Template:Anticholinergic Toxicity Treatement: Difference between revisions
| Line 16: | Line 16: | ||
#*Contraindicated in QRS>100 or Na blockade signs (R' in aVR) | #*Contraindicated in QRS>100 or Na blockade signs (R' in aVR) | ||
#*Relative contraindicated in asthma or ileus | #*Relative contraindicated in asthma or ileus | ||
#*[[Physostigmine]] | #*[[Physostigmine]] - strongly consider poison control consult before giving | ||
#**Crosses blood brain barrier, can be used to help make dx | #**Crosses blood brain barrier, can be used to help make dx | ||
#**Dosing: 0.5-2mg IV over 5min | #**Dosing: 0.5-2mg IV over 5min | ||
Revision as of 03:08, 9 November 2018
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 especially increase seizure threshold
- 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
- Sodium bicarbonate
- 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