During a flight, a patient presents with miosis, excessive salivation, bronchorrhea, diarrhea, and muscle fasciculations. Which of the following is the most likely cause of these symptoms?
Opioid overdose
Benzodiazepine overdose
Carbon monoxide poisoning
Organophosphate poisoning
The described findings constitute a classic cholinergic toxidrome. Organophosphates irreversibly inhibit acetylcholinesterase, allowing acetylcholine to accumulate at muscarinic and nicotinic receptors. The resulting overstimulation leads to miosis, profuse salivation, bronchorrhea, diarrhea, and muscle fasciculations.
Benzodiazepine overdose typically produces CNS depression with minimal autonomic effects. Opioid overdose is characterized by miosis and respiratory depression but not marked respiratory secretions or diarrhea. Carbon-monoxide poisoning more commonly causes headache, dizziness, and altered mental status without cholinergic signs.
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