Public Health Resources


Date of this Version



Reproduced with Permission by the DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE, From the Archives of Environmental Health, Vol. 5, pp. 21-47, July 1962 Copyright 1962, by American Medical Association.


U.S. government work.




Nature and Physiologic Function of Cholinesterase

Symptoms of Organic Phosphorus Poisoning

Mechanism of Inhibition of Cholinesterase

Measurement of Cholinesterase Activity and Its Relationship to Symptomatology

Measurement of Metabolites and Their Relationship to Symptomatology

Use and Action of Atropine and Other Nonspecific Antidotes

Development of Specific Antidotes

Chemical and Physiologic Properties of Oximes

Antidotal Efficacy of Oximes in Poisoned Experimental Animals

Application of 2-P AM in Poisoning in Man

Suggestions for Treatment

Prevention of Poisoning

Comment and Summary


Organic phosphorus compounds are of considerable interest and importance by virture of their widespread use as insecticides; their effectiveness in the treatment of myasthenia gravis, glaucoma, and abdominal distention; and their potential application as war gases. These compounds owe their pharmacologic effect primarily, if not entirely, to their ability to inhibit the enzyme cholinesterase with a resultant overstimulation of the parasympathetic nervous system by the acetylcholine which accumulates. Atropine has been the drug of choice for the treatment of organophosphorus poisoning. This therapy produces relief of symptoms based on blocking the action of excess acetylcholine.