Advances in the Detection and Management of Organophosphate Poisoning

BACKGROUND: The growing prevalence of pesticide poisonings, particularly those derived from organophosphate exposure, represents a significant challenge to global public health, because of their high toxicity and widespread agricultural use.Effective and rapid emergency department management of organophosphate (OP) poisonings is essential to mitigate complications associated with acute exposure and ensure patient survival. AREAS OF UNCERTAINTY: We aim to review the literature and present the most up-to-date treatment strategies, and the use of various technological tools, in the detection of organophosphorus pesticides to improve the management of organophosphate poisoning in emergency medical services. DATA SOURCES: This review will be based on scientific articles published in recognized databases and reports from international organizations such as the World Health Organization, the Environmental Protection Agency, and the European Food Safety Authority, considering the challenges in management and barriers to effective treatment. THERAPEUTICS ADVANCES: Treatment of OP poisoning focuses on life support, the use of antidotes, and the administration of anticonvulsants to mitigate neurotoxicity. Treatment's efficacy depends on the type of compound involved and the time elapsed since exposure, which has prompted the development of new therapeutic strategies, including more effective reactivators and combination therapies. Emerging advances include recombinant bioscavengers, reactivators, along with neuroprotective compounds that could attenuate neurological damage. In parallel, the design of portable biosensors for the rapid detection of OPs represents a promising tool to optimize the medical response in acute or mass exposure contexts. CONCLUSIONS: Challenges in management and barriers (rural/agricultural area, delay in seeking medical help, limited availability of diagnostic tests) could lead to delay diagnosis and recognition of affective treatment, which affects patient safety. Preventive strategies and public health initiatives, including personalized approaches and digital health technologies, must be considered and updated.