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Pharmacology Toxicology & Autonomics Beginner
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Cholinergic Toxidrome Symptoms

SLUDGE
DUMBELS
Classic toxidrome caused by organophosphate pesticides or nerve agents that irreversibly inhibit acetylcholinesterase.

Acetylcholinesterase inhibition accumulates acetylcholine at muscarinic and nicotinic receptors throughout the peripheral and central nervous systems, resulting in massive parasympathetic hyperstimulation.

Systematic Breakdown

D

Defecation / Diarrhea

Muscarinic M3 hypermotility in the gastrointestinal tract.

U

Urination

Detrusor muscle contraction and sphincter relaxation.

M

Miosis & Muscle Fasciculation

Pinpoint pupils (pupillary sphincter constriction) and nicotinic twitches/cramps.

B

Bronchospasm, Bronchorrhea & Bradycardia

The 'Killer B's' — primary causes of mortality due to asphyxiation and copious airway secretions.

E

Emesis

Severe nausea and vomiting from hyperactive visceral peristalsis.

L

Lacrimation

Copious tearing from muscarinic lacrimal gland hypersecretion.

S

Salivation & Sweating

Drooling and profuse diaphoresis (sweat glands are innervated by sympathetic cholinergic fibers).

High-Yield Clinical Pearls & Exam Tips
  • Immediate antidote: Atropine (muscarinic antagonist) given repeatedly until bronchorrhea clears (airway is dry).
  • Pralidoxime (2-PAM) regenerates acetylcholinesterase before irreversible 'aging' of the organophosphate-enzyme complex occurs.
  • Killer B's (Bronchorrhea, Bronchospasm, Bradycardia) are the direct causes of death; monitor lung sounds.
Related Pharmaceuticals
Atropine Pralidoxime Physostigmine Donepezil
Related Clinical Conditions
Organophosphate Poisoning Nerve Agent Exposure Myasthenia Gravis Overdose
Authoritative Sources: Goldfrank's Toxicologic Emergencies 11e · First Aid USMLE Step 1

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System Notice

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