Anticholinesterase syndrome

a. Organophosphates. Commonly available as insecticides, and readily absorbed through skin, mucous membranes, and respiratory and GI tracts. Organophosphates inactivate cholinesterase enzymes, resulting in accumulation of acetylcholine at receptor sites and overstimulation of mus-carinic, nicotinic, and central acetylcholine receptors.

b. Other causes of cholinesterase inhibition. Carbamates and therapeutic cholinesterase inhibitors (eg, physostig-mine, pyridostigmine, neostigmine, edrophonium). Clinical findings suggestive of acute anticholinesterase intoxication include muscarinic effects as well as muscle weakness, fasciculations, altered mental status, seizures, and coma.

c. As a mnemonic to recall many of the muscarinic effects, remember DUMBELS: Defecation, Urination, Miosis, Bronchorrhea, Bronchospasm, Bradycardia, Emesis, Lacrimation, and Salivation.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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