Which of the following is a symptom associated with the DUMBELS acronym?

• A. Hypertension
• B. Miosis
• C. Tremor
• D. Insomnia

Answer: (B)

Recognizing muscarinic signs of cholinergic toxicity is what the DUMBELS mnemonic helps you with. Miosis, or pinpoint pupils, is a classic sign caused by excess acetylcholine at muscarinic receptors in the eye, leading to pupil constriction. DUMBELS stands for Diarrhea, Urination, Miosis, Bronchospasm/Bronchorrhea, Emesis, Lacrimation, and Salivation, highlighting the secretory and smooth-muscle effects of excessive acetylcholine. The other options don’t fit this pattern: hypertension is not a muscarinic symptom and bradycardia with secretions is more typical; tremor can occur from nicotinic effects at the neuromuscular junction but isn’t a muscarinic sign; insomnia has no relation to cholinergic overstimulation. So miosis is the correct association with DUMBELS.