Anticholinergic toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Meds | |||
**Atropine | |||
**Antihistamines | |||
**Antidepressants (SSRIs, TCAs) | |||
**Antipsychotics | |||
**Muscle relaxants | |||
*Plants | |||
**Jimson weed (Devil's trumpet) | |||
**Amanita mushroom | |||
==Clinical Features== | ==Clinical Features== | ||
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*Red as a beet: cutaneous vasodilation | *Red as a beet: cutaneous vasodilation | ||
*Blind as a bat: nonreactive mydriasis (often delayed 12-24hr) | *Blind as a bat: nonreactive mydriasis (often delayed 12-24hr) | ||
*Mad as a hatter: delirium; hallucinations | *Mad as a hatter: delirium; attention deficit; hallucinations; dysarthria; lethargy | ||
*Full as a flask: urinary retention | *Full as a flask: urinary retention | ||
*Tachycardia (HR 120-160) and decreased/absent bowel sounds | *Tachycardia (HR 120-160) and decreased/absent bowel sounds | ||
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#[[Neuroleptic Malignant Syndrome (NMS)]] | #[[Neuroleptic Malignant Syndrome (NMS)]] | ||
#Acute psychotic disorder | #Acute psychotic disorder | ||
==Treatment== | |||
#GI decon | |||
##Activated charcoal may be effective even >1hr after ingestion (decreased GI motility) | |||
#Sedation | |||
##Decreases the risk of hyperthermia, rhabdo, traumatic injuries | |||
##Benzos are agents of choice | |||
#Cholinesterase inhibition | |||
##Indicated for severe agitation or delirium (esp if unresponsive to benzos) | |||
##Avoid when cardiac conduction abnormalities are present | |||
##Physostigmine | |||
###Dosing: 0.5-2mg IV over 5min | |||
###Onset of action: 15-20min | |||
###Side effects: bradycardia, dysrhythmias, cholinergic excess | |||
==See Also== | ==See Also== |
Revision as of 00:10, 30 January 2012
Background
- Meds
- Atropine
- Antihistamines
- Antidepressants (SSRIs, TCAs)
- Antipsychotics
- Muscle relaxants
- Plants
- Jimson weed (Devil's trumpet)
- Amanita mushroom
Clinical Features
- Dry as a bone: anhidrosis (esp axillae, mouth)
- Hot as a hare: anhydrotic hyperthermia (may become severe w/ agitation)
- Red as a beet: cutaneous vasodilation
- Blind as a bat: nonreactive mydriasis (often delayed 12-24hr)
- Mad as a hatter: delirium; attention deficit; hallucinations; dysarthria; lethargy
- Full as a flask: urinary retention
- Tachycardia (HR 120-160) and decreased/absent bowel sounds
DDX
- Sympathomimetic toxicity
- Red, dry skin and absent bowel sounds favors anticholinergic toxicity
- Encephalitis
- Head trauma
- ETOH/sedative withdrawal
- Neuroleptic Malignant Syndrome (NMS)
- Acute psychotic disorder
Treatment
- GI decon
- Activated charcoal may be effective even >1hr after ingestion (decreased GI motility)
- Sedation
- Decreases the risk of hyperthermia, rhabdo, traumatic injuries
- Benzos are agents of choice
- Cholinesterase inhibition
- Indicated for severe agitation or delirium (esp if unresponsive to benzos)
- Avoid when cardiac conduction abnormalities are present
- Physostigmine
- Dosing: 0.5-2mg IV over 5min
- Onset of action: 15-20min
- Side effects: bradycardia, dysrhythmias, cholinergic excess
See Also
Source
Tintinalli