Cholinergic Toxidrome


SLUDE = Muscarinic features: Salivation, Lacrimation, Urination, Defecation, Emesis, plus miosis, bronchorrhea and broncho-spasm = DUMBBELS = Diarrhea, Urination, Miosis, Bronchorrhea, Bronchospasm, Emesis, Lacrimation, and Salivation. Nicotinic features: Weakness, fascicula-tions, sweating, tachycardia, hypertension.


Anticholinergic Toxidrome
Figure 4.1 Mydriasis, left or mydriasis characteristic toxidrome.

eye. Pupillary dilation of an anticholinergic

CNS features: Agitation/confusion, seizures,

Causes: Organophosphates, carbamates and "stigmines" (neostigmine, physostigimine, pyridostigmine, edrophonium), nerve gases, echo-thiophate = anticholinesterase (AchE) inhibitors; pilocarpine; Clitocybe/Inocybe mushrooms. Antidote: Atropine +/- pralidoxime.

CNS features: Agitation/confusion, seizures,

Miosis Eye
Figure 4.2 Miosis, left eye. Pupillary constriction or miosis characteristic of cholinergic and opioid toxidromes.

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