A 38-year-old man comes to his primary care physician for evaluation of intermittent muscle weakness that began around three months ago. He reports having episodes of “seeing-double” and having difficulty chewing
that occur in the evening and resolve the next morning. Past medical history is notable for asthma
, for which he intermittently uses an albuterol
inhaler. His temperature is 37.6°C (99.7°F), pulse
is 65/min and blood pressure
is 122/71 mmHg. During the physical examination, the patient is asked to look upwards toward the ceiling for 60 seconds. This maneuver elicits bilateral diplopia
. The remainder of the examination is noncontributory. Workup is sent to confirm the diagnosis, and the patient is started on the first-line medication for his condition. Which of the following is a likely side-effect from overdose of this medication?