The muscarinic (M) receptors, located in various tissues (the heart, salivary glands, blood vessels, the brain, gastrointestinal tract, etc) are the sites where acetylcholine, the principal neurotransmitter in the peripheral, but also the central nervous system (CNS), exerts its effects [1]. These receptors are also a target of both cholinergic and anticholinergic drugs, and the term anticholinergic toxicity (widely described in the literature as an anticholinergic syndrome) denotes the development of symptoms as a result of profound anticholinergic effects [1] [2] [3] [4]. This clinical entity can be seen after ingestion (either accidental or intentional) of large concentrations of various drugs - atropine and scopolamine (true anticholinergic agents), but also antihistamines (diphenhydramine), tricyclic antidepressants, loperamide, and certain antipsychotics, all possessing anticholinergic effects in addition to their primary roles [3] [4] [5]. Furthermore, ingestion of Atropa belladonna (known as deadly nightshade), a plant that contains an abundant amount of alkaloid compounds that constitute atropine and scopolamine (particularly in the ripe fruit and leaves), is also an important cause of anticholinergic toxicity [6]. In fact, numerous herbal products made from this alkaloid plant exist and have been reported in the literature as agents of anticholinergic toxicity [1] [2]. Regardless of the underlying cause, signs, and symptoms appear due to the same pathophysiological mechanism, and the clinical presentation may encompass numerous systems. Tachycardia, hyperthermia, flushing, urinary retention, reduced gastrointestinal motility, pupillary dilation (mydriasis), reduced light reactivity, dry skin and mouth, as well as reduced salivary gland secretion are notable signs stemming from the inhibition of peripheral muscarinic receptors [1] [4] [5] [6] [7]. On the other hand, psychosis, agitation, confusion, hallucinations, seizures, altered consciousness, and coma in later stages are hallmarks of CNS toxicity [1] [4] [5] [7] [8].

• Fever

  He is disoriented, somnolent, difficult to rouse, and also has a fever. A friend who is with the patient explains that he has a long psychiatric history and has attempted to overdose on prescribed medications in the past. [stepwards.com]

  Findings on examination included fever (101.2 F {38.4 C}), dilated and nonreactive pupils, and dry skin and oral mucous membranes; bowel sounds were absent. [cdc.gov]

  Common manifestations are as follows: Flushing Dry skin and mucous membranes Mydriasis with loss of accommodation Altered mental status (AMS) Fever Additional manifestations include the following: Sinus tachycardia Decreased bowel sounds Functional ileus [emedicine.medscape.com]

  Mild Anticholinergic Toxicity Moderate Anticholinergic Toxicity Severe Anticholinergic Toxicity Tachycardia Flushed face Mydriasis and blurred vision Dry mouth and skin Fever Agitated delirium Urinary retention Hypertension Hyperthermia CNS depression [rch.org.au]

  Physical symptoms that may be experienced include: tachycardia or increased heart rate, drying of skin, development of fever, elevation of blood pressure, dilation of pupils, involuntary jerking of muscles, retention of urine and reduced bowel sounds. [overdoseinfo.com]

• Trisomy 21

  21, spastic paralysis and blond/blue-eyed children). [rch.org.au]

• Decreased Bowel Sounds

  Additional symptoms can include: · “Sinus tachycardia · Decreased bowel sounds · Functional ileus · Urinary retention · Hypertension · Tremulousness · Myoclonic jerking Patients with central anticholinergic syndrome may present with the following: · Ataxia [em.umaryland.edu]

  J Pediatr 1939; 14:755-60) Mouth of marbles voice very characteristic Tachy, decreased bowel sounds, bladder distension, seizures, delirium Belladonna, Jimson Weed, Henbane Muscarinic Blockade Also seen in H1 blockers and TCAs (never give physostigmine [crashingpatient.com]

  Additional manifestations include the following: Sinus tachycardia Decreased bowel sounds Functional ileus Hypertension Tremulousness Myoclonic jerking Patients with central anticholinergic syndrome may present with the following: Ataxia Disorientation [emedicine.medscape.com]

  Peripheral inhibition is variable - but the symptoms may include: hot, dry skin, flushed appearance, mydriasis, tachycardia, decreased bowel sounds and urinary retention. [rch.org.au]

• Absent Bowel Sounds

  Dry mouth, tachycardia, decreased bowel sounds and agitation are all characteristic of both syndromes. [calpoison.org]

  Anticholinergic toxicity can be differentiated from delirium tremens and sympathomimetic toxicity by the presence of dry skin and the absence of bowel sounds. [emjournal.net]

  Mydriasis, dry mucous membranes, absence of axillary sweat, flushed skin, fever, tachycardia, decreased or absent bowel sounds, and urinary retention suggest muscarinic blockade. 18, 23 The patient is often alert but may be nonsensical, agitated, or incoherent [clinicalgate.com]

  Findings on examination included fever (101.2 F {38.4 C}), dilated and nonreactive pupils, and dry skin and oral mucous membranes; bowel sounds were absent. [cdc.gov]

  […] obstruction or perforation Absent bowel sounds Recent bowel surgery Volume depletion Electrolyte imbalance Use only single dose (caution should be used in children younger than one year and in older persons) Adults: 1 to 2 mL per kg sorbitol 70% solution [aafp.org]

• Tachycardia

  Tachycardia, hyperthermia, mydriasis and urinary retention are effects caused by inhibition of peripheral receptors, whereas hallucinations, seizure, and even coma might be encountered when muscarinic receptors in the central nervous system are inhibited [symptoma.com]

  Electrocardiographic abnormalities may include QRS prolongation, abnormal conduction, bundle branch block, AV dissociation, and atrial and ventricular tachycardias. Sinus tachycardia is the most common abnormality. [emjournal.net]

  Antimuscarinic effects occur in a predictable order with salivation, bronchial secretions, and sweating suppressed first, followed by mydriasis and tachycardia. [clinicalgate.com]

  […] hyperpyrexia Red as a beet flushing Dry as a bone decreased salivation, lacrimation Blind as a bat mydriasis and cycloplegia Mad as a hatter confusion, agitation, delirium (don't give elderly anticholinergics) Bloated as a toad constipation, urinary retention Tachycardia [memorize.com]

  Toxicity from several different classes of drugs may cause an altered level of consciousness, tachycardia, and hyperthermia. [mdedge.com]

• Hypertension

  (p. 293) Miscellaneous syndromes: anticholinergic toxicity, clozapine toxicity, and hypertensive crisis with MAOIs Chapter 16 deals with three syndromes that are the result of medications that have pharmacological properties which extend beyond their [oxfordmedicine.com]

  Hypertension usually does not require treatment, but conventional therapy should be used if necessary. The treatment of arrhythmias depends on the type and on the causative agent. [emjournal.net]

  Additional symptoms can include: · “Sinus tachycardia · Decreased bowel sounds · Functional ileus · Urinary retention · Hypertension · Tremulousness · Myoclonic jerking Patients with central anticholinergic syndrome may present with the following: · Ataxia [em.umaryland.edu]

  – severe agitation, seizures, persistent hypertension, and hemodynamic compromise secondary to tachycardia), 3 newer data report its relative safety and efficacy in reversing the anticholinergic toxidrome; specifically anticholinergic delirium. 4,5 [emdocs.net]

  Amitriptyline Cyclobenzaprine Chemical structure Toxicity: TCA effect Wide complex tachycardia (Na channel blockade) Hypotension (alpha blockade) Seizures (GABA antagonism) Yes No Toxicity: Anticholinergic effect Sedation Tachycardia Hypertension Urinary [aliem.com]

• Orthostatic Hypotension

  hypotension - this may be reversed by phenylephrine or methoxamine. lacks atropine's CNS effects & rel.lack of inhib. of ciliary beating; more potent bronchodilatory, dry mouth & tachycardic effects; M3 receptor half life 3hrs ⇒ duration action 4-6hrs [ozemedicine.com]

  Additionally, anticholinergic toxicity can cause orthostatic hypotension (especially in the elderly), picking behavior, and can lead to seizures, coma, and even death. [foamcast.org]

  hypotension (severe drop in systolic blood pressure when standing up suddenly) and significantly increased risk of falls in the elderly population. [14] Older patients are at a higher risk of experiencing CNS sideffects due to lower acetylcholine production [en.wikipedia.org]

• Blurred Vision

  She reported more typical anticholinergic features of blurred vision, dry mouth, lethargy and light-headedness. [mja.com.au]

  Many drugs, mushrooms and plants contain anticholinergic substances and these can produce side effects such as constipation, hot skin, blurred vision, a dry mouth and confusion. [wisegeek.com]

  An overdose of Benadryl may result in extreme drowsiness, blurred vision, increased heart rate, confusion, seizures – even coma. Other symptoms may include dry mouth, nausea, vomiting, unsteadiness, high blood pressure, and hallucinations. [missouripoisoncenter.org]

  Blurred vision and photophobia may be due to mydraisis and paralysis of accomodation. Seizures, paralysis, respiratory depression, and coma may ensue in severe cases. [calpoison.org]

• Photophobia

  She complained of blurry vision, headache, photophobia and nausea. No specific treatment was needed, and the symptoms resolved about 12 h after the exposure. Lupine beans are a popular and worldwide-diffused food. [ncbi.nlm.nih.gov]

  Blurred vision and photophobia may be due to mydraisis and paralysis of accomodation. Seizures, paralysis, respiratory depression, and coma may ensue in severe cases. [calpoison.org]

  […] esophagitis Ulcerative colitis Paralytic ileus Obstructive disease of the gastrointestinal tract (e.g., achalasia, pyloric stenosis or duodenal stenosis ) Obstructive uropathy (e.g., benign prostatic hyperplasia, urinary retention ) Eye Mydriasis and photophobia [amboss.com]

  Symptoms The patient may complain of photophobia and/or blurred vision, but it is not unusual for a patient to be asymptomatic. [eyewiki.aao.org]

  Dry-mouth with possible acceleration of dental caries Cessation of sweating ; consequent decreased epidermal thermal dissipation leading to warm, blotchy, or red skin Increased body temperature Pupil dilation ; consequent sensitivity to bright light ( photophobia [en.wikipedia.org]

• Dry Eyes

  Hot as a hare : increased body temperature Blind as a bat : mydriasis (dilated pupils) Dry as a bone : dry mouth, dry eyes, decreased sweat Red as a beet : flushed face Mad as a hatter : delirium Common anticholinergic medications are dimenhydrinate [sketchymedicine.com]

  BLADDER AND KIDNEYS Inability to urinate EYES, EARS, NOSE, MOUTH, AND THROAT Blurred vision Dry mouth Enlarged pupils Very dry eyes Ringing in the ears HEART AND BLOOD VESSELS Low blood pressure Rapid heartbeat NERVOUS SYSTEM Agitation Confusion Seizures [medlineplus.gov]

  The features of toxicity at peripheral and central receptors can be remembered using the following mnemonic "Hot as a hare": Fever "Red as a beet:" Flushed skin "Blind as a bat": Mydriasis "Dry as a bone": Dry mouth, dry eyes and decreased sweating "Mad [rch.org.au]

• Diplopia

  […] decreased bowel sounds and ileus), “mad as a hatter” (agitation, confusion, hallucinations, coma, seizures, and rarely death), and “blind as a bat” ----->>>> DILATED PUPILS (MYDRIASIS...stems from impaired papillary constriction and accommodation causing diplopia [emergencymedpearls.blogspot.com]

• Flushing

  […] versions of Sx of Atropine Toxicity (Anticholinergic Toxicity) : main | yours | all nehavi 's version from 2014-04-23 19:06 Section Question Answer Hot as a hare decreased sweating = hyperpyrexia Red as a beet flushing Dry as a bone decreased salivation [memorize.com]

  His face is flushed. Mucous membranes and skin are dry. Which of the following toxidromes is this patient exhibiting? A. Anticholinergic B. Cholinergic C. Sedative-hypnotic D. Sympathomimetic Answer A. [foamcast.org]

  Anticholinergic syndrome (overdose) Etiology Clinical features Dry mouth, warm, flushed skin, thirst, tachycardia, arrhythmias, mydriasis, confusion, and agitation Possibly anticholinergic delirium : Excessive use of tricyclic antidepressants (or other [amboss.com]

• Decreased Sweating

  […] versions of Sx of Atropine Toxicity (Anticholinergic Toxicity) : main | yours | all nehavi 's version from 2014-04-23 19:06 Section Question Answer Hot as a hare decreased sweating = hyperpyrexia Red as a beet flushing Dry as a bone decreased salivation [memorize.com]

  Hot as a hare : increased body temperature Blind as a bat : mydriasis (dilated pupils) Dry as a bone : dry mouth, dry eyes, decreased sweat Red as a beet : flushed face Mad as a hatter : delirium Common anticholinergic medications are dimenhydrinate [sketchymedicine.com]

  Side effects can include: dry mouth blurry vision constipation drowsiness sedation hallucinations memory problems trouble urinating confusion delirium decreased sweating decreased saliva Dementia warning Long-term use of anticholinergics, as well as use [healthline.com]

  Side Effects of anticholinergics Body System Side/Adverse Effects Genitourinary Urinary retention Glandular Decreased sweating Respiratory Decreased bronchial secretions 19. [slideshare.net]

  The peripheral effects include arrhythmias, tachycardia, decreased bronchial secretions, dysphagia, decreased gastrointestinal motility, hyperthermia, hypo- or hypertension, decreased salivation, decreased sweating, urinary retention, and vasodilation [emjournal.net]

• Hot, Dry Skin

  Peripheral inhibition is variable - but the symptoms may include: hot, dry skin, flushed appearance, mydriasis, tachycardia, decreased bowel sounds and urinary retention. [rch.org.au]

• Dermatitis

  ) blood disorders ( D56 - D76 ) contact dermatitis ( L23 - L25 ) dermatitis due to substances taken internally ( L27.- ) nephropathy ( N14.0- N14.2 ) Includes adverse effect of correct substance properly administered poisoning by overdose of substance [icd10data.com]

• Visual Hallucination

  Some cases have been reported of agitation, visual hallucinations and other forms of anticholinergic toxicity after application of cyclopentolate eye drops 3, 8. [ispub.com]

  This may include: Restlessness / fidgeting /violent behaviour Visual hallucinations Picking at imaginary objects in the air or on the bedsheets Mumbling / slurred speech Fluctuating mental status Other central signs include tremor, coma, increased tone [rch.org.au]

  He presents with agitation, incoherent speech, visual hallucinations, and seizure-like activity lasting less than one minute. [emresident.org]

  Visual hallucinations are common. Central motor effects may be manifested as myoclonus or choreoathetoid movements. [clinicalgate.com]

• Urinary Retention

  Tachycardia, hyperthermia, mydriasis and urinary retention are effects caused by inhibition of peripheral receptors, whereas hallucinations, seizure, and even coma might be encountered when muscarinic receptors in the central nervous system are inhibited [symptoma.com]

  The quick mnemonic for anticholinergic poisoning is: · Hot as a hare (hyperthermia) · Red as a beet (flushed) · Cry as a bone (decreased secretions) · Blind as a bat (mydriasis) · Mad as a hatter (delirium) · Full as a flask (urinary retention) Bottom [em.umaryland.edu]

  retention Tachycardia b/c of loss of PNS vagal input to heart reversal of atropine toxicity physostigmine plant alkaloids from this plant causes similar sx (gardeners pupil) Jimson weed (Datura) memorize Pages linking here (main versions and versions [memorize.com]

  Urinary retention may contribute to the agitation. Bladder scan will reveal the need for a urinary catheter. The use of decontamination / enhanced elimination depend on the actual medication exposure, and should be discussed with a toxicologist. [rch.org.au]

  retention and paralytic ileus ), and the heart runs alone ( tachycardia ).” [amboss.com]

• Seizure

  Manage seizures with benzodiazepines, preferably diazepam or lorazepam. Use phenobarbital and other barbiturates for intractable seizures. Phenytoin has no proven role for toxin-induced seizures and should not be used. [emedicine.medscape.com]

  An excessive anticholinergic dose could lead to anticholinergic toxicity, or poisoning, with symptoms such as a rapid heart beat, hallucinations, seizures, coma and even death. [wisegeek.com]

  On the other hand, psychosis, agitation, confusion, hallucinations, seizures, altered consciousness, and coma in later stages are hallmarks of CNS toxicity. [symptoma.com]

  Physostigmine may aggravate arrhythmias and seizures and must be used with extreme caution. [emjournal.net]

• Agitation

  Physostigmine can reverse the central effects of coma, seizures, severe dyskinesias, hallucinations, agitation, and respiratory depression. The most common indication for physostigmine is to control agitated delirium. [emedicine.medscape.com]

  He became extremely agitated and was treated with intravenous benzodiazepines (total quantity in 26 hours equivalent to 125 mg diazepam) but remained agitated. [emj.bmj.com]

  The patient appears confused and agitated. He is not following commands. He is tachycardic, warm, agitated, with large pupils. The patient was staring around the room telling you he is seeing "little people." [emergencymedpearls.blogspot.com]

  Some cases have been reported of agitation, visual hallucinations and other forms of anticholinergic toxicity after application of cyclopentolate eye drops 3, 8. [ispub.com]

• Confusion

  It may also be overlooked in elderly patients who are prone to demonstrate confusion and problems with memory. [ncbi.nlm.nih.gov]

  […] yours | all nehavi 's version from 2014-04-23 19:06 Section Question Answer Hot as a hare decreased sweating = hyperpyrexia Red as a beet flushing Dry as a bone decreased salivation, lacrimation Blind as a bat mydriasis and cycloplegia Mad as a hatter confusion [memorize.com]

  Confusion : It is common for an individual experiencing anticholinergic toxicity to appear confused. They may lack momentary awareness, appear as if they don’t know how to interact with others, and they appear confused. [mentalhealthdaily.com]

  Anticholinergics are known to cause confusion, memory loss, and worsening mental function in people who are older than 65 years. In fact, recent studies have linked use of anticholinergics with increased risk of dementia. [healthline.com]

• Mydriasis

  Tachycardia, hyperthermia, mydriasis and urinary retention are effects caused by inhibition of peripheral receptors, whereas hallucinations, seizure, and even coma might be encountered when muscarinic receptors in the central nervous system are inhibited [symptoma.com]

  mydriasis (without impairing the light/near reaction). [eyewiki.aao.org]

  The most persistent symptom of Jimsonweed toxicity is blurred vision, as mydriasis can persist for up to 1 week. Mydriasis can also occur from isolated local contact of Jimsonweed with the eye (cornpicker's pupil). [emjournal.net]

  Anticholinergic syndrome (overdose) Etiology Clinical features Dry mouth, warm, flushed skin, thirst, tachycardia, arrhythmias, mydriasis, confusion, and agitation Possibly anticholinergic delirium : Excessive use of tricyclic antidepressants (or other [amboss.com]

  Toxicity (Anticholinergic Toxicity) : main | yours | all nehavi 's version from 2014-04-23 19:06 Section Question Answer Hot as a hare decreased sweating = hyperpyrexia Red as a beet flushing Dry as a bone decreased salivation, lacrimation Blind as a bat mydriasis [memorize.com]

• Agitated Delirium

  […] nehavi 's version from 2014-04-23 19:06 Section Question Answer Hot as a hare decreased sweating = hyperpyrexia Red as a beet flushing Dry as a bone decreased salivation, lacrimation Blind as a bat mydriasis and cycloplegia Mad as a hatter confusion, agitation [memorize.com]

  Physostigmine can reverse the central effects of coma, seizures, severe dyskinesias, hallucinations, agitation, and respiratory depression. The most common indication for physostigmine is to control agitated delirium. [emedicine.medscape.com]

  The characteristic feature of toxicity at central receptors is agitated delirium. [rch.org.au]

  delirium · Seizures (rare) · Coma · Respiratory failure · Cardiovascular collapse” 1 References [em.umaryland.edu]

  delirium, hallucinations, abnormal picking movements, rarely seizures). [mdedge.com]

Clinical criteria supported by findings obtained during history taking are essential in making the diagnosis of anticholinergic toxicity. Physicians must obtain a complete personal history that will determine if the patient is taking (or has intentionally taken) drugs or herbal products containing Atropa belladonna that possess anticholinergic effects, as both intentional and accidental cases are described in the literature [2] [4] [5] [7] [8]. It is not uncommon for patients to be in a state that is not suitable for communication (altered consciousness, psychosis, etc.), thus a heterogeneous anamnesis (from parents, friends or relatives) might be highly useful for obtaining additional information [7]. A thorough physical examination of all systems should follow, which will confirm the presence of anticholinergic signs and thus lead the physician to raise valid clinical suspicion. Laboratory investigations are of limited use in anticholinergic toxicity, as reports show no significant abnormalities except sporadic leukocytosis and hyperglycemia [7] [8]. Some authors, however, further solidify the diagnosis by performing qualitative and quantitative screening for detecting drugs in urine through procedures such as mass spectrometry (MS) [4] [8].

(s) they received, and classifying the treatments as physostigmine, benzodiazepines, physostigmine and benzodiazepines, antipsychotics, or no definitive treatment. [ncbi.nlm.nih.gov]

TREATMENT Conservative, supportive therapy is the mainstay of treatment of anticholinergic toxicity. Evaluation of the airway, breathing, and circulation is a priority. [emjournal.net]

Updated evidence-based prescribing information reflects the latest national clinical practice guidelines and evidence-based treatment guidelines, including the latest clinical treatment guidelines for diabetes. NEW! [books.google.com]

Prognosis Prognosis is excellent for pharmacologic dilation of the pupil, and the condition should completely resolve with removal of the precipitating agent. Resolution of dilation depends on the different agents' half life. [eyewiki.aao.org]

Anticholinergic syndrome (overdose) Etiology Clinical features Dry mouth, warm, flushed skin, thirst, tachycardia, arrhythmias, mydriasis, confusion, and agitation Possibly anticholinergic delirium : Excessive use of tricyclic antidepressants (or other [amboss.com]

[…] insufficiently explained by the ingested agent or who are unresponsive to appropriate intervention ECG - for all patients with suspected toxic ingestions Lumbar puncture - for patients with fever and AMS in whom CNS infection is suspected as a possible etiology [emedicine.medscape.com]

Montcriol A, Kenane N, Delort G, et al. [ Intentional Datura stramonium intoxication: an unknown etiology of mydriasis ] Ann Fr Anesth Reanim. 26(9):810-813. 3. Datura spp. (Jimsonweed, Downy Thornapple, Devil's Trumpet, and Angel's Trumpet). [emresident.org]

Etiology Agents that affect the central nervous system such as atropine, scopolamine, amphetamine, marijuana, lysergic acid diethylaminde (LSD), and glutethimide can cause bilateral mydriasis. [eyewiki.aao.org]

Pulse oximetry should be initiated in patients with respiratory distress or cyanosis; cardiac monitoring is indicated for patients with hemodynamic instability. 5 In patients with altered mental status of unknown etiology, consider giving naloxone (formerly [aafp.org]

Epidemiology United States Anticholinergic syndrome may be caused by intentional overdose, inadvertent ingestion, medical noncompliance, or geriatric polypharmacy. Systemic effects also have resulted from topical eye drops. [emedicine.medscape.com]

Epidemiology and Social History - The plant has been described throughout history as a toxin famous for its mind altering properties. There are references to it in Homer's Odyssey and Shakespeare plays. [aacc.org]

Epidemiology The 2004 annual report of the American Association of Poison Control Centers listed 1058 cases of exposure to anticholinergic plants, 456 of these being intentional. [calpoison.org]

Regardless of the underlying cause, signs, and symptoms appear due to the same pathophysiological mechanism, and the clinical presentation may encompass numerous systems. [symptoma.com]

Pathophysiology Substances with anticholinergic properties competitively antagonize acetylcholine muscarinic receptors; this predominantly occurs at peripheral (eg, heart, salivary glands, sweat glands, GI tract, GU tract) postganglionic parasympathetic [emedicine.medscape.com]

ANTICHOLINERGIC TOXICITY Background/Pathophysiology Acetylcholine is a neurotransmitter that binds to receptors in the peripheral nervous system and central nervous system The central anticholinergic syndrome refers to the clinical presentation when the [emergencymedpearls.blogspot.com]

Pathophysiology Anticholinergic mydriasis occurs via blockade of parasympathetic muscarinic acetylcholine receptors on the iris sphincter muscle. [eyewiki.aao.org]

Pathophysiology Tropane alkaloids competitively inhibit postsynaptic muscarinic acetylcholine receptors producing the classic anticholinergic syndrome. [calpoison.org]

If drugs, mushrooms or plants have recently been eaten, the stomach can be washed out to prevent any more of the contents from being absorbed. [wisegeek.com]

How to prevent Anticholinergic Toxicity? The best way to prevent the occurrence of anticholinergic toxicity is to take the medications based on the orders of the physician. [overdoseinfo.com]

A convenient layout of short chapters in a narrative outline format promotes quick referencing.Case reports present real-life examples of each complication.Safety standards, ASA guidelines, and other preventive measures are discussed in every chapter [books.google.com]

[…] as a beet, mad as a hatter” Alkaloid antimuscarinics: belladoona (Atrop spp) Scopolamine (l-hyoscine): henbane (Hyoscyamus spp) Used IM (0.008mg/kg) with narcotic → decr. secretions; may → tranquillisation & amnesia but hyperexcit. if pain; Used to prevent [ozemedicine.com]

[…] myclonus hyperthermia urinary retention bowel sounds seizures dysrhythmias INVESTIGATIONS ECG: tachyarrhythmia SPECIFIC MANAGEMENT AND TRIGGERS FOR INTERVENTION activate charcoal: recommended whole bower irrigation: recommended where dose large IV fluid: prevention [lifeinthefastlane.com]

1. Corallo CE, Whitfield A, Wu A. Anticholinergic syndrome following an unintentional overdose of scopolamine. Ther Clin Risk Manag. 2009;5:719-723.
2. Centers for Disease Control and Prevention (CDC). Anticholinergic poisoning associated with an herbal tea--New York City, 1994.
3. Walker A, Delle Donne A, Douglas E, Spicer K, Pluim T. Novel Use of Dexmedetomidine for the Treatment of Anticholinergic Toxidrome. J Med Toxicol. 2014;10(4):406-410.
4. Verheijden NA, Koch BC, Brkic Z, Alsma J, Klein Nagelvoort-Schuit SC. A 45-year-old woman with an anticholinergic toxidrome. Neth J Med. 2016;74(3):133-135.
5. Lee AC, So KT. Acute anticholinergic poisoning in children. Hong Kong Med J. 2005;11(6):520-523.
6. Joshi P, Wicks A, Munshi S. Recurrent autumnal psychosis. Postgrad Med J. 2003;79(930):239-240.
7. Demirhan A, Tekelioğlu ÜY, Yıldız İ, et al. Anticholinergic Toxic Syndrome Caused by Atropa Belladonna Fruit (Deadly Nightshade): A Case Report. Turk J Anaesthesiol Reanim. 2013;41(6):226-228.
8. Heindl S, Binder C, Desel H, Matthies U, Lojewski I, Bandelow B, et al. [Etiology of initially unexplained confusion of excitability in deadly nightshade poisoning with suicidal intent. Symptoms, differential diagnosis, toxicology and physostigmine therapy of anticholinergic syndrome]. Dtsch Med Wochenschr. 2000;125:1361–1365.