Objective: To evaluate the modes of presentation of patients with organophosphorus poisoning at tertiary care hospital of Sindh. Patients and Method: The descriptive study was conducted at medical unit of Liaquat University Hospital Hyderabad/Jamshoro from Jan 2009 to May 2011 inpatients with Organophosphorus poisoning. 200 patients were enrolled for evaluation of presentation, clinical course and outcome. For statistical analysis SPSS 11 was used. Results: During the period of study 200 patients were admitted at LUMHS Hospital with the diagnosis of Organophosphorus poisoning. Their age ranged 20-65 years with mean age of 38.4±3.5 years and median age was 45 years. Males were 162 (81%) and females were 38 (19%). Organophosphate ingestion was most common mode of poisoning and was noted in 110 (55%). Among the clinical features the meiosis, hyper salivation, wheezing and drowsiness were present in all (100%) of the patients. Other modes of presentation were chest crepitations 122 (61%), hypotension 144 (72%), lacrimation 182 (91%), vomiting 124 (62%), diarrhea 102 (51%), abdominal pain 138 (69%), cyanosis 68 (34%), bradycardia 118 (59%), Fasciculations 82 (41%). Mechanical ventilator was required in 57 (28.5%) patients with inotropic support. Average duration of hospital stay was 6.3 days ±SD 4.2 (range 2-26) days. Out of 200 patients 39 (19.5%) patients died and 161 (80.5%) survived. Conclusion: This study concluded that organophosphate poisoning especially with suicidal tendency is not an uncommon entity with high mortality rate in our part of the world.