Cholinergic Crisis

Summary

Cholinergic crisis refers to a clinical syndrome caused by excessive acetylcholine signaling, usually caused by cholinergic medications. Symptoms include increased secretions, a slowed heart rate, miosis, increased urination, diarrhea, as well as muscle twitching and cramping. Cholinergic crisis can be reversed or treated using anticholinergic medications, especially atropine.

Key Points

• Cholinergic Crisis
  • Cause
    • Increased acetylcholine
      • Usually caused by overdose of cholinergic drugs or cholinesterase inhibitors (pyridostigmine, neostigmine, edrophonium, etc.)
  • Symptoms
    • Think excessive “rest and digest”
    • Increased secretions (sweat, saliva, tears etc.)
    • Bradycardia
    • Miosis (pupil constriction)
    • Diarrhea
      • Nausea/vomiting and abdominal cramping may be present
    • Increased Urination
    • Muscle twitching/cramping
      • From overstimulation
  • Treatment
    • Atropine
      • Other anticholinergic medications may also be used