Toxicology

Cholinergic Toxidrome

TRKolinerjik Toksidrom
Also known as:Cholinergic syndrome · Cholinergic crisis

A clinical syndrome of excess acetylcholine activity at muscarinic and nicotinic receptors, most often from acetylcholinesterase inhibition, producing copious secretions, bronchospasm, bradycardia, miosis, fasciculations and weakness.

In depth

Muscarinic features are salivation, lacrimation, urination, diarrhoea, vomiting, bronchorrhoea, bronchospasm, bradycardia, miosis and sweating (mnemonic SLUDGE). Nicotinic features are fasciculations, weakness and paralysis, sometimes with tachycardia and hypertension from ganglionic stimulation; central effects include confusion, seizures and coma. Death is mainly from respiratory failure.

Causes include organophosphate and carbamate insecticides, excess of cholinesterase-inhibitor drugs (myasthenia gravis, dementia), direct muscarinic agonists and muscarine-containing mushrooms. Management is decontamination with staff protection, airway support, atropine titrated to drying of bronchial secretions, an oxime such as pralidoxime to reactivate organophosphate-inhibited cholinesterase before 'ageing', benzodiazepines for seizures, and observation for the delayed intermediate syndrome.

Clinical pearl

Atropine is titrated to clear chest secretions and adequate oxygenation, not to pupil size or heart rate, which are unreliable endpoints; succinylcholine should be avoided because its neuromuscular block is prolonged when cholinesterases are inhibited.

Example drugs

Pyridostigmine Neostigmine Rivastigmine Donepezil Pilocarpine Bethanechol
TRIn Turkish

Kolinerjik Toksidrom

Çoğunlukla asetilkolinesteraz inhibisyonuna bağlı olarak muskarinik ve nikotinik reseptörlerde aşırı asetilkolin etkinliğiyle gelişen; bol salgılar, bronkospazm, bradikardi, miyozis, fasikülasyonlar ve kas güçsüzlüğüyle seyreden klinik sendromdur.

Muskarinik bulgular salivasyon, lakrimasyon, idrar kaçırma, ishal, kusma, bronkore, bronkospazm, bradikardi, miyozis ve terlemedir (İngilizce SLUDGE kısaltması). Nikotinik bulgular fasikülasyon, kas güçsüzlüğü ve paralizidir; gangliyon uyarımına bağlı taşikardi ve hipertansiyon da görülebilir. Merkezi etkiler konfüzyon, nöbet ve komadır. Ölüm başlıca solunum yetmezliğine bağlıdır.

Nedenler organofosfat ve karbamat insektisitler, kolinesteraz inhibitörü ilaçların (miyastenia gravis, demans) fazlası, doğrudan etkili muskarinik agonistler ve muskarin içeren mantarlardır. Tedavi; personeli koruyarak dekontaminasyon, havayolu desteği, bronş salgıları kuruyana dek titre edilen atropin, organofosfatla inhibe olmuş kolinesterazı "yaşlanma" öncesinde yeniden aktive eden pralidoksim gibi bir oksim, nöbetler için benzodiazepinler ve gecikmiş ara sendrom açısından gözlemi kapsar.

Atropin, güvenilir ölçüt olmayan pupil çapına veya kalp hızına göre değil, akciğer salgılarının temizlenmesine ve yeterli oksijenlenmeye göre titre edilir; kolinesterazlar inhibe olduğunda nöromüsküler blok uzayacağından süksinilkolinden kaçınılmalıdır.

Diğer adları:Kolinerjik sendrom · Kolinerjik kriz
Updated 24.09.2026 0 views Educational reference — verify against current sources before clinical use.

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ToxidromeToksidrom

A constellation of signs and symptoms (vital signs, mental status, pupils, skin and bowel sounds) characteristic of poisoning by a particular class of agents, used to identify the likely cause at the bedside.

 Anticholinergic ToxidromeAntikolinerjik Toksidrom

A clinical syndrome caused by blockade of muscarinic acetylcholine receptors, characterised by delirium, tachycardia, hyperthermia, mydriasis, dry flushed skin, urinary retention and reduced bowel sounds.

 AntidoteAntidot

A substance that counteracts the effects of a poison or drug overdose by preventing its absorption, binding or inactivating it, antagonising it at its site of action, enhancing its elimination or reversing its toxic effects.

 Enzyme InhibitionEnzim İnhibisyonu

A reduction in the activity of a drug-metabolizing enzyme by a co-administered drug or other substance, which lowers the clearance of drugs dependent on that enzyme and raises their concentrations.

 Competitive AntagonismYarışmalı Antagonizma

Reversible antagonism in which the antagonist binds to the same site as the agonist, so the block can be overcome by raising the agonist concentration; the agonist curve shifts to the right in parallel without a fall in maximal response.

 AgonistAgonist

A drug or endogenous substance that binds to a receptor and activates it, producing a biological response; it possesses both affinity and efficacy (intrinsic activity).