Cholinergic crisis

Cholinergic symptoms are usually at their most severe 2 h after the last dose of anticholinesterase. It is common to give atropine prophylactically in the treatment of myasthenia which may mask some of the cholinergic symptoms. If a deterioration of myasthenia fails to respond to edrophonium all drugs should be stopped and atropine given (1 mg IV every 30 min to a maximum of 8 mg). The edrophonium test should be repeated every 2 h and anticholinesterases reintroduced when the test is positive. Mechanical ventilation is required if FVC <1l or the PaCO2 is raised.

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