View source for Carbamate toxicity

==Background==
*Class of insecticide
*[[Acetylcholinesterase inhibitors|acetylcholinesterase inhibition]] --> excess accumulation of acetylcholine at the neuromuscular junction and [[cholinergic crisis|cholinergic toxicity]]
*Structurally distinct but toxicity mechanistically similar to [[organophosphate toxicity]]
**Cholinesterase inhibition is ''more'' transient than with organophosphates, so clinical course tends to be more benign<ref> Silberman J, Taylor A. Carbamate Toxicity. [Updated 2019 Jun 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482183/</ref>

==Clinical Features==
{{Autonomic nervous system receptors}}
*Symptoms caused by acetylcholine buildup in CNS and PNS.
*CNS symptoms = [[headache]], [[confusion]], [[vertigo]], [[seizures]], [[coma]]
*Muscarinic Receptors
**SLUDGE(M) = '''S'''alivation, '''L'''acrimation, '''U'''rination, '''D'''iarrhea, '''G'''I pain, '''E'''mesis, '''M'''iosis
*Nicotinic Receptors (NMJ)
**MTWThF = '''M'''ydriasis/Muscle cramps, '''T'''achycardia, '''W'''eakness, '''T'''witching, '''H'''ypertension/Hyperglycemia, '''F'''asiculations 
*Common causes of death in [[organophosphate]] toxicity
**Killers B's = '''B'''radycardia, '''B'''ronchorrhea, '''B'''ronchospasm

==Differential Diagnosis==
{{SLUDGE DDX}}
{{Weakness DDX}}
{{Chemical weapon DDX}}
{{Symptomatic bradycardia}}

==Evaluation==
*Clinical diagnosis- RBC cholinesterase levels are available but of limited utility<ref>https://www.merckmanuals.com/professional/injuries-poisoning/poisoning/organophosphate-poisoning-and-carbamate-poisoning</ref>
*CBC, BMP
*[[CXR]]- may show [[pulmonary edema]]
*[[ECG]]- may show [[AV block]], [[QT prolongation]], [[ventricular dysrhythmias]]

==Management==
*[[Pralidoxime]] not useful with carbamates but should be given unless organophosphate toxicity completely ruled out 
{{Cholinergic Toxicity Treatment}}

==Disposition==
*Admit all patients with respiratory or CNS compromise and all who require atropine


==See Also==
*[[Organophosphate toxicity]]

==External Links==


==References==
<references/>
[[Category:Toxicology]]