Cholinergic Toxidrome

Heirarchy of symptom onset: Muscarinic > nicotinic > CNS

Muscarinic (DUMBBELS): Diarrhea, urination, miosis, bronchospasm, bronchorrhea, emesis, lacrimation, salivation. Miosis > headache > dyspnea > nausea and vomiting > eye pain > diplopia. Miscellaneous: localized sweating. Nicotinic: Weakness > fasciculations > sphincter incontinence > flaccid paralysis. Central nervous system (CNS): Apnea, respiratory depression, loss of consciousness, seizures.

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