Question:
A 5 year old child presents with confusion, increased salivation, lacrimation, fasciculations, miosis, tachycardia and hypertension. Which one of the following poisons can cause these manifestations?
A 5 year old child presents with confusion, increased salivation, lacrimation, fasciculations, miosis, tachycardia and hypertension. Which one of the following poisons can cause these manifestations?
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Think of the mixed muscarinic (SLUD, miosis) plus nicotinic (fasciculations, tachycardia) picture seen with cholinesterase inhibitor poisoning.
Updated On: Jul 8, 2026
- Opium
- Organophosphate insecticide
- Dhatura
- Organochlorine pesticide
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Verified By Collegedunia
The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question.
The child has a mix of features: confusion (a central sign), heavy salivation and lacrimation, muscle fasciculations, small pupils (miosis), and a fast heart rate with high blood pressure. We need a poison that gives this exact mixed picture.
Step 2: Key Concept.
This combination is the classic toxidrome of organophosphate poisoning. Organophosphates block the enzyme acetylcholinesterase, so acetylcholine builds up at nerve endings instead of being broken down.
The extra acetylcholine acts on two kinds of receptors at the same time:
Muscarinic receptors, which give salivation, lacrimation, sweating, urination, diarrhea, vomiting, miosis and a slow heart rate.
Nicotinic receptors, which give muscle fasciculations, weakness, and a faster heart rate with raised blood pressure through sympathetic ganglion stimulation.
Central acetylcholine buildup also causes confusion, restlessness and, in severe cases, seizures and coma.
Step 3: Detailed Explanation.
Opium causes sedation, pinpoint pupils and slow breathing, but it does not cause salivation, fasciculations or a fast heart rate, so it does not fit.
Dhatura contains atropine like alkaloids, which block acetylcholine action. It gives a dry mouth, dilated pupils, flushed skin, fast heart rate and confusion, the opposite of the wet, small pupil picture here, so it does not fit.
Organochlorine pesticides mainly cause central nervous system over excitation, tremor and seizures, but not the marked salivation, miosis and fasciculations described.
Only organophosphate poisoning explains every feature together: the muscarinic signs (salivation, lacrimation, miosis), the nicotinic sign (fasciculations, tachycardia, hypertension) and the central sign (confusion).
Step 4: Final Answer.
The poison responsible is an organophosphate insecticide, which matches option (2).
The child has a mix of features: confusion (a central sign), heavy salivation and lacrimation, muscle fasciculations, small pupils (miosis), and a fast heart rate with high blood pressure. We need a poison that gives this exact mixed picture.
Step 2: Key Concept.
This combination is the classic toxidrome of organophosphate poisoning. Organophosphates block the enzyme acetylcholinesterase, so acetylcholine builds up at nerve endings instead of being broken down.
The extra acetylcholine acts on two kinds of receptors at the same time:
Muscarinic receptors, which give salivation, lacrimation, sweating, urination, diarrhea, vomiting, miosis and a slow heart rate.
Nicotinic receptors, which give muscle fasciculations, weakness, and a faster heart rate with raised blood pressure through sympathetic ganglion stimulation.
Central acetylcholine buildup also causes confusion, restlessness and, in severe cases, seizures and coma.
Step 3: Detailed Explanation.
Opium causes sedation, pinpoint pupils and slow breathing, but it does not cause salivation, fasciculations or a fast heart rate, so it does not fit.
Dhatura contains atropine like alkaloids, which block acetylcholine action. It gives a dry mouth, dilated pupils, flushed skin, fast heart rate and confusion, the opposite of the wet, small pupil picture here, so it does not fit.
Organochlorine pesticides mainly cause central nervous system over excitation, tremor and seizures, but not the marked salivation, miosis and fasciculations described.
Only organophosphate poisoning explains every feature together: the muscarinic signs (salivation, lacrimation, miosis), the nicotinic sign (fasciculations, tachycardia, hypertension) and the central sign (confusion).
Step 4: Final Answer.
The poison responsible is an organophosphate insecticide, which matches option (2).
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