text: As a result of cholinergic crisis, the muscles stop responding to the high synaptic levels of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms reminiscent of organophosphate poisoning. Other symptoms include increased sweating, salivation, bronchial secretions along with miosis (constricted pupils).  
  This crisis may be masked by the concomitant use of atropine along with cholinesterase inhibitor medication in order to prevent side effects. Flaccid paralysis resulting from cholinergic crisis can be distinguished from myasthenia gravis by the use of the drug edrophonium (Tensilon), as it only worsens the paralysis caused by cholinergic crisis but strengthens the muscle response in the case of myasthenia gravis. (Edrophonium is a cholinesterase inhibitor, hence increases the concentration of acetylcholine present).
  Some of the symptoms of increased cholinergic stimulation include:
  * Salivation: stimulation of the salivary glands 
  * Lacrimation: stimulation of the lacrimal glands (tearing)
  * Urination: relaxation of the internal sphincter muscle of urethra, and contraction of the detrusor muscles
  * Defecation
  * Gastrointestinal distress:     Smooth muscle tone changes causing gastrointestinal problems, including cramping
  * Emesis: Vomiting 
  * Miosis constriction of the pupils of the eye via stimulation of the pupillary constrictor muscles
  * Muscle spasm: stimulation of skeletal muscle (due to nicotinic acetylcholine receptor stimulation)