Organophosphates and carbamates are pesticides whose acute toxicities are caused by inhibition of acetylcholinesterase. A liquid chromatography–mass spectrometry/mass spectrometry method was developed and validated for the quantification of 16 organophosphate and carbamate insecticides in human serum. Nonpolar and polar pesticides were simultaneously extracted from serum samples using a simple and fast monolithic spin column procedure using mixed-mode C-C18 cartridges. Recovery was achieved in the range 11.9–99.2 %. Chromatography was carried out on an InertSustain® C18 HP 3 μm analytical column with gradient elution. Mass spectrometric analysis was performed using an Agilent 6410 Triple Quad Tandem mass spectrometer coupled with an electrospray ionization source in the positive ion mode. The assay was validated over a large concentration range and the limits of detection for all compounds ranged from 0.1 to 50 ng mL−1. The precision for both intra- and inter-day determination of all analytes was found to be acceptable (< 12.9 %) and no significant matrix effect was observed. The developed method was effectively applied to clinical samples from patients presenting at hospital with symptoms of acute intentional organophosphate or carbamate poisoning, demonstrating its applicability to diagnostic applications.