Podcast 534: Nerve Agents

<p><strong>Author: Michael Hunt, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Organophosphate “nerve agents” were developed in the 1930’s</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE”</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Salivation</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Lacrimation</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Urination</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Defecation </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">GI cramping</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Emesis </span></li> </ul> </li> <li style="font-weight: 400;"><span style="font-weight: 400;">The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to muscle paralysis </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Death in these cases is from respiratory collapse due to secretions (bronchorrhea) and diaphragmatic paralysis </span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Treatment includes atropine to reduce secretions (often in incredibly high doses) and pralidoxime (2-PAM) to treat muscle paralysis </span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Benzodiazepines may be necessary for seizures</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><a href= "https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html"> <span style= "font-weight: 400;">https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html</span></a></span></p> <p><span style="font-size: 10pt;