Organophosphate poisoning can cause a cholinergic crisis. What are the two acronyms to help you recognize this type of poisoning?

• A. DUMBELS & SLUDGEM
• B. SLUDGE & DUMBBELLS
• C. CHOLINERGIC CRISIS & DUMBBELS
• D. DUMBBELS & SLUDGES

Answer: (A)

Recognizing a cholinergic crisis from organophosphate poisoning comes from remembering the signs caused by excess acetylcholine. Two handy mnemonics to recall quickly are DUMBBELS and SLUDGEM. DUMBBELS stands for Diarrhea, Urination, Miosis, Bronchorrhea, Bradycardia, Emesis, Lacrimation, and Salivation. SLUDGEM stands for Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis, and Miosis. The overlap highlights the muscarinic effects you’ll see: increased secretions, GI upset, constricted pupils, slowed heart rate, and bronchial secretions or bronchospasm. Organophosphates inhibit acetylcholinesterase, causing acetylcholine to pile up at muscarinic and nicotinic receptors, producing these signs. When you notice this pattern in a patient with potential exposure, it points to a cholinergic crisis and prompts the appropriate antidotal and supportive treatment.