Anticholinergic toxicity: Difference between revisions
No edit summary |
No edit summary |
||
Line 42: | Line 42: | ||
###Side effects: bradycardia, dysrhythmias, cholinergic excess | ###Side effects: bradycardia, dysrhythmias, cholinergic excess | ||
==Disposition== | |||
*Consider d/c for pts w/ mild symptoms after 6hr obs if their symptoms resolve | |||
*Admit if physostigmine was given (half-life of physo is often shorter than the ingested drug) | |||
==See Also== | ==See Also== |
Revision as of 20:14, 30 January 2012
Background
- 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; attention deficit; hallucinations; dysarthria; lethargy
- Full as a flask: urinary retention
- Tachycardia (HR 120-160) and decreased/absent bowel sounds
DDX
- Sympathomimetic toxicity
- Red, dry skin and absent bowel sounds favors anticholinergic toxicity
- Encephalitis
- Head trauma
- ETOH/sedative withdrawal
- Neuroleptic Malignant Syndrome (NMS)
- Acute psychotic disorder
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
- Cholinesterase inhibition
- Indicated for severe agitation or delirium (esp if unresponsive to benzos)
- Avoid when cardiac conduction abnormalities are present
- Physostigmine
- Dosing: 0.5-2mg IV over 5min
- Onset of action: 15-20min
- Side effects: bradycardia, dysrhythmias, cholinergic excess
Disposition
- Consider d/c for pts w/ mild symptoms after 6hr obs if their symptoms resolve
- Admit if physostigmine was given (half-life of physo is often shorter than the ingested drug)
See Also
Source
Tintinalli