Agrochemical and household poisons

Cholinergic crisis: secure the airway, then atropinise fast by doubling boluses every 5 min until the chest is clear, HR > 80, SBP > 80 mmHg, axillae dry and pupils no longer pinpoint; then infuse 10-20% of the loading dose per hour. Watch for the intermediate syndrome on days 1-4.

Phosphine gas causes refractory shock from myocardial toxicity, severe metabolic acidosis and arrhythmias within hours. There is no antidote: early ICU care, gastric decontamination, magnesium, vasopressors, inotropes, bicarbonate and, where available, VA-ECMO as a bridge.

A mouthful of 20% paraquat can kill. Confirm with the urine dithionite test, give activated charcoal early, avoid supplemental oxygen unless SpO2 is very low, support the kidneys, and discuss prognosis honestly; immunosuppression and haemoperfusion are unproven.

Rat-killer paste (3% yellow phosphorus) causes a deceptive latent phase followed by acute liver failure on days 3-5. Admit every ingestion, monitor INR and liver tests daily, refer early to a liver unit, and consider plasma exchange as a bridge; transplantation for King's criteria.

Yellow/common oleander seeds act like digoxin: vomiting, bradyarrhythmias, heart block and hyperkalaemia; treat with atropine, temporary pacing, potassium control and digoxin Fab if available. Datura causes an anticholinergic toxidrome: sedate with benzodiazepines, cool, and catheterise.

Corrosives: protect the airway, no emesis, neutralisation or blind NG tube; early endoscopy (within 12-48 h) or CT to grade injury and identify perforation needing surgery. Hydrocarbons: the danger is aspiration pneumonitis; no lavage or emesis; supportive respiratory care.