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Toxicology
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Patients present with degrees of cholinergic crisis, usually within 4 h of ingestion or exposure. Specific manifestations include: Muscarinic:bronchorrhoea, bronchospasm, vomiting, pinpoint pupils, bradycardia and hypotensionexcessive sweating, lacrimation, salivation, profuse diarrhoea and urination.Nicotinic: fasciculation, tremor, weakness, muscle paralysis, tachycardia and hypertension.CNS: initial agitation followed by sedation and altered mental status leading to convulsions and coma.
Cholinergic Agonists
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Rupali Patil, Aman Upaganlawar
It is used mainly in the diagnosis of myasthenia gravis. Muscle weakness due to causes other than myasthenia gravis is not improved by an anti-ChE. Rapid increase in muscle strength is observed after i.v. injection (2 mg). An excess drug may provoke a cholinergic crisis and atropine may be used as an antidote (Harvey et al., 2011).
Therapies
Published in Marc H. De Baets, Hans J.G.H. Oosterhuis, Myasthenia Gravis, 2019
Myasthenic crisis is a neurologic emergency. The patient has difficulty swallowing and breathing. Often infections or surgery are precipitating factors of rapid deterioration. “Cholinergic crisis” results from excessive doses of AChE inhibitors, but this is now rare, and some experienced clinicians have never seen a case.
Acute organophosphate and carbamate pesticide poisonings – a five-year survey from the National Poison Control Center Of Serbia
Published in Drug and Chemical Toxicology, 2023
Žana M. Maksimović, Jasmina Jović-Stošić, Slavica Vučinić, Nataša Perković-Vukčević, Gordana Vuković-Ercegović, Ranko Škrbić, Miloš P. Stojiljković
With energetic supportive measures (securing a breathing line), poison removal and detoxification (gastric lavage until obtaining clear lavage liquid, application of activated charcoal) and symptomatic therapy, specific treatment of OPP poisoning include administration of antidotes (atropine, oximes, diazepam) (Vanova et al.2018, Eddleston 2019, Jokanović et al.2020). Atropine, which has a 100 times stronger affinity for cholinergic receptors than ACh, alleviates the muscarinic effects but has no impact on the nicotinic ones. It is given for as long as there are signs of acute cholinergic crisis, that is until the signs of atropinization occur (Henretig et al.2019). Oximes, AChE reactivators, bind to OPP already bound to AChE, which leads to the reactivation of AChE. The affinity of oximes for different organophosphorus compounds (OPCs) varies significantly. Globally, pralidoxime (PAM-2) is the oxime most frequently used for the treatment of OPP poisoning. Apart from that, in practice, obidoxime (LüH-6) is also used and it is considered the most effective oxime against OPP poisonings (Worek et al.2020, Maksimović et al.2021). Diazepam inhibits the excitability of the neurons in the CNS; by increasing the effect of GABA, it increases cAMP, decreases the level of cGMP, leading to the cessation of convulsions (Lundy and Magor 1978).
Lipid emulsion for the treatment of acute organophosphate poisoning: an Open-Label randomized trial
Published in Clinical Toxicology, 2022
Ashok Kumar Pannu, Sahil Garg, Ashish Bhalla, Deba Prasad Dhibar, Navneet Sharma
The cholinergic crisis was defined with characteristic muscarinic or/and nicotinic manifestations of typical anticholinesterase poisoning. Muscarinic features include diarrhea, urination, miosis, bronchorrhea (or bronchospasm), bradycardia, emesis, lacrimation, low blood pressure, and salivation (acronym - DUMBBELLS). Nicotinic stimulation at sympathetic ganglia and neuromuscular junction include mydriasis, tachycardia, weakness, hypertension, fasciculations, shallow breathing (diminished respiratory effort), and sweating (a memory aid using the first letter of the days’ names from Monday to Sunday) [4–6,38]. Thus, a mnemonic “DUMBBELLS - Monday to Sunday” is helpful to describe the overall cholinergic crisis [6,38]. Peradeniya OP severity scale was used to define toxidrome severity at ED admission [39]. It consists of five clinical variables - pupil size, respiratory rate, heart rate, muscle fasciculation, level of consciousness, on a scale of 0 to 2 for each of five variables, with aggregated scores of 0–3 indicating mild poisoning, 4–7 for moderate, and 8–11 for severe toxidrome.
Organophosphate induced delayed neuropathy after an acute cholinergic crisis in self-poisoning
Published in Clinical Toxicology, 2021
A. K. Pannu, A. Bhalla, R. I. Vishnu, D. P. Dhibar, N. Sharma, R. Vijayvergiya
Patients aged between 13 and 40 years presenting with a history of OP consumption and clinical features of cholinergic toxidrome of typical anticholinesterase poisoning were recruited. The cholinergic crisis comprises muscarinic effects (e.g., bradycardia, increased trachea-bronchial secretions, lacrimation, urination) and nicotinic effects (e.g., muscle weakness, fasciculations) [7–9]. Patients with doubtful history, poisoning with unknown compounds, poisoning with more than one compound, chronic exposure to OP, history of pre-existing medical comorbidities (e.g., neurological disorders, diabetes mellitus, renal failure, hypothyroidism, or chronic alcohol use disorders) were excluded. Because the prevalence of PN increases with age, we also excluded middle and older aged patients [29].