DISCUSSION: Organophosphate toxicity is uncommon in the United States, and Malathion, a commonly used pesticide, is one of the safest organophosphates due to its selective toxicity profile. Dermal exposure to Malathion has a lower exposure threshold for adverse events than inhalation. Organophosphates irreversibly inhibit acetylcholinesterase, resulting in pooling of acetylcholine at the muscarinic and nicotinic receptors. Symptoms of cholinergic excess include diarrhea, urination, miosis, bronchorrhea, bradycardia, emesis, lacrimation, and salivation (DUMBELLS). Diagnosis is based around the toxidrome and treatment is supportive, including atropine to decrease bronchial secretions and pralidoxime for respiratory muscle weakness. In severe situations, patients can have delayed neuropathy, or suffer from Intermediate Syndrome which may reflect inadequate treatment. Most patients, however, improve once the toxin leaves the system.