Return to Spontaneous Circulation in a patient with Cholinergic Syndrome at the Emergency Department of Buea Regional Hospital, Cameroon

Abstract

IntroductionAlthough developed countries have seen a decline in organophosphate poisoning cases due to stricter regulations on the use of these chemicals, developing countries continue to face clinical problems related to this issue in recent years. Pesticides are frequently used as a means of self- harm due to their lethality and widespread availability in the developing world. Therefore, developing countries that rely heavily on agriculture and often have less stringent pesticide regulations account for the majority of organophosphate poisoning cases. Research indicates that deliberate poisoning results in a higher mortality rate than accidental exposure to these compounds. [1]Cholinergic toxicity is caused by substances that stimulate, enhance, or mimic the neurotransmitter acetylcholine, the primary neurotransmitter of the parasympathetic nervous system. Acetylcholine stimulates muscarinic and nicotinic receptors to cause muscle contraction and glandular secretions. Cholinergic toxicity occurs when too much acetylcholine is present at the receptor synapse, leading to excessive parasympathetic effects. [2]The mechanism involves excessive cholinergic receptor stimulation, which can be caused by substances that mimic, stimulate, or enhance acetylcholine. The symptom complex produced by the agent depends on what type of receptor or combination of receptors is activated. There are three types of cholinergic receptors: central, muscarinic, and nicotinic. Excess acetylcholine at muscarinic receptors will result in symptoms of increased secretions, bronchoconstriction, bradycardia, vomiting, and abdominal cramping. Excess acetylcholine at nicotinic receptors causes muscle fasciculations or paralysis due to activation of the neuromuscular junction. Acetylcholine excess in the central nervous system can cause confusion, headache, or drowsiness. [3]We report the case of successful management of cholinergic syndrome following the ingestion of a powdered concoction from a traditional herbalist