Master Acetylcholinesterase Inhibitor Poisoning with Picmonic for Paramedic

Acetylcholinesterase inhibitor poisoning, also known as organophosphate toxicity and cholinergic overdose, is a syndrome of excess cholinergic activity after exposure to an acetylcholinesterase inhibitor, such as organophosphate-containing insecticides. These substances, including malathion and parathion, can irreversibly inhibit acetylcholinesterase. Normally, this enzyme breaks down the neurotransmitter acetylcholine, which is important for normal functioning of the parasympathetic nervous system. Organophosphates prevent acetylcholinesterase from working, however, leading to excess acetylcholine activity and a parasympathetic response. Atropine and pralidoxime may be used as antidotes. Clinical manifestations can be remembered with the mnemonic DUMBBELSS: diarrhea, urination, miosis, bronchospasm, bradycardia, emesis, lacrimation, salivation, and sweating. These signs and symptoms are a result of excess parasympathetic nervous system activity.