Which symptom is a hallmark of a cholinergic crisis?

• A. Excessive secretions and salivation
• B. Tremor only
• C. Hyperthermia
• D. Dehydration

Answer: (A)

Cholinergic crisis is driven by excessive stimulation of muscarinic receptors from acetylcholine buildup. The most distinctive sign of this muscarinic overactivity is copious secretions from glands—salivation, as well as tearing, sweating, and bronchial/mucous secretions. This classic “SLUDGE/SALT” picture reflects the glandular effects of increased acetylcholine, so excessive secretions and salivation is the hallmark symptom you’d look for in the field.

Tremor can occur due to nicotinic receptor activation affecting skeletal muscles, but it isn’t as specific to a cholinergic crisis as glandular secretions are. Hyperthermia is not typical for cholinergic excess and would point you toward other toxicities or processes. Dehydration may happen with vomiting or diarrhea in various conditions, but it isn’t the defining sign of a cholinergic crisis.