The acronym SLUDGEM is used to describe the signs and symptoms of exposure to which category of warfare agents?

• A. Nerve agents
• B. Vesicants
• C. Nuclear agents
• D. Biological agents

Answer: (A)

SLUDGEM captures the classic muscarinic signs of a cholinergic crisis: Salivation, Lacrimation, Urination, Defecation, Gastric upset, Emesis, and Miosis. These occur when acetylcholinesterase is inhibited, causing an excess of acetylcholine at nerve endings. Nerve agents are among the most potent acetylcholinesterase inhibitors, leading to rapid, widespread stimulation of muscarinic receptors and the SLUDGEM pattern.

Vesicants, nuclear agents, and biological agents produce other kinds of effects—blistering and skin damage, radiation-related or systemic illness, or infection-like symptoms—rather than the immediate cholinergic overactivity shown by SLUDGEM. So SLUDGEM is the hallmark of nerve-agent exposure.