ACHE and acute respiratory failure: Like OP insecticides, carbamates inhibit the acetylcholinesterase (AChE) enzyme resulting in overstimulation of cholinergic synapses and death from acute respiratory failure.[9,10] However, unlike many OP insecticides, carbamates do not require activation after absorption and onset of clinical features can be rapid.[11,12] Management involves resuscitation, ventilatory support, and administration of atropine;[13,14] oximes are usually not recommended in carbamate poisoning due to rapid spontaneous reactivation of AChE.[10]