department of Health and Human Services
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Environmental Medicine
Environmental Medicine and Educational Services Branch