Development of the Acute Cholinergic Syndrome

The presentation and initial treatment of the characteristic acute cholinergic syndrome following severe OP exposure was considered in earlier chapters. Experience with OP pesticide poisoning has shown that in most cases, the signs and symptoms resolve after about 18 h with continuing anticholinergic and oxime treatment. Ventilation, if it had been required, can be discontinued at this stage. 

Experience with nerve agents is more limited. In the case of some nerve agents, such as soman (GD), which quickly produce an irreversible complex with acetylcholinesterase, an extension of the cholinergic period may be expected with appropriate life support if there is significant respiratory failure. 

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