While the most common mnemonics used with cholinergic poisonings are SLUDGE or DUMBBELS, the mnemonic for the days of the week is also important for remembering the clinical effects of the cholinergic toxidrome. SLUDGE or DUMBBELS refers to the muscarinic effects such as diarrhea, urination, miosis, bronchorrhea, bronchoconstriction, bradycardia, emesis, lacrimation, salivation, etc; however, cholinergic poisoning also results in excess acetylcholine at nicotinic sites in addition to muscarinic sites. Nicotinic receptors are located at the neuromuscular junctions. Stimulation at these sites results in fasciculations, muscle weakness, and paralysis. Nicotinic receptors are also located at the preganglionic sites of both the parasympathetic and the sympathetic sides of the autonomic nervous system. As a result of the preganglionic stimulation of the sympathetic side in the setting of early cholinergic poisoning, sympathomimetic effects may be seen, such as tachycardia and mydriasis.
Thus remembering the weekdays (Monday, Tuesday, Wednesday, Thursday, Friday) may assist in recalling this part of the cholinergic toxidrome.
M = mydriasis
T = tachycardia
W = weakness
H = hypertension
F = fasciculation
This question prepared by: Saralyn Williams, MD Medical Toxicologist
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Donna Seger, MD
Tennessee Poison Center
Poison Help Hotline: 1-800-222-1222