Fourth Generation Agents

Typical Signs and Symptoms (Cholinergic Toxidrome) of Nerve Agent Poisoning

The presentation and timing of symptom onset depends on the agent, dose, and route of exposure. Potential signs and symptoms may include:

Mouth/Skin: drooling (salivation), foaming at the mouth, excessive sweating

Nose/Eyes: runny nose, watery eyes (lacrimation) with small (often pinpoint) pupils (miosis)

Chest: cough, bronchospasm (severe bronchoconstriction), bronchorrhea (excessive bronchial secretions), labored breathing, wheezing, respiratory failure

Genitourinary: excessive urination

Abdominal: diarrhea, abdominal (gastrointestinal) cramps, nausea, belching, vomiting (emesis)

Heart Rate: bradycardia

Mental Status: confusion, drowsiness

Musculoskeletal: twitching, fasciculations, cramps, fatigue, weakness

Neurological: tremors, slurred speech, ataxia, absent reflexes, seizures/convulsions, unconsciousness, coma