Jan 21, 2020
Author: Michael Hunt, MD
Educational Pearls:
- Organophosphate “nerve agents” were developed in the 1930’s
- These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE”
-
- Salivation
- Lacrimation
- Urination
- Defecation
- GI cramping
- Emesis
- The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to muscle paralysis
- Death in these cases is from respiratory collapse due to secretions (bronchorrhea) and diaphragmatic paralysis
- Treatment includes atropine to reduce secretions (often in incredibly high doses) and pralidoxime (2-PAM) to treat muscle paralysis
- Benzodiazepines may be necessary for seizures
References
https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html
Michael Eddleston Novel Clinical Toxicology and Pharmacology of Organophosphorus Insecticide Self-Poisoning. Annual Review of Pharmacology and Toxicology 2019 59:1, 341-360
Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD