This is a flowchart on cholinergic crisis (including organophosphate poisoning), covering the etiology, pathophysiology, manifestations, and management.
ADDITIONAL TAGS:
Risk factors / SDOH
Cell / tissue damage
Nervous system path
Cholinergic crisis
Medicine / drugs
Infectious / microbial
Biochem / organic chem
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environment / toxins
Genetics / hereditary
Flow physiology
Pathophysiology
+ Management
Etiology
Manifestations
Irreversible inhibition of acetylcholinesterase
↑ acetylcholine levels
Activation of acetylcholine receptors (muscarinic and nicotinic) → parasympathetic nervous system overactivation
Exposure to organophosphate insecticides (parathion or E605)
Farmer, field work
Exposure to nerve agents
(sarin, VX, Novichok agents)
Excess dose of cholinesterase inhibitors
Patient with myasthenia gravis (taking pyridostigmine)
Following general anesthetic, to reverse neuromuscular blockade (with neostigmine)
Military, war
Garlic-like or petrol-like odor
Odorless, tasteless
Blue dye stains mucosa, saliva
Poisonous fungi (containing muscarine: Inocybe and Clitocybe)
Nicotine poisoning?
DUMBBELLSS:
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis (vomiting)
Lacrimation
Lethargy
Sweating
Salivation
Fasciculations
Weakness
Spasms
Paralysis
Bronchorrhea
Respiratory failure (greatest danger)
Seizures
+/- coma
Hypotension
Decontaminate patient (use PPE)
Secure airway + oxygen
Competitive agonist at muscarinic receptors
Atropine
Regen acetylcholinesterase by dephosphorylation
Oximes: pralidoxime (2-PAM), obidoxime
Benzodiazepines
Wheezing