Anticholinergic Poisoning, Emergency Medicine

Patrick M. Whiteley Reviewed 06/2017
 


Basics

Description

  • 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...

Diagnosis

Signs and Symptoms

History

  • Onset and duration of symptoms

  • Type and extent of ingestion/exposure

Physical Exam

  • Classic toxidrome:

    • Mad as a hatter”altered mental status

    • Hot as a hare”—hyperthermia

    • ...

Treatment

Pre-Hospital

Transport all pills/pill bottles involved in overdose for identification in ED. 

Initial Stabilization/Therapy

  • Airway, breathing, and circulation (ABCs):

    • Airway control essential

    • Adm...

Follow-Up

Disposition

Admission Criteria

  • ICU admission for moderate to severe anticholinergic symptoms (agitation control, temperature control, and observation for seizures or dysrhythmias)

  • Any patient r...

Pearls and Pitfalls

  • Aggressively treat hyperthermia.

  • Antipyretic medications are not effective in toxic hyperthermia.

  • Use physostigmine cautiously and consult with medical toxicologist when available.

Additional Reading

  • 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.

  • Ceh...

Codes

ICD9

971.1 Poisoning by parasympatholytics (anticholinergics and antimuscarinics) and spasmolytics 

ICD10

T44.3X1A Poisoning by oth parasympath and spasmolytics, acc, init 

SNOMED

  • 216593002 Accidenta...

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