A cholinergic crisis is excessive stimulation of the nerve-muscle junction caused by too much acetylcholine (ACh) produced in response to a lack of AChE, which typically breaks down the neurotransmitter.
Several factors, such as certain drugs, insecticides, and food allergies, can cause it. The most common symptoms are abdominal cramps, salivation, lacrimation (tear production), urination defecation, gastrointestinal distress (diarrhea or vomiting), muscle fasciculation (twitching), and generalized weakness.
To remember the classic signs and symptoms of a cholinergic crisis, many clinicians use an acronym called “SLUDGE.”
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Evaluation of Patients with Cholinergic Crisis
Evaluation of patients with a cholinergic crisis should include a comprehensive history and physical examination to identify any associated toxidromes. Ancillary tests such as
- Complete blood count (CBC): To detect elevated white cell counts that may point towards an underlying infection,
- Comprehensive metabolic panel (CMP): To identify electrolyte disturbances related to organophosphate poisoning.
- Red blood cell cholinesterase activity: Usually decreased in cases of cholinergic crisis and can be used to help confirm the diagnosis. Plasma pseudocholinesterase may also be employed but is less reliable,
- Electrocardiogram (ECG): To detect any arrhythmia linked to organophosphate poisoning,
- Chest X-Ray: To check for the presence of pulmonary edema or aspiration, and
- Head CAT Scan: When the patient’s mental status is altered, or there is a notable deviation in Glasgow Coma Scale results.
What is S.L.U.D.G.E. Acronym Stand For?
The SLUDGE acronym remembers a cholinergic crisis’s classic signs and symptoms. It stands for
- S = Salivation
- L = Lacrimation
- U = Urination
- D = Defecation
- G = Gastrointestinal Distress
- E = Excessive Muscular Activity.
- S = Salivation: Excessive saliva production is a common symptom of a cholinergic crisis. Patients may experience drooling or difficulty controlling saliva flow from their mouths.
- L = Lacrimation: This refers to the excessive production of tears in response to the stimulation of the nerve-muscle junction. It is important to note that several other medical conditions can also cause this symptom, so it is essential to consider other potential causes.
- U = Urination: Patients may experience difficulties controlling their bladder and may feel the urge to urinate more frequently than usual. Residual urine in the bladder after voiding could also indicate a cholinergic crisis.
- D = Defecation: Patients may have difficulty controlling their bowels and might experience cramping or diarrhea due to the stimulation of the nerve-muscle junction.
- G = Gastrointestinal Distress: Stomach cramps, nausea, vomiting, and diarrhea are signs of something wrong with your digestive system. This is often a result of too much [ACh] being produced in response to a lack of AChE and can cause severe discomfort or pain.
- M = Muscle Fasciculation: Patients may experience small twitches or jerks throughout their body due to the stimulation of the nerve-muscle junction. Feelings of weakness and fatigue often accompany these due to prolonged muscle activity.
What is Sludge Anticholinergic?
Sludge anticholinergic is a medication used to treat various conditions. It is a class of drugs that works by blocking the action of the neurotransmitter acetylcholine in the body.
Although effective in treating specific conditions, it can have side effects such as confusion, dry mouth, and blurred vision. This medication is commonly used for patients with Parkinson’s disease and overactive bladder.
However, consulting with your doctor before starting any new medication is essential. Despite the potential side effects, sludge anticholinergic can greatly improve the quality of life for those who require it.
Final Thoughts
Acronym sludge is a helpful mnemonic to remember the classic signs and symptoms of a cholinergic crisis. Certain drugs, insecticides, and food allergies can cause this condition. It is essential to understand that this condition can have severe consequences if left untreated.
Therefore, individuals must seek medical attention immediately if they experience any associated symptoms. Additionally, those with certain medical conditions, such as Parkinson’s disease, may need to take sludge anticholinergic medications to manage their condition.
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.