Cholinergic Syndrome

Question 1

Cholinergic syndrome

Answer 1

Direct action muscarinic & nicotinic receptors

Acetylcholinesterase inhibition

Question 2

Causative agents Acetylcholinesterase inhibitors

Answer 2

Organophsphate insecicides

Carbamate insecticides
Chemical warfare nerve agents: 
Agents in dementia
-donepezil
-rivastigmmine
Agents in myasthenia gravis
-edrophonium
-neostigmine
-physostigmine

Question 3

Causative agents: acetylchoine agonists

Answer 3

Muscarinic
-acetylcholine
-carbachol
-pilocarpine
Nicotinic
-nicotine
Muschrooms

Question 4

Clinical features

Answer 4

CNS:
-Agitatino
- Central respiratory depression
-Coma
-confusion
-lethargy
-seizure
Neuromuscular
-Fasciculations
-muscle weakness
Parasympathetic muscarinic effects
-abdominal cramping
-bradycardia
-bronchoconstriction
-bronchorrhea
-diarrhea
-lacrimatin
-misois
-salivation
-urinary incontinence
-vomiting
Sympathetic nicotinic effects
- HTN
-Mydriasis
-sweating
-tachycardia

Question 5

Cholinergic DDx

Answer 5

Causes of weakness
-neurotoxic snake
-Gullian barre
-myasthenia gravis
-botulism
Cardiotropic intoxication (bradycardia/ vomting)
-digoxin
-oleander
- BBlockers
-CCB
Gastroenteritis & abdominal emergencies
Ictal phenomenon
mushroom ingestion
respiratory
-asthma
-CCF
Salicylate intoxication
Serotonin syndrome
Sympathomimetic syndrome
Theophylline

Question 6

Cholinergic Complication

Answer 6

Rapid respiratory failure
Sz
Dehydration
Medium & long term Organophosphate neuro sequelae

Question 7

Cholinergic Mx

Answer 7

Resus
-ABC
-Atropine if Muscarinic
-Sz- benzo
- Oxygenation Intubate & ventilate
Supportive
-well ventilated
-PPE
-reassure
-IV fluids
-IDC

Question 8

Cholinergic Ix

Answer 8

Cholinesterase levels
CXR
ABG
UEC
DDx

Question 9

Cholinergic antidote

Answer 9

Atropine

• 1.2 mg q 2 min double dose each time
• end pt: drying of secretions/ resolution bradycardia

Pralidoxime

• bolus: 2g in 100 mL nsaline over 15 min
• infusion 500mg/hr for 24 hrs + check red cell acetylchoinesterase level