Monday 30 May 2011

Cholinergic Toxidrome


Cholinergic Toxidrome Details:
  • From an occupational & environmental health point of view, the cholinergic toxidrome is the most important syndrome to be aware of.
  • The other toxidromes (ie anticholinergic, sympathomimetic, opioid, sedative/hypnotic, hallucinogenic) are most often associated with overdoses of drugs or medications.
  • SLUDGE or DUMBELLS are simple mnemonics for the common clinical symptoms (see below).
  • Clinical interpretation of this toxidrome can be complicated if multiple agents are involved.
Cholinergic Toxidrome Aetiologic Agents:
  • Organophosphate pesticides (ie malathion, diazinon)
  • Carbamates (ie physostigmine, carbaryl)
  • Mushrooms (certain types)
  • Sarin (warfare agent)
Cholinergic Toxidrome Pathophysiology:
  • The underlying mechanism is excessive cholinergic (acetylcholine) receptor stimulation.
  • There are various classes of cholinergic receptors (see table) that can be stimulated in this toxidrome.
  • The symptoms induced depend on the relative stimulation of the different receptors.
  • Common clinical features can be remembered by the mnemonics SLUDGE or DUMBELLS syndrome.
SLUDGE Syndrome:
  • S - Salivation
  • L - Lacrimation
  • U - Urination
  • D - Diarrhoea
  • G - Gastrointestinal distress
  • E - Emesis
DUMBELLS Syndrome:
  • D - Diarrhoea
  • U - Urination
  • M - Miosis (small pupils)
  • B - Bradycardia
  • E - Emesis
  • L - Lacrimation
  • L - Lethargy
  • S - Salivation
Tags: Acetylcholine - Carbaryl - Cholinergic Toxidrome - Diazinon - DUMBELLS - Malathion - Muscarinic Receptor - Nicotinic Receptor - Organophosphate Pesticide - Physostigmine - Sarin - SLUDGE Syndrome - Toxidrome
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