Template:Anticholinergic Toxicity Treatement: Difference between revisions

Revision as of 11:36, 24 February 2019

Treatment

Consider GI decon with Activated Charcoal
Sedation
- Decreases the risk of hyperthermia, rhabdo, traumatic injuries
- Benzos are agents of choice especially increase seizure threshold
Sodium bicarbonate for conduction abnormalities (QRS prolongation)
- 2 mEq/kg bolus (typically 2-3 amps of bicarb)
- Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
- Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
Cholinesterase inhibition
- Indicated for severe agitation or delirium (esp if unresponsive to benzos)
- Contraindicated in QRS>100 or Na blockade signs (R' in aVR)
- Relatively 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)

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