. "Sarin." Gulf War and Health: Volume 1. Depleted Uranium, Pyridostigmine Bromide, Sarin, and Vaccines. Washington, DC: The National Academies Press, 2000.
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Gulf War and Health: Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines
TABLE 5.2 Acute Cholinergic Syndrome
Site of Action
Signs and Symptoms
Muscarinic
Pupils
Miosis, marked, usually maximal (pinpoint), sometimes unequal
Ciliary body
Frontal headache, eye pain on focusing, blurring of vision
Anorexia, nausea, vomiting, abdominal cramps, epigastric and substernal tightness with heartburn and eructation, diarrhea, tenesmus, involuntary defecation
Sweat glands
Increased sweating
Salivary glands
Increased salivation
Lacrimal glands
Increased lacrimation
Heart
Bradycardia
Bladder
Frequency, involuntary micturition
Nicotinic
Striated muscle
Easy fatigue, mild weakness, muscular twitching, fasciculations, cramps, generalized weakness or flaccid paralysis (including muscles of respiration), with dyspnea and cyanosis
Sympathetic ganglia
Pallor, transitory elevation of blood pressure followed by hypotension
Central nervous system
Immediate (acute) effects: generalized weakness, depression of respiratory and circulatory centers with dyspnea, cyanosis, and hypotension; convulsions, loss of consciousness, and coma
Delayed (chronic) effects: giddiness, tension, anxiety, jitteriness, restlessness, emotional lability, excessive dreaming, insomnia, nightmares, headaches, tremor, withdrawal and depression, bursts of slow waves of elevated voltage on electrogram, drowsiness, difficulty concentrating, slowness of recall, confusion, slurred speech, ataxia
SOURCE: Gunderson et al., 1992.
occurred when the acute cholinergic effect is limited to miosis (contraction of the pupil), rhinorrhea (an extreme type of runny nose), and depressed cholinesterase levels in the blood. Finally, low-level exposure may have occurred even though there are no immediately detectable cholinergic signs and symptoms (Brown and Brix, 1998). The health effects of low levels of sarin exposure are of