Template:Anticholinergic Toxicity Treatement

Treatment

1. GI decon
   • Activated Charcoal may be effective even >1hr after ingestion (decreased GI motility)
2. Sedation
   • Decreases the risk of hyperthermia, rhabdo, traumatic injuries
   • Benzos are agents of choice especially increase seizure threshold
3. Conduction abnormalities (QRS prolongation)
   • Sodium bicarbonate
     • Should be given at 2 mEq/kg
     • Typically 2-3 amps of bicarb
     • Begin continuous NaCO3 infusions if bolus effective
     • Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
     • Run NaHCO3 solutions at 250 mL/hr
4. Cholinesterase inhibition
   • Indicated for severe agitation or delirium (esp if unresponsive to benzos)
   • Contraindicated in QRS>100 or Na blockade signs (R' in aVR)
   • Relative contraindicated in asthma or ileus
   • Physostigmine - strongly consider poison control consult before giving
     • Crosses blood brain barrier, can be used to help make dx
     • Dosing: 0.5-2mg IV over 5min
     • Onset of action: 15-20min
     • Side effects: bradycardia, dysrhythmias, cholinergic excess
     • Always have atropine at the bedside for bradycardia or cholinergic excess
     • Contraindicated in TCA toxicity, associated with cardiac arrest