Author: Michael Hunt, MD Educational Pearls: Organophosphate “nerve agents” were developed in the 1930’s These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE” Salivation Lacrimation Urination Defecation  GI cramping Emesis  The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to muscle paralysis  Death in these cases is from respiratory collapse due to secretions (bronchorrhea) and diaphragmatic paralysis  Treatment includes atropine to reduce secretions (often in incredibly high doses) and pralidoxime (2-PAM) to treat muscle paralysis  Benzodiazepines may be necessary for seizures References https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html Michael Eddleston Novel Clinical Toxicology and Pharmacology of Organophosphorus Insecticide Self-Poisoning. Annual Review of Pharmacology and Toxicology 2019 59:1, 341-360 Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD