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Anticholinergic Toxidrome and Physostigmine

Diagnosis and treatment of anticholinergic poisoning in the emergency department.

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 Toxidrome and Physostigmine?

Anticholinergic toxidrome is summarised by the mnemonic 'red as a beet, dry as a bone, hot as a hare, mad as a hatter, blind as a bat'; agents include atropine, antihistamines, tricyclic antidepressants and Datura plant.

Symptoms include dry skin and mucous membranes, mydriasis, tachycardia, hyperthermia, urinary retention, ileus, agitation, hallucinations and seizures.

Physostigmine is a centrally acting cholinesterase inhibitor used in selected cases when delirium or seizures are present, ECG is normal, there is no tricyclic ingestion and a poisons centre is consulted.

Symptoms

Hyperthermia
Dry skin
Mydriasis
Tachycardia
Urinary retention
Agitation and hallucination
Seizures

Risk Factors

Older age
Polypharmacy
Tricyclic antidepressant use
Antihistamine use
Datura ingestion
Antipsychotic use
Use of antiparkinsonian agents

When to See a Doctor?

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

  • New confusion and hallucination
  • Severe hyperthermia
  • Persistent palpitations
  • Seizure
  • Loss of consciousness

Treatment Methods

01
Cooling and supportive care
02
Aggressive fluid replacement
03
Benzodiazepines for sedation
04
Activated charcoal in early presentation
05
Carefully titrated physostigmine in selected patients
06
ECG monitoring and intensive care

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.

Learn About Acil Servis Department

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You can make an appointment with our specialists or contact us for your concerns.

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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.