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Potentially life-threatening emergency
Cholinergic syndrome
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Potentially life-threatening emergency

Cholinergic syndrome

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Contributors: Joon B. Kim MD, Benjamin L. Mazer MD, MBA, Michael W. Winter MD
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Synopsis

Cholinergic syndrome (Muscarinic) : Vomiting, Hyperactive bowel sounds, Insecticide exposure, Urinary incontinence, Diaphoresis, Excessive tearing, Miosis, Wheezing, HR decreased, Confusion
Muscarinic
Cholinergic syndrome is a toxidrome, or a set of symptoms associated with poisoning from certain substances. Symptoms are predominantly caused by activation of muscarinic receptors that control the parasympathetic nervous system.

Symptoms include bradycardia, wheezing, diaphoresis, miosis, diarrhea, and salivation. Activation of nicotinic acetylcholine receptors can also cause hypertension. Muscarinic effects result from parasympathetic overstimulation (miosis and blurred vision; excessive secretions, especially salivation, lacrimation, urination, defecation, gastric cramping, and emesis [SLUDGE]).

Drugs that can induce cholinergic syndrome include organophosphates (insecticides), carbamates, cholinergic drugs such as physostigmine, and nicotine. Cholinergic syndrome can be life threatening.

Treatment is with anticholinergic drugs, such as atropine. Pralidoxime is additionally used in cases of organophosphate poisoning.

Codes

ICD10CM:
T44.1X4A – Poisoning by other parasympathomimetics [cholinergics], undetermined, initial encounter

SNOMEDCT:
61356009 – Poisoning by parasympathomimetic drug

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:03/06/2019
Last Updated:11/07/2019
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Potentially life-threatening emergency
Cholinergic syndrome
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A medical illustration showing key findings of Cholinergic syndrome (Muscarinic) : Vomiting, Hyperactive bowel sounds, Insecticide exposure, Urinary incontinence, Diaphoresis, Excessive tearing, Miosis, Wheezing, HR decreased, Confusion

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