Signs of Cholinergic Crisis

Just as there are contraindications, one of the things you might worry about is overdoing the muscarinic stimulation, which can lead to a cholinergic crisis due to excessive cholinomimetic effects from Pilocarpine or its cousins, or anything that promotes excess cholinergic influence. The manifestations are arrhythimias or bradycardia (slowing of the heart). Hypotension implies arterial dilation—we’ll come back to this some other time. In the CNS acetylcholine and cholinergic neuron are prominent everywhere in the brain, often manifested by confusion, nausea, tremors, vomiting, and visual disturbances. In the GI tract, you can get diarrhea and stomach cramps.

The antidote for all of these symptoms associated with a cholinergic crisis, is Atropine. In fact, during WWII and the Gulf War soldiers were given kits with ampules of atropine so that if they were ever exposed to an anticholinesterase nerve gas and began to show these symptoms they could give themselves an intramuscular injection.

**So you’d better be aware of dosage and side effects of the muscarinic agonists (a la Pilocarpine, et al.)

Category: Pharmacology Notes