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Emergency Medical Minute


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


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