Cholinergic Toxidrome
The most likely place to encounter this type of poisoning is on written examinations. Although not a very common toxidrome, it is an important one to recognize if encountered. - Central East Prehospital Care Program
HWN Suggests
Cholinergic toxidrome from organophosphates
The atropine dose for the treatment of organophosphate poisoning is 1 to 3 mg (0.05 mg/kg in children) intravenously with doubling of each subsequent dose every 5 minutes until there is control of the muscarinic effects, particularly reduction in airway secretions.
KEY point: “The endpoint of atropinization is drying of respiratory secretions, easing of respiratory effort, and normalization of respiratory rate. Early and rapid atropinization is associated with better control of seizures and reduced mortality in animal models.” Also, atropine will NOT reverse the respiratory muscle paralysis.
Articles of Interest
How can I remember the adverse effects of over-activation of the parasympathetic nervous system?
The adverse effects of over-activation of the parasympathetic nervous system, for example by poisoning with an acetylcholinesterase inhibitor, can be remembered by the following mnemonic, SLUDGE/BBB:
The Cholinergic Toxidrome
It is the result of inhibition of the enzyme acetylcholinesterase which normally breaks down the neurotransmitter, acetylcholine. The end result is the build up of excessive levels of the neurotransmitter.
Resources
Life in the Fastlane
Cholinergic Toxidrome was the first flashcard I created. My original idea was to have a small illustration on the top of the card and pearls at the bottom. However, as the flashcards became more complex, it became obvious that we would be better suited to utilize both the front and back of the card for our illustrations and text.
StatPearls
Cholinergic toxicity may result from insecticides, nerve agents, medications, and mushrooms. The most common cause of cholinergic toxicity worldwide is exposure to organophosphate and carbamate insecticides. Exposure to these insecticides may be through inhalation of vapors, ingestion, or direct contact of the chemical with the skin or mucous membrane.
WikEM
Atropine blocks muscarinic acetylcholine receptors (a different subtype than the nicotinic receptors at the neuromuscular junction), so will not improve the muscle strength and ability to breathe. So, such patients will frequently require mechanical ventilation until the crisis resolves. There is not specific antidote for the respiratory compromise.
