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.

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