TOADS-P

 Q: Patients with which of the following poisoning may have an odor like garlic or kerosene? (select one)

A) Isopropyl alcohol 

B) Cyanide 

C) Organophosphates 

D) Hydrogen sulfide 

E) Methyl salicylate

Answer: C

The objective of this question is to emphasize the importance of a proper physical exam to find clues on patients with poisonings. A distinct smell during history taking and examination can help to reach the proper diagnosis.

The list on this topic is long and beyond the scope/space of this pearl. When it comes to the odor of garlic or horseradish, the  mnemonic of "TOADS-P" may help

• Thallium 
• Organophosphate
• Arsenic Poisoning
• Dimethyl Sulfoxide
• Sulfur Mustard 
• Phosphite

Organophosphate may also smell like kerosene.

#toxicology

References:

1. Schiffman SS, Williams CM. Science of odor as a potential health issue. J Environ Qual. 2005 Jan-Feb;34(1):129-38. PMID: 15647542. 

2. Bajracharya SR, Prasad PN, Ghimire R. Management of Organophosphorus Poisoning. J Nepal Health Res Counc. 2016 Sep;14(34):131-138. PMID: 28327676.