What does DUMBELS stand for?

• A. Diaphoresis/diarrhea; Urination; Miosis; Bradycardia/bronchoconstriction; Emesis; Lacrimation; Salivation
• B. Diaphoresis; Urination; Mydriasis; Bradycardia; Emesis; Lacrimation; Salivation
• C. Diaphoresis; Urination; Miosis; Bronchodilation; Emesis; Lacrimation; Salivation
• D. Defecation; Urination; Miosis; Bradycardia; Emesis; Lacrimation; Salivation

Answer: (A)

DUMBELS is a mnemonic for a cholinergic toxidrome—the muscarinic effects that occur with excess acetylcholine, such as from organophosphate exposure. The D stands for Diaphoresis or Diarrhea, U for Urination, M for Miosis (constricted pupils), B for Bradycardia and bronchoconstriction, E for Emesis, L for Lacrimation, and S for Salivation. This pattern—sweating or diarrhea, urination, small pupils, slow heart rate with airway constriction, vomiting, tearing, and drooling—captures the classic muscarinic signs. Variants may differ slightly (for example, bronchorrhea instead of bronchoconstriction), but the key idea is the same: these are the parasympathetic, muscarinic effects of toxin exposure.