Trojano_2026_Toxicol.Rep_17_102311

Organophosphates (OP) have a variety of applications, including widespread use as pesticides. Although OP poisoning in the U.S. has been declining, toxicity from intentional ingestions of commercially available preparations is still a concern. We describe a case of a 17-year-old female who intentionally ingested an acephate-based fire ant insecticide and developed severe cholinergic toxicity, despite acephate's classification as a safer OP. The patient was successfully treated with atropine and pralidoxime, but had recurrence of symptoms after long asymptomatic periods requiring repeat dosing, which is atypical. We encourage clinicians to have a low threshold for prolonged observation in these patients, even in the absence of symptoms.