These symptoms are found in most severe cases and are relevant of an exposure to large amounts of toxins. Their occurrence usually requires emergency hospitalization.

Bradycardia and hypotension require IV or IM atropine (0.5 to 1 mg every 5 minutes, if necessary) to maintain a heart rate greater than 60 bpm.

Cardiotonics (Isoprenaline…) can be administered in case of persistent bradycardia, and pralidoxime (Contrathion®…; 200 to 1000 mg, slow infusion) for its cholinesterase reactivator property.

Finally, rehydration is required in the event of severe hypotension.