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