SLUDGE syndrome

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SLUDGE is a mnemonic for the 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, ingestion of certain poisonous mushrooms (particularly the muscarine-containing members of the genera Inocybe and Clitocybe), or exposure to nerve gases. 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:[1]

An extension is SLUDGEM, where the additional M indicates:


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. Nicotine poisoning can also present with symptoms similar to SLUDGE, as it also involves excessive parasympathetic stimulation.[3]

SLUDGE may be treated with atropine or other anticholinergics. Pralidoxime can be used if organophosphate poisoning is suspected.


  1. ^ Mary Jo Wagner; Susan B. Promes (1 January 2007). Last Minute Emergency Medicine : A Concise Review for the Specialty Boards. McGraw Hill Professional. p. 12. ISBN 978-0-07-150975-6. 
  2. ^ Burchum, Jacqueline. Lehne's Pharmacology for Nursing Car. 
  3. ^ Schep, Leo J.; Slaughter, Robin J.; Beasley, D. Michael G. (September–October 2009). "Nicotinic plant poisoning". Clinical Toxicology (Philadelphia, Pa.). 47 (8): 771–781. doi:10.1080/15563650903252186. PMID 19778187.