Cholinergic toxidromes result from excessive acetylcholine activity, while anticholinergic toxidromes result from its inhibition. Cholinergic signs include “SLUDGEM” (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis, Miosis), while anticholinergic signs include “dry as a bone, blind as a bat, red as a beet, hot as a hare, and mad as a hatter”.
Cholinergic Toxidrome:
- Cause:Excessive acetylcholine activity, often due to cholinesterase inhibitor poisoning (e.g., organophosphates).
- Mechanism:Cholinesterase inhibitors prevent the breakdown of acetylcholine, leading to its accumulation at cholinergic receptors.
- Signs and Symptoms:
- SLUDGEM: Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis, Miosis (pinpoint pupils).
- Other signs: Bronchorrhea (excessive mucus), muscle twitching, weakness, and paralysis.
- Examples of Agents:Organophosphates (pesticides), certain medications.
Anticholinergic Toxidrome:
- Cause:Inhibition of acetylcholine activity, often due to anticholinergic medications or exposure to anticholinergic agents.
- Mechanism:Anticholinergic agents block acetylcholine from binding to its receptors, primarily muscarinic receptors.
- Signs and Symptoms:
- “Dry as a bone, blind as a bat, red as a beet, hot as a hare, and mad as a hatter”: Dry mouth, skin, and mucous membranes; blurred vision (mydriasis); flushing; fever; delirium, and agitation.
- Other signs: Tachycardia, urinary retention, decreased bowel sounds.
- Examples of Agents:Atropine, scopolamine, certain antihistamines, cyclic antidepressants, and some anti-Parkinson’s medications.
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