I need the pathophysiologic mechanisms surrounding A. constricted pupils B. whee

Question

I need the pathophysiologic mechanisms surrounding A. constricted pupils B. wheezing and rales C. nausea and vomitting D.excessive tear formation and finally E. dyspnea in relation to SLUDGE / Cholinergic Syndrome due to organophosphate poisoning. I'm looking for SPECIFIC mechanisms for each one. I understand that organophosphates attaching to AChE leads to a build up of ACh (acetylcholine). What I don't understand is how it can cause muscle weakness, but also constrict the pupils, or how it specifically causes wheezing and rales.

Explanation / Answer

AChE breaks ACh into choline and acetic acid. In organophosphate poisoning, organophosphate binds to AChE to prevents its function on ACh.

This results in accumulation of ACh in nervous system overstimulation of muscarinic and nicotinic receptors leading to activation of the autonomic and central nervous systems and at nicotinic receptors on skeletal muscle.

ACh causes stimulation of vagus nerve

It also causes vasodilatation

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