Central and peripheral cholinergic blockade
Depending on the drug involved, antagonism occurs at muscarinic (most common), nicotinic, or both receptors.
Onset of activity: 15–30 min af...
Onset and duration of symptoms
Type and extent of ingestion/exposure
“Mad as a hatter”—altered mental status
“Hot as a hare”—hyperthermia
Airway, breathing, and circulation (ABCs):
Airway control essential
ICU admission for moderate to severe anticholinergic symptoms (agitation control, temperature control, and observation for seizures or dysrhythmias)
Any patient r...
Aggressively treat hyperthermia.
Antipyretic medications are not effective in toxic hyperthermia.
Use physostigmine cautiously and consult with medical toxicologist when available.
Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000;35:374–381.
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