Anticholinergic poisoning

But, still, this was New York. Sin City. Drug Metropolis. A localized problem. Right No. Reports of anticholinergic poisoning are on the increase across the United States and Canada. 

FIGURE 12—28. Icon for the cholinesterase inhibitor physostigmine. This agent is used intravenously as a short-acting cholinesterase inhibitor to reverse anticholinergic poisoning and is in testing in an oral sustained-release formulation for Alzheimer s disease. 

Anticholinergic poisoning involving adulterated cocaine has been reported (387). 

Weiner AL, Bayer MJ, McKay CA Jr, DeMeo M, Starr E. Anticholinergic poisoning with adulterated intranasal cocaine. Am J Emerg Med 1998 16(5) 517-20. 

Rumack, B. H. 1973 Anticholinergic poisoning treatment with physostlgmlne. Pediatrics, 52, 449-451. 

Contact allergy has been reported with mace (8). Nutmeg is sometimes abused for its hallucinogenic potential less than one tablespoon can be enough to produce severe symptoms similar to those seen in anticholinergic poisoning (9,10). It can also cause psychosis, both acute (11,12) and chronic (13). 

Finlay P. Anticholinergic poisoning due to Datura Candida. Trop Doct 1998 28(3) 183-4. 

Chan TY. Anticholinergic poisoning due to Chinese herbal medicines. Vet Hum Toxicol 1995 37(2) 156-7. 

In 23 patients who took an overdose of Sleep-Qik (valerian dry extract 75 mg, mean dose 2.5 g, hyoscine hydrobromide 0.25 mg, and cyproheptadine hydrochloride 2 mg) the main problems were central nervous system depression and anticholinergic poisoning (7). There was no evidence of liver damage, subclinical, acute, or delayed. It is unlikely that valerian contributed to the adverse effects in these cases. 

Animals are at risk for anticholinergic poisoning from atropine. Toxicity is similar to that in humans. Gastrointestinal decontamination and supportive care should be employed. 

The toxicity of antihistamines is related to their anticholinergic (antimuscarinic) activity. The action of acetylcholine at the muscarinic receptors is blocked resulting in signs and symptoms of anticholinergic poisoning. 

Anticholinergic poisoning occurs from belladonna alkaloids in various plants. Toxins may include atropine, hyoscyamine, and scopolamine. 

Once touted as the medication of choice to treat lethal tricyclic antidepressant overdoses, physostigmine (antilirium ) has very limited uses today in overdose management. Physostigmine is a cholinesterase inhibitor and finds its primary application in the treatment of severe anticholinergic poisoning. When indicated, physostigmine is administered preferably in small incremental doses of 2 mg mixed in 10 cc of saline by slow intravenous infusion over 10 min. 

Acute abdomen Anticholinergic poisoning Carbon monoxide poisoning Chemical/drug poisoning [14]... 

Willems. J. L.. and Bcipaire. F. M. (1992). Anticholinergic poisoning An overview of pharmacotherapy In Clinical and Experimental Toxicology of Organophospbates and Carba-nitite.y (B. Bailauiync and T. C. Marrs. Eds.), pp. 536-542. Butlerworth-Hcineiiiann. Oxford. 

Rumack BH. Anticholinergic poisoning Treatment with physostigmine. Pediatrics. 1973 52 449-451. 

A. An overdose results in many symptoms similar to anticholinergic poisoning drowsiness, dilated pupils, flushed dry skin, fever, tachycardia, delirium, hallucinations, and myoclonic or choreoathetoid movements. Convulsions, rhab-domyolysis, and hyperthermia may occur with a serious overdose. 

B. Specific drugs and antidotes. There is no specific antidote for antihistamine overdose. As for anticholinergic poisoning (see p 84), physostigmine has been used for treatment of severe delirium or tachycardia. However, because antihistamine overdoses carry a greater risk for seizures, physostigmine is not routinely recommended. Sodium bicarbonate (see p 419), 1-2 mEq/kg IV, may be useful for myocardial depression and QRS intenral prolongation after a massive diphenhydramine overdose. 

There is no evidence that physostigmine (see p 489) is beneficial for this overdose, although it may reverse signs of anticholinergic poisoning. 

Rhoads, P.M., T.G. Tong, W. Banner, Jr., and R. Anderson. 1984 Anticholinergic poisonings associated with commercial burdock root tea. ). Toxicol. Clin. Toxicol. 22(6) 581-584. 

In overdose, belladonna elicits symptoms typical of anticholinergic poisoning, with symptoms colloquially described as "hot as a hare, dry as a bone, red as a beet, mad as a hatter, blind as a bat" (Lee 2007). The most common poisoning symptoms are redness of the face, dilation of the pupils, increased heart rate, meaningless speech, hallucinations, dry mouth, and agitation (Caksen et al. 2003 Lee 2007). 

Hsu, C.K., P. Leo, D. Shastry, et al. 1995. Anticholinergic poisoning associated with herbal tea. Arch. Int. Med. 155(20) 2245-2248. Kanto, J., R. Virtanen, E. lisalo, K. Maenpaa, and P. Liukko. 1981. Placental transfer and pharmacokinetics of atropine after a single maternal intravenous and intramuscular administration. Acta Anaesthesiol. Scand. 25(2) 85-88. 

A set of anticholinergic poisonings, improperly attributed to lungwort, was reported (Baca-Garcia et al. 2007). Lungwort does not contain compounds that would cause anticholinergic poisoning. 

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