Anticholinesterase exposure

Misra, U.K. (1992). Neurophysiological monitors of anticholinesterase exposure. In B. Ballantyne and T.C. Marrs. (Eds.) Clinical and Experimental Toxicology of the Organophosphates and Carbamates 446-459. 

Von Kaulla, K. and Holmes, J.H., 1961 Changes following anticholinesterase exposures. Arch Environ. Health 2 82-168. 

Traumatic brain injury, simulated by a model of closed head injury to mice, had also been shown to result in disruption of the BBB. The temporal resolution of this disruption was monitored by MRI in rats subjected to closed head injury. Blood-brain barrier disruption appeared immediately after the impact, and declined gradually, until full reversal to control levels 30 min post-injury. Opening of the BBB was similarly demonstrated in response to acute anticholinesterase exposure, however, low-level exposure has not yet been tested. BBB disruption under anticholinesterase exposure was proven to be seizure-dependent, as it could be blocked by the use of anticonvulsant agents. The anticholinesterase effect on BBB ultrastructure did not impair endothelial tight junctions. Yet, an increased number of endothelial vesicles were observed, suggesting increased transcytosis as the mechanism involved. ... 

C. Seizures, Neuropathology, and Blood-Brain Barrier Alterations Following Anticholinesterase Exposure... 

IX. OCCUPATIONAL HYGIENE CONSIDERATIONS FOR RESTRICTION OF ANTICHOLINESTERASE EXPOSURES... 

Excessive levels of acetylcholine following anticholinesterase exposure can have a profound effect on cardiac activity. The expected effect on the heart based upon the effects on muscarinic receptors would be increased vagal tone with bradycardia and QT prolongation and atrioventricular heart block up to the third degree. 

If there is an excess of acetylcholine following anticholinesterase exposure, the administration of atropine should produce no ill effects. However, excessive amounts of atropine, either from giving too much to a symptomatic patient or from giving atropine to an unexposed person, can produce anticholinergic effects such as dry mouth, blurred vision, dilated pupils, urinary retention, tachycardia and inability to sweat These side effects are generally considered minor, but they can last for 24-48 h. 

The Importance of Respiratory Support in the Management of Severe Anticholinesterase Exposure... 

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