A 45 year old farmer, is brought to emergency by his wife after experiencing a sudden onset of profuse sweating, vomiting and feeling that ‘his legs would not hold him up’.

His wife informs you that during the journey he developed slurred speech and abdominal pains and the urgent desire to defecate.

On examination the patient has constricted pupils and is salivating. His pulse rate is regular at 65 beats per minute. There were generalised rhonchi on chest auscultation.

His wife brought a tin of pesticide that they were using. The patient had wiped up some liquid that the farmhand had spilt earlier, without wearing gloves or overalls.