Cholinergic toxidrome

At a glance

• The cholinergic toxidrome is acetylcholine excess at muscarinic, nicotinic and central receptors, usually from cholinesterase inhibition.
• In Australia the main causes are organophosphate and carbamate insecticides (mostly rural, often deliberate ingestion) and medicinal cholinesterase inhibitors (pyridostigmine, donepezil, rivastigmine).
• The patient is wet: salivating, sweating, vomiting, with diarrhoea and bronchorrhoea. Pinpoint pupils are common but not universal.