Clinical meaning
Cholinergic toxidrome results from excessive stimulation of muscarinic and nicotinic acetylcholine receptors, most commonly caused by organophosphate or carbamate poisoning (pesticides), nerve agent exposure, or cholinesterase inhibitor overdose. Organophosphates irreversibly inhibit acetylcholinesterase, causing accumulation of acetylcholine at neuromuscular junctions, autonomic ganglia, and CNS synapses. Muscarinic effects produce the SLUDGE/DUMBELS mnemonic findings. Nicotinic effects cause fasciculations, weakness, and paralysis. Without treatment, progressive respiratory failure from bronchospasm, bronchorrhea, and diaphragmatic paralysis leads to death.
Diagnosis & workup
Diagnostics & workup: - Serum butyrylcholinesterase (pseudocholinesterase) level—decreased confirms exposure - Red blood cell acetylcholinesterase level—more specific for organophosphate toxicity - ABG showing respiratory acidosis from hypoventilation - Chest X-ray for pulmonary edema or aspiration - ECG for bradycardia, QTc prolongation, or heart block - Blood glucose (organophosphates can cause hypoglycemia or hyperglycemia)