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Anticholinergic Syndrome

Anticholinergic syndrome is recognized by its classic 'hot, dry, red, blind, and mad' picture.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Anticholinergic Syndrome?

Anticholinergic syndrome arises from blockade of muscarinic receptors by antihistamines (diphenhydramine), tricyclic antidepressants, belladonna alkaloids (atropine, scopolamine), certain plants (jimson weed), and some antiparkinson drugs.

Central features include delirium, agitation, hallucinations, and seizures, while peripheral features include tachycardia, hyperthermia, mydriasis, dry mouth, urinary retention, and decreased bowel sounds. The classic mnemonic is 'mad as a hatter, hot as a hare, dry as a bone, red as a beet, blind as a bat.'

Treatment is supportive; physostigmine can reverse central anticholinergic features but is contraindicated in tricyclic poisoning. Benzodiazepines should be preferred for agitation.

Symptoms

Dry skin and dry mouth
Hyperthermia and flushed face
Dilated pupils (mydriasis)
Tachycardia and hypertension
Urinary retention and decreased bowel sounds
Agitation, delirium, and visual hallucinations

Risk Factors

Polypharmacy in older adults
High-dose antihistamines and sleep aids
Plant ingestion (angel's trumpet, jimson weed)
Intentional ingestion in psychiatric illness
Household accidents in children
Oral ingestion of eye drops

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Go to the emergency department immediately for delirium, hyperthermia, or urinary retention
  • Even low doses can cause the syndrome in older adults
  • ECG QRS assessment is important
  • Poison center consultation is recommended

Treatment Methods

01
Airway, breathing, and circulation support
02
Agitation control with benzodiazepines
03
Active cooling for hyperthermia
04
Bladder catheterization
05
Physostigmine in selected cases (without TCA suspicion)
06
Continuous cardiac monitoring

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.