RT Book, Section A1 Williams, Saralyn R. A1 Thurman, R. Jason A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181056708 T1 Cholinergic Toxidrome T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessmedicine.mhmedical.com/content.aspx?aid=1181056708 RD 2024/03/29 AB Acetylcholine (Ach) is a neurotransmitter of both the central and peripheral nervous system. It is the neurotransmitter for both muscarinic and nicotinic receptors. Inhibition of acetylcholinesterase increases Ach in the synapse. This results in the clinical syndrome of both muscarinic and nicotinic effects. One mnemonic for the muscarinic effects is DUMBBEL(L)S: diarrhea, urination, miosis, bronchorrhea, bradycardia, emesis, lacrimation, and salivation. Nicotinic effects include the fasciculations, paralysis, and occasional sympathomimetic effects of mydriasis and tachycardia.