Template:Anticholinergic Toxicity Treatement

Treatment

• Consider GI decon with Activated Charcoal if patient presents <2 hours after ingestion and remains cooperative
• Sedation
  • Decreases the risk of hyperthermia, rhabdo, traumatic injuries
  • Benzos are agents of choice especially increase seizure threshold
  • Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation
• 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
  • Goal: QRS duration < 110 msec
• Cholinesterase inhibition
  • Indicated for severe agitation or delirium (esp if unresponsive to benzos)
  • Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma
  • 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: 1-2mg IV over 5min
    • Onset of action: 5-10min
    • If partial response, repeat x3
    • If 3 or more administrations are needed over a 6-hour period, start IV infusion (bolus 1-2 mg followed by 1 mg/hour)
    • Stop infusion every 12 hours to determine resolution of the toxidrome
    • 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) and in the presence of bradycardia or AV block