Introduction: Organophosphates (OP) are used as pest control agents worldwide and have been seen in accidental and intentional poisonings.  

Case Report: A patient presented after intentional ingestion of the OP Orthene (50% acephate).  Due to copious secretions, the patient was intubated and given atropine by the paramedic before transport. In the emergency department he displayed both muscarinic and nicotinic effects from OP ingestion. The patient was given multiple doses of atropine and a pralidoxime bolus. He was extubated and transferred to psychiatry two days later. 

Conclusion: Acute OP exposure is a rare but complex presentation in the United States. In the United States there are bans on several organophosphate varieties, which have reduced the number and severity of OP toxicities. Acephate is generally considered a safer OP by United States regulators and the World Health Organization. In this case report, we describe an OP exposure with marked symptoms requiring intubation and successful treatment with atropine and pralidoxime. We also discuss the role of oximes in acephate toxicity.