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Anticholinergic Toxicity

Anticholinergic toxicity, also known as the anticholinergic syndrome, can occur after introduction of various herbal substances and certain pharmacological drugs that possess anticholinergic effects in abnormally high concentrations. 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. The diagnosis rests on clinical criteria and findings obtained during history taking.


Presentation

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]
  • 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]
  • 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]
  • If you develop a fever, especially with some of these other symptoms, it may be a sign to seek immediate medical attention.[mentalhealthdaily.com]
  • The mnemonic refers to the symptoms of flushing, dry skin and mucous membranes, mydriasis with loss of accommodation, altered mental status (AMS), fever, and urinary retention, respectively.[emedicine.medscape.com]
Medication Noncompliance
  • 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]
Decreased Bowel Sounds
  • 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]
  • 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]
  • 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]
  • 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
  • bowel sounds, tachycardia, flushed skin, disorientation, urinary retention, hyperthermia, dry skin and mucous membranes, and auditory and visual hallucinations.[emjournal.net]
  • Anticholinergic findings suggestive of poisoning include hyperthermia, dry mouth, tachycardia, blurred vision, flushed dry skin, absent bowel sounds, urinary retention, agitation, hallucinations, lethargy, mumbling speech, undressing behavior (generally[calpoison.org]
  • 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[clinicalgate.com]
  • Findings on examination included increased pulse (120 beats per minute), oral temperature of 98.2 F (36.8 C), dilated pupils, dry skin, and absent bowel sounds. Anticholinergic syndrome was diagnosed, and the NYCPC was notified.[cdc.gov]
  • 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; or 250 mL magnesium citrate[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]
  • […] 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]
  • The patient was unconscious on admission to hospital, with mydriasis, hyperthermia, tachycardia, hypotension and respiratory failure after using cannabis all day and a portion of ‘magic mushrooms’ in addition to his regular medication which included GABAergic[nvic.nl]
  • Evaluation: Focused H&P: 1 Perform a medication reconciliation VS: obtain rectal temperature, look for tachycardia Neurologic examination: possible altered mental status, mydriasis, visual deficits Additional exam findings: patient commonly flushed with[emdocs.net]
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]
  • Symptoms classified into systemic and CNS manifestations: Systemic (peripheral) symptoms: blurred vision, photophobia, nonreactive mydriasis, loss of accommodation response, flushed and dry skin, dry mouth, tachycardia, hypertension and fever.[fpnotebook.com]
  • . – 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]
  • 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]
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]
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, lacrimation[memorize.com]
  • 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[symptoma.com]
  • Flushing of skin : In addition to developing extremely dry skin, from the perspective of others, the skin may appear to be completely flushed. This means that a person’s skin will become abnormally red in certain areas.[mentalhealthdaily.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, lacrimation[memorize.com]
  • 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 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]
  • Decreased sweating can put you at risk of heat stroke . Overdose and alcohol Using too much of an anticholinergic drug can result in unconsciousness or even death. These effects can also happen if you take anticholinergics with alcohol.[healthline.com]
  • Side Effects of anticholinergics Body System Side/Adverse Effects Genitourinary Urinary retention Glandular Decreased sweating Respiratory Decreased bronchial secretions 19.[slideshare.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]
Blurred Vision
  • 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]
  • 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]
  • Symptoms classified into systemic and CNS manifestations: Systemic (peripheral) symptoms: blurred vision, photophobia, nonreactive mydriasis, loss of accommodation response, flushed and dry skin, dry mouth, tachycardia, hypertension and fever.[fpnotebook.com]
  • She reported more typical anticholinergic features of blurred vision, dry mouth, lethargy and light-headedness.[mja.com.au]
  • 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]
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]
  • Symptoms classified into systemic and CNS manifestations: Systemic (peripheral) symptoms: blurred vision, photophobia, nonreactive mydriasis, loss of accommodation response, flushed and dry skin, dry mouth, tachycardia, hypertension and fever.[fpnotebook.com]
  • 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]
  • ., benign prostatic hyperplasia , urinary retention ) Eye Mydriasis and photophobia Blurred vision Narrow-angle glaucoma CNS Excitement, agitation, and hallucinations with the use of lipophilic parasympatholytics (e.g., atropine ), especially in elderly[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 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]
Visual Hallucination
  • Central Anticholinergic Syndrome is an acute psychosis-like picture characterized by delirium, agitation, disorientation, and visual hallucinations. Ataxia, choreoathetosis, myoclonus and seizures may also occur without peripheral symptoms.[fpnotebook.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]
  • 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]
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]
  • 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 : In addition to constipation, many people find that they are unable to completely empty their bladder. This excess urinary retention is considered “acute” but can be highly uncomfortable for the individual.[mentalhealthdaily.com]
  • 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]
  • Treatment: 1 Delirium/Agitation: benzodiazepines Avoid haldoperidol – may worsen symptoms Urinary retention: foley placement Hyperthermia: active cooling with misting/fanning, cooled IV fluids; benzodiazepines for shivering Hypotension: IVF; if intractable[emdocs.net]
Seizure
  • On the other hand, psychosis, agitation, confusion, hallucinations, seizures, altered consciousness, and coma in later stages are hallmarks of CNS toxicity.[symptoma.com]
  • 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]
  • 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]
  • Of note, physostigmine (30 patients) was much better in improving agitation and reversing delirium (96% and 87%) compared with benzodiazepines (22 patients) (24% and no effect on delirum).[osuemed.wordpress.com]
  • […] 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]
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]
  • 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]
  • 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]
  • The patient was unconscious on admission to hospital, with mydriasis, hyperthermia, tachycardia, hypotension and respiratory failure after using cannabis all day and a portion of ‘magic mushrooms’ in addition to his regular medication which included GABAergic[nvic.nl]
  • , Giovanni ; Fantauzza, Bruno ; Noto, Paola CASE REPORTS Abstract Author Information Authors We describe a case of acute poisoning in a 51-year-old female patient who presented to the Emergency Department with weakness, anxiety, dry mouth, bilateral mydriasis[journals.lww.com]
Confusion
  • It may also be overlooked in elderly patients who are prone to demonstrate confusion and problems with memory.[ncbi.nlm.nih.gov]
  • […] 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 and cycloplegia Mad as a hatter confusion[memorize.com]
  • On the other hand, psychosis, agitation, confusion, hallucinations, seizures, altered consciousness, and coma in later stages are hallmarks of CNS toxicity.[symptoma.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]
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]
  • Although its use is controversial, physostigmine is safe and effective for controlling agitated delirium if the ECG indicates the absence of prolonged PR and QRS intervals.[emedicine.medscape.com]
  • delirium Seizures (rare) Coma Respiratory failure Cardiovascular collapse Causes In addition to anticholinergics, drug classes that have anticholinergic properties include antihistamines, antipsychotics, antispasmodics, cyclic antidepressants, and mydriatics[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]

Workup

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].

Treatment

  • (s) they received, and classifying the treatments as physostigmine, benzodiazepines, physostigmine and benzodiazepines, antipsychotics, or no definitive treatment.[ncbi.nlm.nih.gov]
  • Patients who present with acute neuropsychiatric syndromes pose difficult diagnostic and treatment challenges.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • TREATMENT Conservative, supportive therapy is the mainstay of treatment of anticholinergic toxicity. Evaluation of the airway, breathing, and circulation is a priority.[emjournal.net]

Prognosis

  • 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]

Etiology

  • […] 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]
  • 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[amboss.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]
  • Poisoning with which of the following is the most likely etiology? Review Topic QID: 105613 3 Tricyclic antidepressants M2 Select Answer to see Preferred Response PREFERRED RESPONSE 4 ARTICLES (28) Topic COMMENTS ( 33 ) Please login to add comment.[medbullets.com]

Epidemiology

  • 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]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • Muscarinic receptor signaling in the pathophysiology of asthma and COPD. Respiration Research, 7 , 73. CrossRef Google Scholar Hardman, J. G., Limbird, L. E., Molinoff, P. B., Ruddon, R. W., & Goodman Gilman, A. (1998).[link.springer.com]
  • Pathophysiology Anticholinergic mydriasis occurs via blockade of parasympathetic muscarinic acetylcholine receptors on the iris sphincter muscle.[eyewiki.aao.org]
  • 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]

Prevention

  • 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]
  • These patients should be intubated with a cuffed endotracheal tube to prevent aspiration prior to administration of activated charcoal via orogastric tube. Gastric lavage is typically not indicated following anticholinergic medication overdose.[emedicine.medscape.com]
  • […] red 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]
  • Steps should be made to prevent repeat exposure to the precipitating agent.[eyewiki.aao.org]

References

Article

  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.

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Last updated: 2018-06-21 22:12