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| Cholinergic crisis | |
|---|---|
| Other names | Cholinergic toxicity, cholinergic poisoning, SLUDGE syndrome |
| Symptoms | Hypersalivation,lacrimation, increasedurination anddefecation,vomiting,sweating,constricted pupils,spasms |
| Complications | Respiratory failure,flaccid paralysis, death |
| Causes | Excess synaptic levels ofacetylcholine |
| Differential diagnosis | Myasthenia gravis |
| Medication | Anticholinergics (atropine,diphenhydramine) |
Acholinergic crisis is an over-stimulation at aneuromuscular junction due to an excess ofacetylcholine,[1] as a result of the inactivity of theacetylcholinesteraseenzyme, which normally breaks down acetylcholine.
As a result of cholinergic crisis, the muscles stop responding to the high synaptic levels of acetylcholine, leading toflaccid paralysis,respiratory failure, and other signs and symptoms reminiscent oforganophosphate poisoning. Other symptoms include increased sweating, salivation,bronchial secretions along withmiosis (constricted pupils).[citation needed]
Some of the symptoms of increasedcholinergic stimulation include:
Cholinergic crisis, sometimes known by themnemonic "SLUDGE syndrome" (salivation, lacrimation, urination, defecation, gastrointestinal distress, and emesis),[4] can be a consequence of:
Some elements of the cholinergic crisis can be reversed withantimuscarinic drugs likeatropine ordiphenhydramine, but the most dangerous effect — respiratory depression, cannot.[6]
The neuromuscular junction, where the brain communicates with muscles (like thediaphragm, the main breathing muscle), works by acetylcholine activating nicotinic acetylcholine receptors and leading to muscle contraction. Atropine only blocksmuscarinic acetylcholine receptors (a different receptor class than the nicotinic receptors at theneuromuscular junction), so it will not improve the muscle strength and ability to breathe in someone with cholinergic crisis. Such a patient will requireneuromuscular-blocking drugs andmechanical ventilation until the crisis resolves on its own.[citation needed]