SLUDGE syndrome

SLUDGE syndrome is a mnemonic of a syndrome (often a toxidrome) of pathological effects indicative of massive discharge of the parasympathetic nervous system. Unlikely to occur naturally, SLUDGE is usually encountered only in cases of drug overdose or exposure to nerve gases. Nerve gases irreversibly inhibit the enzyme acetylcholinesterase; this results in a chronically high level of acetylcholine at cholinergic synapses throughout the body, thus chronically stimulating acetylcholine receptors throughout the body. The symptoms of "SLUDGE" are due to chronic stimulation of muscarinic acetylcholine receptors, in organs and muscles innervated by the parasympathetic nervous system. It is useful to remember some of the symptoms of increased cholinergic stimulation through the mnemonic SLUDGE:

• Salivation: stimulation of the salivary glands
• Lacrimation: stimulation of the lacrimal glands
• Urination: relaxation of the internal sphincter muscle of urethra, and contraction of the detrusor muscles
• Defecation: relaxation of the internal anal sphincter
• Gastrointestinal upset: Smooth muscle tone changes causing gastrointestinal problems, including diarrhea
• Emesis: Vomiting

An extension is SLUDGEM, where the additional M indicates:

• Miosis: stimulation of the pupillary constrictor muscles

or

• Muscle spasm: stimulation of skeletal muscle

Another mnemonic is DUMBBELSS which stands for diarrhea, urination, miosis/muscle weakness, bronchorrhea, bradycardia, emesis, lacrimation, salivation/sweating.

One common cause of SLUDGE is exposure to organophosphorus insecticides (including parathion, malathion, and diazinon) or nerve gas, such as sarin. These agents phosphorylate acetylcholinesterase, thereby irreversibly deactivating acetylcholinesterase and raising acetylcholine levels and causing SLUDGE(M).

SLUDGE may be treated with Atropine or other anticholinergics.