Organophosphorus poisoning is a common cause of death in developing countries. These compounds inhibit acetylcholinesterase leading to accumulation of acetylcholine, causing overstimulation of nicotinic and muscarinic receptors. Atropine and oximes are the mainstay of treatment. Atropine helps in countering muscarinic effects and decreasing secretions. It also makes the secretions thick, tenacious and may obstruct the airway. We observed five cases of organophosphorus poisoning being treated with atropine developing sudden respiratory distress attributed to mucus plug obstructing the airway which was confused with intermediate syndrome. After removal of the mucus plug these patients recovered uneventfully. © 2021 Elsevier B.V., All rights reserved.