Background: Organophosphate compounds (OP) have been used as pesticides and chemical warfare nerve agents worldwide. They are readily available because of inadequate regulations controlling their sale. The easy availability of these compounds has resulted in a gradual increase in accidental and suicidal poisoning. It also has resulted in many deaths that occur within hours of the ingestion. The efficacy of the traditional treatment of OP which includes atropine and oximes still an issue of debate. Aim of the Work: Assessing the potential role of intravenous MgSO4 administration on the outcome of acutely OP intoxicated patients via a prospective single-blind randomized controlled trial in the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH). Patients and Methods:The study assesses the potential role of intravenous MgSO4 administration on the outcome of 40 acutely OP intoxicated patients within the period from 8-11-2016 to 18-1-2018. The study is prospective single-blinded randomized controlled trial that was carried out on patients admitted to (PCC-ASUH) with acute OP toxicity. Patients were divided according severity into moderate and severe groups then each group was subdivided into two subgroups; one received MgSO4 and the other didn't receive it. MgSO4 treated patients received 4g/d for only the first 24 hours after admission. Patients were observed for outcomes such as; mortality, total duration of hospital stay, need for ICU admission and its duration and intermediate syndrome and CVS toxicity occurrence. Results: There was no significant difference in duration of ICU stay, total duration of hospital stay and need for mechanical ventilation between MgSO4 treated and non-treated patients. MgSO4 administration may have decreased mortality, intermediate syndrome and CVS toxicity, but the difference was statistically insignificant between MgSO4 treated and non-treated patients Conclusion: Our study found that intravenous MgSO4 administration didn't modify the total dose of atropine and oximes given to OP intoxicated patients during their hospital stay, also MgSO4 didn't modify the need for mechanical ventilation. Although MgSO4 had reduced the number of patients who developed intermediate syndrome and CVS toxicity, duration of ICU stay, total duration of hospital stay and mortality, but unfortunately this reduction was statistically insignificant.