Management

The edrophonium test in the cholinergic patient should be performed with care. It is possible to precipitate a crisis with edrophonium. Signs of the cholinergic state are excessive salivation, abdominal cramps and diarrhea, small pupils, and sweating. As with the myasthenic crisis, if there is respiratory distress it is prudent to control the airway with intubation and ventilate in the first instance. Nutrition and medication should be administered through a nasogastric tube.

Anticholinesterase therapy should be stopped and only restarted when the patient is definitely myasthenic. Meanwhile treatment should be reviewed, and plasma exchange and other means of improving the situation should be considered in the same way as with a myasthenic crisis.

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