Cholinergic crisis

Introduction Various physiological, pathological or drug factors, such as neostigmine excess, organophosphorus pesticide poisoning, etc., cause acetylcholine to accumulate in the neuro-muscle junction, and continue to act on the acetylcholine receptor, so that the postsynaptic membrane continues to depolarize. The process of repolarization is blocked, the nerve-muscle junction is blocked, and the signal transmission is disordered. In addition to respiratory muscle paralysis such as dyspnea, there are symptoms of muscarinic poisoning and niacin-like poisoning such as vomiting, abdominal pain, and diarrhea. , pupil dilation, sweating, runny, increased tracheal secretions, slow heart rate, muscle tremors, cramps and tightness. Application of neostigmine can aggravate the symptoms of myasthenia gravis. The cholinesterase inhibitor should be stopped, and the choline receptor blocker atropine, 654-2 (acanitine) and other intramuscular injections can alleviate the symptoms.

Cause

1. In recent years, according to ultrastructural studies, the disease is mainly caused by lesions of the postsynaptic membrane acetylcholine receptor (AChR).

2. Many clinical phenomena are also associated with disorders of the disease and immune mechanisms. Various physiological, pathological or drug factors, such as neostigmine excess, organophosphorus pesticide poisoning, etc., cause acetylcholine to accumulate in the neuro-muscle junction, and continue to act on the acetylcholine receptor, so that the postsynaptic membrane continues to depolarize. The process of repolarization is blocked, the nerve-muscle junction is blocked, and the signal transmission is disordered, except for respiratory muscle paralysis such as dyspnea.

an examination

Related inspection

Blood routine urine routine

1. Myasthenia gravis crisis: that is, Xinshi's lack of crisis, often caused by infection, trauma, and reduction. Respiratory muscle paralysis, cough, swallowing, and life-threatening.

2. Cholinergic crisis: the new crisis of overdose. In addition to the aforementioned muscle weakness crisis, there are symptoms of excessive accumulation of acetylcholine:

1 muscarinic poisoning: nausea, vomiting, diarrhea, abdominal pain, small pupils, excessive sweating, runny nose, tracheal secretions, slow heart rate.

2 niacin-like poisoning symptoms: muscle tremor, convulsions, tight feeling.

3 central nervous symptoms: anxiety, insomnia, mental confusion and so on.

3. Anti-crime: It is difficult to distinguish the nature of the crisis and can not be used to stop the drug or increase the dose of the drug to improve symptoms, more often after long-term treatment with larger doses.

Differential diagnosis

Identification of myasthenia gravis, cholinergic crisis, and rumination crisis. Three types of crisis can be identified by the following methods:

1 Tengxilong test.

2 atropine test.

3 EMG examination.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.