NREMT Paramedic Practice

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Which condition is NOT associated with signs of anticholinergic overdose?

Dilated pupils
SLUDGE
Dry/flushed skin
Tachycardia

The correct answer is: SLUDGE

Anticholinergic overdose is characterized by a specific set of signs and symptoms due to the inhibition of acetylcholine at muscarinic receptors. The term "SLUDGE" refers to a group of symptoms associated with cholinergic overstimulation, which includes salivation, lacrimation, urination, diarrhea, gastrointestinal distress, and emesis. These symptoms are typically the result of increased acetylcholine activity rather than decreased activity, which occurs with anticholinergic overdose. In contrast, signs such as dilated pupils, dry or flushed skin, and tachycardia are all indicators of anticholinergic effects. For example, dilated pupils occur due to the blockade of the iris sphincter muscle, dry skin results from reduced glandular secretions, and tachycardia is attributed to increased heart rate from reduced parasympathetic activity. Thus, the presence of "SLUDGE" is contradictory to the effects of anticholinergic substances, making it the condition that does not align with the signs of an anticholinergic overdose.