SLUD
Encyclopedia
SLUDGE is a mnemonic of a (often a toxidrome
) 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
mushroom
s (particularly the muscarine
-containing members of the genera Inocybe
and Clitocybe
), or exposure to nerve gases
. Nerve gases irreversibly inhibit the enzyme acetylcholinesterase
; this results in a chronically high level of acetylcholine
at cholinergic synapses throughout the body, thus chronically stimulating acetylcholine receptors throughout the body. 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:
An extension is SLUDGEM, where the additional M indicates:
or
Another mnemonic is DUMBBELSS which stands for diarrhea, urination, miosis/muscle weakness, bronchorrhea, bradycardia, emesis, lacrimation, salivation/sweating.
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(M).
SLUDGE may be treated with atropine
, pralidoxime
or other anticholinergics.
Toxidrome
Toxidrome is a syndrome caused by a dangerous level of toxins in the body. The term was coined in 1970 by Mofenson and Greensher. It is often the consequence of a drug overdose. Common symptoms include dizziness, disorientation, nausea, vomiting, and oscillopsia...
) pathological effects indicative of massive discharge of the parasympathetic nervous system
Parasympathetic nervous system
The parasympathetic nervous system is one of the two main divisions of the autonomic nervous system . The ANS is responsible for regulation of internal organs and glands, which occurs unconsciously...
. Unlikely to occur naturally, SLUDGE is usually encountered only in cases of drug overdose, ingestion of certain poisonous
Mushroom poisoning
Mushroom poisoning refers to harmful effects from ingestion of toxic substances present in a mushroom. These symptoms can vary from slight gastrointestinal discomfort to death. The toxins present are secondary metabolites produced in specific biochemical pathways in the fungal cells...
mushroom
Mushroom
A mushroom is the fleshy, spore-bearing fruiting body of a fungus, typically produced above ground on soil or on its food source. The standard for the name "mushroom" is the cultivated white button mushroom, Agaricus bisporus; hence the word "mushroom" is most often applied to those fungi that...
s (particularly the muscarine
Muscarine
Muscarine, L--muscarine, or muscarin is a natural product found in certain mushrooms, particularly in Inocybe and Clitocybe species, such as the deadly C. dealbata. Mushrooms in the genera Entoloma and Mycena have also been found to contain levels of muscarine which can be dangerous if ingested...
-containing members of the genera Inocybe
Inocybe
Inocybe is a large, complex genus of mushrooms. Members of Inocybe are mycorrhizal, and some evidence shows that the high degree of speciation in the genus is due to adaptation to different trees and perhaps even local environments.-Description:...
and Clitocybe
Clitocybe
Hundreds of species of mushrooms compose the fungus genus Clitocybe. They are characterized by white, off-white, buff, cream, pink, or light-yellow spores, gills running down the stem, and pale white to brown or lilac coloration. They are primarily saprotrophic, decomposing forest ground litter...
), or exposure to nerve gases
Nerve agent
Nerve agents are a class of phosphorus-containing organic chemicals that disrupt the mechanism by which nerves transfer messages to organs...
. Nerve gases irreversibly inhibit the enzyme acetylcholinesterase
Cholinesterase
In biochemistry, cholinesterase is a family of enzymes that catalyze the hydrolysis of the neurotransmitter acetylcholine into choline and acetic acid, a reaction necessary to allow a cholinergic neuron to return to its resting state after activation.-Types:...
; this results in a chronically high level of acetylcholine
Acetylcholine
The chemical compound acetylcholine is a neurotransmitter in both the peripheral nervous system and central nervous system in many organisms including humans...
at cholinergic synapses throughout the body, thus chronically stimulating acetylcholine receptors throughout the body. 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
Cholinergic
The word choline generally refers to the various quaternary ammonium salts containing the N,N,N-trimethylethanolammonium cation. Found in most animal tissues, choline is a primary component of the neurotransmitter acetylcholine and functions with inositol as a basic constituent of lecithin...
stimulation through the mnemonic
Mnemonic
A mnemonic , or mnemonic device, is any learning technique that aids memory. To improve long term memory, mnemonic systems are used to make memorization easier. Commonly encountered mnemonics are often verbal, such as a very short poem or a special word used to help a person remember something,...
SLUDGE:
- Salivation: stimulation of the salivary glands
- Lacrimation: stimulation of the lacrimal glands
- UrinationUrinationUrination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
: relaxation of the internal sphincter muscle of urethraInternal sphincter muscle of urethraThe internal sphincter muscle of urethra is a urethral sphincter muscle which constricts the internal urethral orifice. It is the junction of the urethra with the urinary bladder. The muscle is made of smooth muscle, so therefore it is under involuntary control. It is kept tonically contracted by...
, and contraction of the detrusor musclesDetrusor urinae muscleThe detrusor urinae muscle, also detrusor muscle, muscularis propria of the urinary bladder and muscularis propria, contracts when urinating to squeeze out urine. Otherwise, it remains relaxed to allow the bladder to fill... - DefecationDefecationDefecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
: relaxation of the internal anal sphincter - Gastrointestinal upsetNauseaNausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
: Smooth muscleSmooth muscleSmooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by...
tone changes causing gastrointestinal problems, including diarrheaDiarrheaDiarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and... - Emesis: Vomiting
An extension is SLUDGEM, where the additional M indicates:
- MiosisMiosisMiosis is the constriction of the pupil of the eye to two millimeters or less...
: stimulation of the pupillary constrictor musclesIris sphincter muscleThe iris sphincter muscle is a muscle in the part of the eye called the iris...
or
- Muscle spasm: stimulation of skeletal muscleSkeletal muscleSkeletal muscle is a form of striated muscle tissue existing under control of the somatic nervous system- i.e. it is voluntarily controlled. It is one of three major muscle types, the others being cardiac and smooth muscle...
Another mnemonic is DUMBBELSS which stands for diarrhea, urination, miosis/muscle weakness, bronchorrhea, bradycardia, emesis, lacrimation, salivation/sweating.
One common cause of SLUDGE is exposure to organophosphorus insecticides (including parathion
Parathion
Parathion, also called parathion-ethyl or diethyl parathion, is an organophosphate compound. It is a potent insecticide and acaricide. It was originally developed by IG Farben in the 1940s. It is highly toxic to non-target organisms, including humans. Its use is banned or restricted in many...
, malathion
Malathion
Malathion is an organophosphate parasympathomimetic which binds irreversibly to cholinesterase. Malathion is an insecticide of relatively low human toxicity, however one recent study has shown that children with higher levels of organophosphate pesticide metabolites in their urine are more likely...
, and diazinon
Diazinon
Diazinon , a colorless to dark brown liquid, is a thiophosphoric acid ester developed in 1952 by Ciba-Geigy, a Swiss chemical company...
) or nerve gas, such as sarin
Sarin
Sarin, or GB, is an organophosphorus compound with the formula [2CHO]CH3PF. It is a colorless, odorless liquid, which is used as a chemical weapon. It has been classified as a weapon of mass destruction in UN Resolution 687...
. These agents phosphorylate acetylcholinesterase, thereby irreversibly deactivating acetylcholinesterase and raising acetylcholine levels and causing SLUDGE(M).
SLUDGE may be treated with atropine
Atropine
Atropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...
, pralidoxime
Pralidoxime
Pralidoxime or 2-PAM, usually as the chloride or methiodide salts, belongs to a family of compounds called oximes that bind to organophosphate-inactivated acetylcholinesterase. It is used to combat poisoning by organophosphates or acetylcholinesterase inhibitors , in conjunction with atropine and ...
or other anticholinergics.