Cholinergic Toxicity

Aka: Cholinergic Toxicity, Cholinergic Overdose, Parasympathomimetic Poisoning, Cholinergic

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II. Causes

  1. See Organophosphate Poisoning
  2. See Nerve Agent Exposure

III. Findings: General

  1. Cardiopulmonary
    1. Bradycardia
    2. Bronchospasm
    3. Bronchorrhea
    4. Vasopressor resistant Hypotension
    5. Aspiration Pneumonitis
  2. Neurologic
    1. Miosis
    2. Anxiety or Agitation
    3. Lethargy or coma
    4. Acute Respiratory Failure (Bellows Failure from loss of respiratory drive)
    5. Muscle Fasciculations
    6. Flaccid Paralysis (including respiratory Muscles)
    7. Seizures (uncommon)
  3. Sludge
    1. Salivation
    2. Lacrimation
    3. Urination
    4. Diarrhea (and Diaphoresis)
    5. Gastrointestinal cramping
    6. Emesis (Nausea and Vomiting)

IV. Findings: Mnemonic - SLUDgE + Killer Bs, or DUMBELLS

  1. Sludge
    1. Salivation
    2. Lacrimation
    3. Urination
    4. Diarrhea (and Diaphoresis)
    5. Gastrointestinal cramping
    6. Emesis (Nausea and Vomiting)
  2. Killer B's
    1. Bronchospasm
    2. Bronchorrhea
    3. Bradycardia (muscarinic)
      1. Tachycardia may occur with nicotinic toxicity
  3. Other
    1. Miosis (Pinpoint Pupils)

V. Diagnostics

  1. Electrocardiogram

VI. Management

  1. See Nerve Agent Exposure

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