Is based on the history of exposure and the presence of characteristic muscarinic, nicotinic, and CNS manifestations of acetylcholine excess. In the majority of cases, the most prominent symptoms are due to excessive muscarinic stimulation. (A useful mnemonic for muscarinic toxicity is DUMBBELSS: diarrhea, urinary incontinence, miosis, bronchospasm, bronchorrhea, emesis, lacrimation, salivation, and sweating.) There may be a solvent odor, and some agents have a strong "garlic" odor. A Glasgow Coma Scale (GCS) score of 13 or lower at presentation is considered a poor prognostic indicator. Several other scoring systems for critically ill patients (such as APACHE II Score and Simplified Acute Physiology Score) have also been advocated to help with prediction of clinical outcomes from cholinesterase inhibitor poisoning. Other drugs or toxins that increase cholinergic activity, such as nicotine alkaloids, should be considered in the differential diagnosis.