Acetylcholinesterase Inhibitors Toxicity


4.7 out of 5 (21 Reviews)



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Expiration Date

31 Dec 2023

Last Reviewed

1 Jan 2021

Estimated Time To Finish

75 Minutes

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Activity Description

Nerve agents are some of the most deadly and easily employed chemical warfare agents. Given the global threat of terrorism, it is prudent to have a baseline knowledge of nerve agents. Some of the more recognizable nerve agents are sarin [(RS)-propan-2-yl methyphosphonofluoridate], also known as GB; soman (O-Pinacolyl methylphosphonofluoridate), also known as GD; and VX (ethyl ({2-[bis(propan-2yl)amino]ethyl}sulfanyl)(methyl)phosphinate). Initially developed in the early-to-mid 1900s from chemically similar insecticides, their volatility and potential to be weaponized was exploited during World War II. More recent examples of nerve agent use include the 1995 Tokyo subway attack with Sarin gas and the 2017 assassination of Kim Jong-Nam with VX gas. This activity reviews some of the more common nerve agents used, their associated signs and symptoms, and recommendations for management. This activity reviews the importance of the interprofessional team in diagnosing and treating patients exposed to nerve agents.

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Target Audience

This activity has been designed to meet the educational needs of physicians.

Learning Objectives

At the conclusion of this activity, the learner will be better able to:

  • Describe the signs and symptoms that a patient with acetylcholinesterase inhibitor toxicity might exhibit.
  • Identify the organ system most at risk of failing and thereby leading to mortality in patients with acetylcholinesterase inhibitor toxicity.
  • Explain important treatment considerations for patients with acetylcholinesterase inhibitor toxicity.
  • Identify the most likely setting in which the interprofessional team would be expected to deal with widespread acetylcholinesterase inhibitor toxicity. Describe how team members would communicate and collaborate to reduce the burden of the toxicity.

Author(s) / Contributors Disclosure of Conflicts of Interest

Each author, editor, faculty and planning committee member have completed a disclosure form indicating that neither they nor their spouse/partner has a financial interest/arrangement or affiliation that could be perceived as a real or apparent conflict of interest related to the content of this activity.

COMMERCIAL SUPPORT: This activity has received NO commercial support.

Continuing Education Accreditation Information

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Quillen College of Medicine, East Tennessee State University, and StatPearls, LLC. The Quillen College of Medicine, East Tennessee State University is accredited by the ACCME to provide continuing medical education for physicians.

Quillen College of Medicine, East Tennessee State University designates this activity for a maximum of 1.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity is reported to the following Maintenance of Certification (MOC) boards:
American Board of Anesthesiology
  • General Operative Anesthesia
American Board of Internal Medicine
  • Adolescent Medicine
  • Hospital Medicine
  • Internal Medicine
American Board of Ophthalmology
  • Glaucoma
  • Neuro-Ophthalmology and Orbit
American Board of Pathology
  • Chemical Pathology
  • Forensic Pathology
  • Neuropathology (incl. Neuromuscular)
American Board of Pediatrics
  • Adolescent Medicine
  • General Pediatrics
  • Medical Toxicology
  • Pediatric Neurology

Cancellation Policy: Cancellations must be received in writing and a money-back guarantee is provided if not completely satisfied.

  • StatPearls and ETSU reserve the right to cancel any course due to unforeseen circumstances. StatPearls and ETSU will not be responsible for other expenses incurred by the participant in the unlikely event that the program is canceled.

Equal Opportunity

  • StatPearls and ETSU are Equal Opportunity / Affirmative Action / Equal Access Institutions. 

Medium or Media Used:

  • Computer Requirements:  Internet Access
  • E-mail Address

Instructions for Credit

  1. Register for the activity and create a StatPearls login.     
  2. Review the required accreditation information:  Target audience, learning objectives, and disclosure information.
  3. Complete the entire self-study activity.
  4. Complete the post-test assessments.
  5. Successfully pass the post-test with a minimum score of 100%.
  6. Complete the evaluation survey. 
  7. Obtain a certificate.

StatPearls and ETSU adhere to ACCME Standards regarding commercial support of continuing medical education. It is the policy of StatPearls and ETSU that the faculty and planning committee disclose real or apparent conflicts of interest relating to the topics of this educational activity, that relevant conflict(s) of interest are resolved, and also that authors and editors will disclose any unlabeled/unapproved use of drug(s) or device(s) during their presentation. Detailed disclosure will be made prior to starting the activity.

The information provided at this CME/CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

  • If you need help with the system or have a question about content, please contact
  • If you have a question about the ETSU CME providership, please contact


Media Usage Rights

The contributors and editors of StatPearls have attested that all associated media (images and video) have been legally cleared for use with this activity.  All copyrights are reserved.


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    Harry A. on 9/26/2021

    Thank you so much!! So valuable - I may never need it, but I'll be more likely to help now knowing this!

    lee a. on 10/1/2021

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    Karl on 11/17/2021

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    Edward M. on 3/31/2022

    very concise and to the point

    Alexei K. on 3/8/2022

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