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WordNet

an unstable situation of extreme danger or difficulty; "they went bankrupt during the economic crisis"
a crucial stage or turning point in the course of something; "after the crisis the patient either dies or gets better"
releasing or activated by acetylcholine or a related compound

PrepTutorEJDIC

(社会上・政治上の)『重大な事態』,『難局』,危機 / (人生の)重大な転機(岐路),重大事 / 最悪状態

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/06/05 18:43:02」(JST)

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A cholinergic crisis is an over-stimulation at a neuromuscular junction due to an excess of acetylcholine (ACh), as of a result of the inactivity (perhaps even inhibition) of the AChE enzyme, which normally breaks down acetylcholine. This is a consequence of some types of nerve gas, (e.g. sarin gas). In medicine, this is seen in patients with myasthenia gravis who take too high a dose of their cholinesterase inhibitor medications, or seen following general anaesthesia, when too high a dose of a cholinesterase inhibitor drug is given to reverse surgical muscle paralysis.

Symptoms and diagnosis

As a result of cholinergic crisis, the muscles stop responding to the bombardment of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms reminiscent of organophosphate poisoning. Other symptoms include increased sweating, salivation, bronchial secretions along with miosis.

This crisis may be masked by the concomitant use of atropine along with cholinesterase inhibitor in order to prevent side effects. Flaccid paralysis resulting from cholinergic crisis can be distinguished from myasthenia gravis by the use of the drug edrophonium (Tensilon), which worsens the paralysis caused by cholinergic crisis, but strengthens the muscle in the case of myasthenia gravis. (Edrophonium is an cholinesterase inhibitor hence increases the concentration of acetylcholine present).

Treatment

Some elements of cholinergic crisis can be treated with antimuscarinic drugs like atropine, but the most important element, respiratory arrest, cannot. The neuromuscular junction, where the brain communicates with muscles (like the diaphragm, the main breathing muscle), works by acetylcholine activating nicotinic acetylcholine receptors and leading to muscle contraction. Atropine blocks muscarinic acetylcholine receptors (a different subtype than the nicotinic receptors at the neuromuscular junction), so atropine will not improve the muscle strength and ability to breathe in someone with cholinergic crisis. Such a patient will require mechanical ventilation support via endotracheal intubation until the crisis resolves on its own. The respiratory compromise from cholinergic crisis unfortunately has no pharmacologic solution or therapy.

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English Journal

Time Course, Behavioral Safety, and Protective Efficacy of Centrally Active Reversible Acetylcholinesterase Inhibitors in Cynomolgus Macaques.

Hamilton LR1, Schachter SC2, Myers TM3.
Neurochemical research.Neurochem Res.2016 Nov 30. [Epub ahead of print]
Galantamine hydrobromide and (-)huperzine A, centrally active reversible acetylcholinesterase inhibitors, are potentially superior to the current standard, pyridostigmine bromide, as a pretreatment for organophosphorus chemical warfare nerve agent intoxication. Galantamine, huperzine, and pyridostig
PMID 27900576

Sarin (GB, O-isopropyl methylphosphonofluoridate) neurotoxicity: critical review.

Abou-Donia MB1, Siracuse B1, Gupta N1, Sobel Sokol A1.
Critical reviews in toxicology.Crit Rev Toxicol.2016 Nov;46(10):845-875. Epub 2016 Oct 5.
Sarin (GB, O-isopropyl methylphosphonoﬂuoridate) is a potent organophosphorus (OP) nerve agent that inhibits acetylcholinesterase (AChE) irreversibly. The subsequent build-up of acetylcholine (ACh) in the central nervous system (CNS) provokes seizures and, at sufficient doses, centrally-mediated r
PMID 27705071

Zebrafish is a predictive model for identifying compounds that protect against brain toxicity in severe acute organophosphorus intoxication.

Faria M1,2, Prats E3, Padrós F4, Soares AM1, Raldúa D5.
Archives of toxicology.Arch Toxicol.2016 Sep 21. [Epub ahead of print]
Acute organophosphorus (OP) intoxication is a worldwide clinical and public health problem. In addition to cholinergic crisis, neurodegeneration and brain damage are hallmarks of the severe form of this toxidrome. Recently, we generated a chemical model of severe acute OP intoxication in zebrafish t
PMID 27655295

Japanese Journal

ジスチグミン臭化物の大量服薬によりコリン作動性クリーゼで心停止に至った1例

西沢拓也,松本敬,仲村尚司,笹野幹雄,間山泰晃
日本集中治療医学会雑誌 26(2), 123-124, 2019
NAID 130007606896

ジスチグミン臭化物によるコリン作動性クリーゼの臨床

小野寺誠,伊関憲,藤田友嗣,菊池哲,藤野靖久,井上義博
日本毒性学会学術年会 45.1(0), S5-5, 2018
<p>　重症筋無力症や排尿障害治療薬であるジスチグミン臭化物は、カーバメート系コリンエステラーゼ阻害剤に属し、可逆的な抗コリンエステラーゼ作用を有する薬剤であるが、漫然と投与することによりアセチルコリン過剰状態でかつ呼吸困難を伴う病態であるコリン作動性クリーゼに陥るときがある。コリン作動性クリーゼの発生頻度は0.2%と稀ではあるが、65歳以上の症例や投与開始後2週間以内に多くが発生して …
NAID 130007432621

ネオスチグミン長期内服によるコリン作動性クリーゼの1例

大邉寛幸,小張祐介,遠山昌平,小林正和,小林道生,石橋悟
日本集中治療医学会雑誌 24(2), 149-150, 2017
NAID 130005440105

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