https://wikem.org/w/index.php?action=history&feed=atom&title=Template%3AAnticholinergic_Toxicity_Treatement%2FenTemplate:Anticholinergic Toxicity Treatement/en - Revision history2026-04-20T13:02:05ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Template:Anticholinergic_Toxicity_Treatement/en&diff=383785&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-23T09:23:35Z<p>Updating to match new version of source page</p>
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==Treatment==<br />
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*Consider GI decon with [[Special:MyLanguage/Activated Charcoal|Activated Charcoal]] if patient presents <2 hours after ingestion and remains cooperative<br />
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===Sedation===<br />
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*Decreases the risk of [[Special:MyLanguage/hyperthermia|hyperthermia]], [[Special:MyLanguage/rhabdo|rhabdo]], traumatic injuries<br />
*[[Special:MyLanguage/Benzos|Benzos]] are agents of choice especially increase seizure threshold<ref>Burns MJ, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000:35(4):374-381.</ref><br />
**Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation<br />
**Goal: QRS duration < 110 msec<br />
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===Cholinesterase inhibition===<br />
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*Indicated for severe agitation or delirium (esp if unresponsive to [[Special:MyLanguage/benzos|benzos]])<br />
*Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma<br />
*Relatively contraindicated in asthma or ileus<br />
*[[Special:MyLanguage/Physostigmine|Physostigmine]] - strongly consider poison control consult before giving<br />
**Crosses blood brain barrier, can be used to help make dx<br />
**Dosing: 0.5mg-1mg IV over 5min (repeat dosing up to 2mg in first hour)<ref>Rosenbaum C and Bird SB. Timing and frequency for physostigmine redosing for antimuscarininc toxicity. J Med Toxicol. 2010;6:386-92.</ref><br />
**Onset of action: 5-10min<br />
**If partial response, repeat x3<br />
**If 3 or more administrations are needed over a 6-hour period, start IV infusion (bolus 1-2 mg followed by 1 mg/hour)<br />
**Stop infusion every 12 hours to determine resolution of the toxidrome<br />
**Side effects: bradycardia, dysrhythmias, cholinergic excess<ref>Pentel P and Peterson CD. Aystole complicating physostigmine treatment of tricyclic antidepressant overdose. Ann Emerg Med. 1980 Nov;9(11):588-90.</ref><br />
**Always have [[Special:MyLanguage/atropine|atropine]] at the bedside for bradycardia or cholinergic excess</ref><ref>Nguyen TT, et al. Adverse events from physostigmine: an observational study. Am J Emerg Med. 2018;36:141-2.</ref><br />
**'''Contraindicated''' in [[Special:MyLanguage/TCA toxicity|TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block<br />
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===Other therapies===<br />
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*[[Special:MyLanguage/Sodium bicarbonate|Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)<br />
**2 mEq/kg bolus (typically 2-3 amps of bicarb)<br />
**Begin continuous NaCO3 infusion at 250mL/hr if bolus effective <br />
**Solution preparation = 1L D5W mixed with 3 ampules NaHCO3</div>FuzzyBot