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wikitox:cholinergictoxicity [2025/02/16 16:43] – kharriswikitox:cholinergictoxicity [2025/02/17 00:33] (current) – kharris
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- <font 36px/inherit;;#c12b04;;inherit>Cholinergic Toxicity</font> +====== Cholinergic Toxicity ======
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 ===== Introduction ===== ===== Introduction =====
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 Cholinergic toxicity occurs when there is excess acetylcholine activity in the body. This can occur from decreased breakdown of acetylcholine due to the presence of acetylcholinesterase inhibitors or direct stimulation by acetylcholine receptor agonists. Cholinergic toxicity occurs when there is excess acetylcholine activity in the body. This can occur from decreased breakdown of acetylcholine due to the presence of acetylcholinesterase inhibitors or direct stimulation by acetylcholine receptor agonists.
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 ===== Cholinergic agents ===== ===== Cholinergic agents =====
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 ===== Clinical Presentation ===== ===== Clinical Presentation =====
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**CNS effects: **Coma, seizures, agitation/delirium</font> + 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**Autonomic effects:** salivation, lacrimation, sweating, flushing, miosis</font> +**CNS effects:**  Coma, seizures, agitation/delirium \\  \\ **Autonomic effects:**  salivation, lacrimation, sweating, flushing, miosis \\  \\ **Neuromuscular effects:**  Fasciculations, weakness/paralysis \\  \\ **Cardiovascular effects:**  Bradycardia or tachycardia (common early), hyper/hypotension \\  \\ **Respiratory effects:**  Bronchoconstriction, bronchorrhea \\  \\ **Gastrointestinal effects:**  vomiting, diarrhoea
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**Neuromuscular effects: **Fasciculations, weakness/paralysis</font> +
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**Cardiovascular effects: **Bradycardia or tachycardia (common early), hyper/hypotension</font> +
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**Respiratory effects: **Bronchoconstriction, bronchorrhea</font> +
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**Gastrointestinal effects:** vomiting, diarrhoea</font>+
  
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 ===== Management ===== ===== Management =====
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>The main priorities in management are treatment of muscarinic effects and airway management. For advice regarding specific agents, see the relevant monograph.</font> + 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**Antidote- Atropine: **</font> +The main priorities in management are treatment of muscarinic effects and airway management. For advice regarding specific agents, see the relevant monograph. 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>Treat muscarinic effects, particularly bradycardia and pulmonary secretions, early, with atropinisation. Atropine dosage can vary widely based on the causative agent and degree of toxicity. Toxicity secondary to organophosphates or carbamates may require cumulative doses of up to 100mg.</font> + 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>**Give: atropine 0.6mg (child 0.02 mg/kg up to 0.6mg) intravenously, repeat every 3-5 minutes, doubling the dose on each occasion until end-points achieved. **</font> +**Antidote- Atropine: ** \\  \\ 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>** End-points: clear chest without wheeze, HR >80bpm, systolic BP >80.**</font> +Treat muscarinic effects, particularly bradycardia and pulmonary secretions, early, with atropinisation. Atropine dosage can vary widely based on the causative agent and degree of toxicity. Toxicity secondary to organophosphates or carbamates may require cumulative doses of up to 100mg. 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>It is common to require an ongoing infusion of 10-20% of the total dose of atropine required to achieve atropinisation of the patient per hour.</font> + 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>During titration observe for signs of over atropinisation (confusion, pyrexia, loss of bowel sounds).</font> +**Give: atropine 0.6mg (child 0.02 mg/kg up to 0.6mg) intravenously, repeat every 3-5 minutes, doubling the dose on each occasion until end-points achieved** 
- <font 11pt/Aptos,sans-serif;;inherit;;inherit>Intravenous benzodiazepines should be used to manage agitation and seizures.</font> + 
- <font 11.0pt/inherit;;inherit;;inherit>The exact role of pralidoxime is controversial and is discussed in more detail in the organophosphate monograph.</font>+**End-points: clear chest without wheeze, HR >80bpm, systolic BP >80.** 
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 + \\ 
 +It is common to require an ongoing infusion of 10-20% of the total dose of atropine required to achieve atropinisation of the patient per hour. \\  \\ 
 +During titration observe for signs of over atropinisation (confusion, pyrexia, loss of bowel sounds). \\  \\ 
 +Intravenous benzodiazepines should be used to manage agitation and seizures. \\  \\ 
 +The exact role of pralidoxime is controversial and is discussed in more detail in the organophosphate monograph.
  
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