What is a potential adverse effect of neostigmine treatment in clients with myasthenia gravis?

Neostigmine is a cholinesterase inhibitor used to treat myasthenia gravis, as it helps increase the level of acetylcholine at the neuromuscular junction, improving muscle strength. However, one of the potential adverse effects of neostigmine treatment is excessive muscarinic stimulation. This occurs because neostigmine not only increases acetylcholine at the neuromuscular junction but also increases acetylcholine at muscarinic receptors throughout the body.

Excessive activation of muscarinic receptors can lead to a range of symptoms due to over-activation of parasympathetic nervous system activity. These symptoms may include increased salivation, lacrimation, urination, defecation, gastrointestinal distress, and bradycardia. This is a significant concern in patients being treated with neostigmine, requiring careful monitoring and management of dosages to avoid such adverse effects.

Other adverse effects like decreased heart rate are associated with this excessive stimulation, but they stem from the broader issue of muscarinic overstimulation rather than being direct effects of the medication alone. Fever and rash are not typical effects of neostigmine, and muscle wasting is not a direct consequence of its use; rather,