Cholinergic Poisoning (SLUG BAM)

• S - Salivation
• L - Lacrimation
• U - Urination
• G - Gastrointestinal (V + D)
• B - Bronchorrhea and Bronchospasm (Atropine Titrated to this)
• A - Abdominal distress
• M - miosis

Sources

• OrganoPhosphates - pesticides
  
• Nerve gas - Sarin, VX

Treatment

• Atropine - titrated to respiratory symptoms NOT heart rate or miosis
  
• Adults - initial dose of 2-6 mg every 2-30 minutes to control respiratory secretions
• Then gtt of 0.2-2 mg/hr titrated to respiratory symptoms
  
• Pediatrics - initial dose of 0.05-0.1 mg/kg every 2-30 minutes to control respiratory secretions
• Then gtt of 0.025 mg/kg/hr titrated to respiratory symptoms
• Competitive muscarinic acetylcholine receptor antagonist
• Doses for organophosphate poisoning may be higher than nerve agents
• May require doses of 50 mg or more over 24 hours for severe poisoning
  
• Pralidoxime (2-PAM)
• Adults - 30 mg/kg (usually 1-2 g) IV over 15-30 minutes and repeated 60 minutes later
• Pediatrics - 20-50 mg/kg IV over 15-30 minutes followed gtt 5-10 mg/kg/hr
  
• Must be given before aging (agent forms permanent bond w/ receptor)