SLUDGE · Cholinergic Crisis Signs and Symptoms Acronym

A cholinergic crisis is a condition that happens due to overstimulation of cholinergic receptors, which are cell-surface receptors that get activated when they bind a type of neurotransmitter called acetylcholine (Ach). Acetylcholine is the main neurotransmitter of the parasympathetic nervous system, which controls the involuntary activity of smooth muscles and organ glands. Acetylcholine also plays an essential role in voluntary movement by signaling skeletal muscles to contract. 

A cholinergic crisis occurs when there is excess acetylcholine at the neuron’s synapses, often due to inhibition of the enzyme acetylcholinesterase (AChE), which is responsible for breaking down acetylcholine. A common cause of this is exposure to organophosphates, which are potent anticholinesterase agents found in pesticides (e.g., carbofuran). Although rare, a cholinergic crisis may occur as a side effect of cholinesterase inhibitors, like pyridostigmine, which are commonly used in the treatment of myasthenia gravis. Finally, other medications that stimulate cholinergic receptors may result in a cholinergic crisis if given at high doses. These include pilocarpine, used in glaucoma treatment, and rivastigmine or galantamine, used in the treatment of Alzheimer disease.