cholinergic toxidrome

cho·lin·er·gic tox·i·drome

(kō'lin-ĕr'jik tok'si-drōm)
The constellation of clinical effects (i.e., signs and symptoms) characteristic of poisoning by a cholinergic agent such as an anticholinesterase compound and caused by overstimulation and eventually fatigue and failure of cholinergically innervated target organs; typical effects involve skeletal muscle (e.g., twitching, fasciculations, weakness, paresis, paralysis), smooth muscle (e.g., miosis, bronchospasm due to overstimulation of bronchial smooth muscle, and nausea, vomiting, and diarrhea due to hyperperistalsis), exocrine glands (e.g., lacrimation, rhinorrhea, hypersalivation, bronchorrhea, diaphoresis), and neurons in the central nervous system (e.g., seizures, convulsions, central apnea).
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Section 10: Laboratory Assessment of the Cholinergic Toxidrome Red Blood Cell (RBC) and Serum Cholinesterase.
DISPOSITION: The risk of intermediate syndrome has important implications for patient management, because those who have apparently recovered from the acute cholinergic toxidrome may then suffer from acute respiratory failure or arrest 3-4 days later.
Karalliedde and Senanayake 1989; Erdman 2004) The intermediate syndrome is a condition of muscular weakness and paralysis that occurs 1-4 days after the resolution of acute cholinergic toxidrome due to organophosphate exposure.
However, during 1994-1997, the New York City Poison Control Center (NYCPCC) was consulted about 25 patients, primarily persons who had emigrated from the Dominican Republic, who had manifestations consistent with the cholinergic toxidrome, which is not characteristic of poisoning by the anticoagulant rodenticides, after ingesting a rodenticide known as Tres Pasitos ("Three Little Steps").
Of these, 20 presented to EDs with signs and symptoms consistent with cholinergic toxidrome, although the specific findings for each patient varied.