Anticholinergic toxicity

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Background

  • Anticholinergic activity:
    • 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; hallucinations, dysarthria, lethargy
  • Full as a flask: urinary retention
  • Tachycardia (HR 120-160) and decreased/absent bowel sounds

DDX

  1. Sympathomimetic toxicity
    1. Red, dry skin and absent bowel sounds favors anticholinergic toxicity
  2. Encephalitis
  3. Head trauma
  4. ETOH/sedative withdrawal
  5. Neuroleptic Malignant Syndrome (NMS)
  6. Acute psychotic disorder

See Also

Source

Tintinalli

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