Part 4: The Cholinergic Toxidrome

Upon completion of this section, you should be able to

• Identify the most important organ system requiring supportive care in patients suffering from the cholinergic toxidrome.

Monitoring and intensive supportive care are critical components of patient management in severe poisoning cases. Monitoring of exposed patients may need to be prolonged because of the possibility of delayed onset of effects from cholinesterase inhibitors.

Death from cholinesterase inhibitor poisoning is usually due to respiratory failure from a combination of: (Zwiener and Ginsburg 1988; Sofer, Tal et al. 1989; Reigart and Roberts 1999)

• Bronchoconstriction.
• Bronchorrhea.
• Central respiratory depression.
• Weakness or paralysis of respiratory muscles.

Therefore, early, aggressive respiratory support is a mainstay of treatment, including endotracheal intubation and mechanical ventilation when indicated.

• Supportive care plays a critical role in the medical management of the cholinergic toxidrome.
• Aggressive respiratory support is particularly important, since respiratory failure is the usual cause of fatality.