NREMT Paramedic Practice

What sign is characteristic of cholinergic overdose?

1. Tachycardia

2. Dry mouth

3. Weakness

4. Dilated pupils

The correct answer is: Weakness

Cholinergic overdose occurs due to an excessive accumulation of acetylcholine in the body, often as a result of exposure to certain toxins, medications, or nerve agents. The hallmark signs of cholinergic toxicity are often recalled with the acronym SLUDGE (Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal distress, and Emesis) and the killer Bs (Bradycardia, Bronchorrhea, Bronchospasm). Weakness is characteristic of a cholinergic overdose as excessive stimulation of the muscarinic receptors leads to increased muscle activity initially, followed by fatigue and weakness due to prolonged receptor activation and potential muscle fatigue. This is opposed to other options, as tachycardia, dry mouth, and dilated pupils are more commonly associated with anticholinergic effects rather than cholinergic effects. Therefore, weakness effectively highlights the neuromuscular impact of cholinergic overdose, which can lead to decreased strength and response in these individuals.