A 50 year old female patient presented to the emergency room (ER) approximately 5 h after ingestion of an insecticide and showed signs of weakness, dyspnoea, sialorrhoea, and diaphoresis. Gastric lavage was carried out and activated charcoal administered as first aid measures.

Tachycardia, muscle weakness, fasciculations, and rales on auscultation of the chest were noted on examination. A serum cholinesterase of 161 units/L was also encountered. The mentioned symptoms disappeared after 6 mg IV atropine plus 0.03 mg/kg.h⁻¹ infusion, which was retired in a 12 h period. Pralidoxime was not available. Sertraline and clonazepam were prescribed by the …