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?

Question

Image below highlights jugular foramen. Which of the following structures do not pass through the marked structure “A”?

Answer 1

The child shows small pupils, heavy salivation and tearing, muscle twitching, a fast heart rate and high blood pressure, along with confusion. This is a cholinergic overload picture, so acetylcholine is not being cleared properly at the nerve endings. Let's go through each poison.

Opium: Opium and other opioids cause sleepiness, slow breathing and pinpoint pupils, but they do not cause salivation, sweating or muscle fasciculations, so this does not explain the picture.
Organophosphate insecticide: These compounds stop the enzyme that normally breaks down acetylcholine. Acetylcholine then piles up everywhere, giving both the wet muscarinic signs (salivation, lacrimation, miosis) and the nicotinic signs (fasciculations, fast heart rate, high blood pressure), plus confusion from the brain effect. Every symptom in the question fits.
Dhatura: Dhatura blocks acetylcholine receptors instead of raising acetylcholine, so it produces a dry mouth, hot flushed skin, dilated pupils and a fast heart rate without sweating or salivation, the reverse pattern of what is described.
Organochlorine pesticide: These act on nerve sodium channels and mainly cause tremor, irritability and seizures, without the salivation, miosis and fasciculation combination seen here.

Only the organophosphate insecticide produces this exact combined muscarinic and nicotinic overload with confusion, so it is the poison responsible.

Let's summarize:

Muscarinic signs: salivation, lacrimation, miosis, slow gut and slow heart rate.
Nicotinic signs: fasciculations, muscle weakness, and a fast heart rate with high blood pressure.

The correct answer is organophosphate insecticide poisoning.

Answer 2

The child shows small pupils, heavy salivation and tearing, muscle twitching, a fast heart rate and high blood pressure, along with confusion. This is a cholinergic overload picture, so acetylcholine is not being cleared properly at the nerve endings. Let's go through each poison.

Opium: Opium and other opioids cause sleepiness, slow breathing and pinpoint pupils, but they do not cause salivation, sweating or muscle fasciculations, so this does not explain the picture.
Organophosphate insecticide: These compounds stop the enzyme that normally breaks down acetylcholine. Acetylcholine then piles up everywhere, giving both the wet muscarinic signs (salivation, lacrimation, miosis) and the nicotinic signs (fasciculations, fast heart rate, high blood pressure), plus confusion from the brain effect. Every symptom in the question fits.
Dhatura: Dhatura blocks acetylcholine receptors instead of raising acetylcholine, so it produces a dry mouth, hot flushed skin, dilated pupils and a fast heart rate without sweating or salivation, the reverse pattern of what is described.
Organochlorine pesticide: These act on nerve sodium channels and mainly cause tremor, irritability and seizures, without the salivation, miosis and fasciculation combination seen here.

Only the organophosphate insecticide produces this exact combined muscarinic and nicotinic overload with confusion, so it is the poison responsible.

Let's summarize:

Muscarinic signs: salivation, lacrimation, miosis, slow gut and slow heart rate.
Nicotinic signs: fasciculations, muscle weakness, and a fast heart rate with high blood pressure.

The correct answer is organophosphate insecticide poisoning.

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?

Show Hint

The Correct Option is B

Solution and Explanation

Questions Asked in NEET (PG) exam