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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
General
syndrome
References
- Wikipedia: Cholinergic crisis
http://en.wikipedia.org/wiki/Cholinergic_crisis