Cholinergic crisis - Revision history

Danbot: Strip excess bold

2026-03-22T09:30:27Z

Strip excess bold

← Revisión anterior		Revisión del 09:30 22 mar 2026
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	==Clinical Features==		==Clinical Features==
	===SLUDGE(M) syndrome===		===SLUDGE(M) syndrome===
	~~'''S'''alivation~~, ~~'''L'''acrimation~~, ~~'''U'''rination~~, ~~'''D'''iarrhea~~, ~~'''G'''I~~ pain, ~~'''E'''mesis~~, ~~'''M'''iosis~~		Salivation, Lacrimation, Urination, Diarrhea, GI pain, Emesis, Miosis

	==Differential Diagnosis==		==Differential Diagnosis==

2026-03-20T21:08:56Z

Add MedicationDose entries for atropine, lorazepam, pralidoxime

@@ Línea 31: / Línea 31: @@
 *Consider [[intubation]] and [[mechanical ventilation]]
 **Poisoning of acetylcholinesterase will prolong effects of succinylcholine.  Consider nondepolarizing agent such as [[rocuronium]] if paralytic needed
 ==Disposition==

2021-02-27T17:49:29Z

Management

← Revisión anterior		Revisión del 17:49 27 feb 2021
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	*[[Benzodiazepines]] prn for seizures		*[[Benzodiazepines]] prn for seizures
	**Lorazepam 2-4 mg IV		**Lorazepam 2-4 mg IV
	*~~Praldoxime~~ (2-PAM)		*Pralidoxime (2-PAM)
	**Loading dose 20 mg/kg (max 2 g) IV bolus x 30 minutes then		**Loading dose 20 mg/kg (max 2 g) IV bolus x 30 minutes then
	**Infusion 8-10 mg/kg/hr (max 650 mg/hr) IV		**Infusion 8-10 mg/kg/hr (max 650 mg/hr) IV

2019-11-22T06:35:15Z

Disposition

← Revisión anterior		Revisión del 06:35 22 nov 2019
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	==Management==		==Management==
			*Decontaminate immediately - takes priority, prevent exposure of health care workers, remove patient from exposure and remove all clothing
	*[[Atropine]] (antimuscarinic)		*[[Atropine]] (antimuscarinic)
			**2-4mg IV q5min, titrate to resolution of bronchorrhea (may need > 100 mg total dose)
			**Then initiate atropine infusion at 10% of total initial dose and titrate up by 0.2 mg/kg/hr to maintain resolution of bronchorrhea
			*[[Benzodiazepines]] prn for seizures
			**Lorazepam 2-4 mg IV
			*Praldoxime (2-PAM)
			**Loading dose 20 mg/kg (max 2 g) IV bolus x 30 minutes then
			**Infusion 8-10 mg/kg/hr (max 650 mg/hr) IV
	*Consider [[intubation]] and [[mechanical ventilation]]		*Consider [[intubation]] and [[mechanical ventilation]]
			**Poisoning of acetylcholinesterase will prolong effects of succinylcholine. Consider nondepolarizing agent such as [[rocuronium]] if paralytic needed

	==Disposition==		==Disposition==
			*Admit, consider ICU

	==See Also==		==See Also==

2018-09-16T01:18:26Z

2018-09-13T21:27:59Z

← Revisión anterior		Revisión del 21:27 13 sep 2018
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	==Evaluation==		==Evaluation==




	{{Myasthenic vs cholinergic crisis}}		{{Myasthenic vs cholinergic crisis}}


	==Management==		==Management==

2018-09-13T20:53:09Z

Differential Diagnosis

@@ Línea 14: / Línea 14: @@
 ==Differential Diagnosis==
-===[[Cholinergic crisis|SLUDGE Syndrome]]===
+{{SLUDGE DDX}}
 ==Evaluation==

2018-09-13T20:17:31Z

Background

← Revisión anterior		Revisión del 20:17 13 sep 2018
Línea 6:		Línea 6:
	*Atropine blocks muscarinic acetylcholine receptors (a different subtype than the nicotinic receptors at the neuromuscular junction), so will not improve the muscle strength and ability to breathe.		*Atropine blocks muscarinic acetylcholine receptors (a different subtype than the nicotinic receptors at the neuromuscular junction), so will not improve the muscle strength and ability to breathe.
	**So, such patients will frequently require mechanical ventilation until the crisis resolves. There is not specific antidote for the respiratory compromise.		**So, such patients will frequently require mechanical ventilation until the crisis resolves. There is not specific antidote for the respiratory compromise.

			{{Autonomic nervous system receptors}}

	==Clinical Features==		==Clinical Features==

2018-09-13T20:03:34Z

SLUDGE Syndrome

← Revisión anterior		Revisión del 20:03 13 sep 2018
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	**[[Novichok agent]]		**[[Novichok agent]]
	*[[Nicotine toxicity]] (look alike)		*[[Nicotine toxicity]] (look alike)
	*~~Overdose of cholinesterase~~ inhibitor (e.g in [[myasthenia gravis]] or post anesthesia reversal)		*[[Acetylcholinesterase inhibitor]] overdose (e.g in [[myasthenia gravis]] or post anesthesia reversal)

	==Evaluation==		==Evaluation==

2018-09-13T19:26:24Z