Salivation, lacrimation, urination, dyspnea

Regardless of their subclassification, all of these compounds have the identical mechanism of action, which is inhibition of acetylcholinesterase at nerve junctions where the molecule acetylcholine is the neuotransmitter. Most acute signs of toxicity are expressed as uncontrollable activity of the nervous system, which clinically is presented as salivation, lacrimation, urination, defecation, and dyspnea. After lethal doses, death results from failure of the respiratory system. Variations in the specific nerves affected, in how the body metabolizes the individual chemical, in where the chemical enters the body, and in the route of administration employed will change the specific clinical presentation seen for an individual exposure scenario. 

The general symptoms of exposure to a nerve agent in gas form can be remembered by the acronym DUMBELS diarrhea, urination, miosis, bronchoconstric-tion (dyspnea, wheezing), emesis (vomiting), lacrimation, and salivation. Some prefer the acronym SLUDGEM salivation, lacrimation, urination, diarrhea, gastric upset, emesis, and miosis (Table S3.1). 

Acute toxicity includes pupillary constriction, stimulation of GI tract (cramps, nausea, vomiting, and diarrhea [NVD]) and urinary tract (incontinence, urination), bronchoconstriction (wheezing, dyspnea), increased glandular secretions (sweating, salivation, lacrimation), bradycardia and hypotension, skeletal muscle fasciculations and then paralysis (e.g., respiratory muscles), and CNS effects (behavioral excitation, depression of cardiovascular [CV] and respiratory centers). 

Diarrhea, diaphoresis, urination, miosis, blurred vision, pulmonary congestion, dyspnea, emesis, lacrimation, salivation, and shortness of breath within 1 hour... 

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