امرأة عمرها ٤٥ سنة عندها وهن عضلي، زادت جرعات البيريدوستيغمين بنفسها لأنها شعرت بضعف. صار عندها ضعف شديد مع سيلان لعاب وتعرق وتقلصات بطن وإسهال، وحدقتان ضيقتان، والنبض ٥٢. ما الحالة؟

A 45-year-old woman with myasthenia increased her pyridostigmine herself because she felt weak. She now has severe weakness with drooling, sweating, abdominal cramps, diarrhoea, constricted pupils and HR 52. What is the condition?

1. Myasthenic crisis from too little drug
2. Acute bacterial food poisoning
3. A severe allergy of another type
4. Cholinergic crisis from excess drug

Answer: D) Cholinergic crisis from excess drug. Excess cholinesterase inhibitor causes a cholinergic crisis: weakness with muscarinic signs (salivation, sweating, diarrhoea, miosis, bradycardia). The drug is held, atropine given as ordered and breathing supported.