SLUDGE syndrome

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]

• Salivation: stimulation of the salivary glands
• Lacrimation: stimulation of the lacrimal glands (tearing)
• Urination: relaxation of the internal sphincter muscle of urethra, and contraction of the detrusor muscles
• Diaphoresis: stimulation of the sweat glands
• Gastrointestinal upset: Smooth muscle tone changes causing gastrointestinal problems, including diarrhea
• Emesis: Vomiting^[2]

An extension is SLUDGEM, where the additional M indicates:

• Miosis: stimulation of the pupillary constrictor muscles

or

• Muscle spasm: stimulation of skeletal muscle

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.

References