The principal effect of nerve agents is exerted by inhibition of the enzyme acetylcholinesterase (AChE), which results in cholinergic overt stimulation with both muscarinic and nicotinic effects [101] . Pathophysiologically, their effects are the opposite of botulinum toxin; nerve agents result in increased acetylcholine in the synaptic cleft, while botulinum toxin results in decreased acetylcholine. The clinical manifestations of nerve agent intoxication are those of cholinergic excess. Muscarinic effects mainly manifest with symptoms from affected smooth muscles (Table 4 ) of airways, GI tract and eyes, glands, and the heart. Nicotinic effects concern skeletal muscles and pre-ganglionic nerves [1] . The mnemonic Salivation, Lacrimation, Urination, Defecation, GI hypermotility, Emesis (SLUDGE) summarizes the commonly experienced early symptoms of salivation, lacrimation, urination, defecation, GI hypermotility, and emesis [14] .