Importance: Locked-in state, or “coma vigilante,” is a moribund condition where the patient is literally locked inside the body, fully awake and aware of the environment but unable to perform psychomotor responses except for eye winking. The most common cause is ventral pontine stroke. This presentation has also been reported due to peripheral neural and neuromuscular diseases such as Guillain–Barré syndrome, iatrogenic agents, krait bite, etc. However, organophosphate poisoning presenting as a de-efferented state has never been reported before. Aim: To share this observation with the scientific community and disseminate awareness that organophosphate poisoning can cause locked-in state, deceptively masquerading as coma. Design: Prospective observational case series report. Setting and participants: Organophosphate-poisoned patients admitted to the intensive care unit of a government tertiary care hospital. Main outcome: Case series description with supporting video recordings. Results: Four cases of locked-in state were described. All four patients had consumed monocrotophos with intentional self-harm. All patients presented with incomplete variants of locked-in state; three of them expired. Conclusion: Consciousness with absolute unresponsiveness occurs in organophosphate poisoning. It is often mislabeled as coma. This presentation signifies the severity of muscle paralysis and is associated with poor outcomes. Relevance: Intensivists must maintain a high index of suspicion for this presentation to avoid misdiagnosis. Confusing it with coma can have serious consequences for both the patient and the treating physician.