cholinergic crisis

Etiology

• inhibition of acetylcholinesterase
  • nerve gas, (sarin gas)
  • cholinesterase inhibitor overdose
    • patients with myasthenia gravis
    • reversal of surgical muscle paralysis

Pathology

• over-stimulation at a neuromuscular junction due to an excess of acetylcholine

Clinical manifestations

• flaccid paralysis
• respiratory failure
• other signs & symptoms similar to organophosphate poisoning
• crisis may be masked by the concomitant use of atropine along with cholinesterase inhibitors*

* atropine blocks muscarinic receptors not nicotinic receptors thus will not improve the muscle strength & ability to breath

Differential diagnosis

• myasthenia gravis
  • edrophonium (Tensilon) worsens paralysis of cholinergic crisis, but strengthens muscle in the case of myasthenia gravis

Management

• respiratory support including endotracheal intubation & mechanical ventilation for respiratory failure

More general terms

• syndrome