A forensic pathologist is comparing two cases of pesticide poisoning. Case A: a 35-year-old worker with acute onset of SLUDGE syndrome, miosis, and bradycardia. Case B: a 42-year-old farmer with similar initial presentation but who later develops muscle fasciculations, paralysis, and respiratory failure requiring mechanical ventilation. Which finding most reliably distinguishes organophosphate poisoning from carbamate poisoning in Case B?

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