Anticholinergic toxicity

VangalaV, Tueth M. Chronic anticholinergic toxicity identification and management in older patients. Geriatrics 2003 58 36-37. 

Rumack BH, Anderson RJ, Wolfe R, Fletcher EC, Vestal BK. Ornade and anticholinergic toxicity. Hypertension, hallucinations, arrhythmias. Clin Toxicol 1974 7(6) 573-81. 

Anticholinergic agents are typically used as treatment for anticholinesterase poisoning and vice versa. Riysostlgmlne, tetrahydroamlnoacrldlne, and other cholinesterase Inhibitors were used successfully as antidotes In several dozen subjects. The demonstration of physosclgmlne s effectiveness led to the first controlled study of Its ability to reverse delirium due to scopolamine (31). Riysosclgmlne has been used to overcome anticholinergic toxicity. 

Anticholinergic Belladonna Atropa belladonna 0.3%-0.6% hyoscyamine in leaves and root Anticholinergic toxicity Toxic effects with 5mg-50mg... 

Bittersweet nightshade Solanum dulcamara Solasonine in stem and unripe berries Anticholinergic toxicity Toxic effects with >10 berries fatal adult dose 200 berries... 

Black nightshade Solanum nigrum 2% solasonine in stem, root, unripe berries Anticholinergic toxicity Less toxic than belladonna... 

Henbane Hyoscyamus niger 0.04%-0.28% hyoscyamine in leaves Anticholinergic toxicity More sedating than belladonna... 

Jimsonweed Daturia stramonium 0.1%-0.6% hyoscyamine in ripe seeds, leaves, flowers Anticholinergic toxicity Seeds may be chewed or leaves smoked as cigarettes... 

Jimsonweed Daturia stramonium Anticholinergic toxicity, hallucinations... 

Acute anticholinergic toxicity with fever, hallucinations, and tachycardia occurred in a 2.5-year-old boy from apphcations of calamine + diphenhydramine lotion (10). 

Tsiodras S, Shin RK, Christian M, Shaw LM, Sass DA. Anticholinergic toxicity associated with lupine seeds as a home remedy for diabetes meUitus. Ann Emerg Med 1999 33(6) 715-17. 

Anticholinergic toxicity can result from the alkaloids that... 

Acute overdosage with antimuscarinics produces both peripheral and CNS symptomatology. The quaternary ammonium compounds do not readily penetrate the CNS and thus exhibit minimal central effects even at toxic doses. Patients with anticholinergic toxicity will typically show peripheral symptoms including dry mouth, thirst, fixed dilated pupils, flushed face, fever, hot, dry, red skin, urinary retention, hyperthermia, hypotension, tachycardia, and increased respiratory rate. In addition to tachycardia, cardiac manifestations may include EKG abnormalities similar to those produced by quini-dine. Speech and swallowing may be impaired in association with blurred vision. Other peripheral signs and symptoms may include nausea and vomiting. 

Ceha LJ, Presperin C, and Young E (1997) Anticholinergic toxicity from nightshade berry poisoning responsive to physostigmine./oMfWij/ of Emergency Medicine 15 65-69. 

Tsiodras, S., Shin, R., Christian, M., Shaw, L., and Sass, D. 1999. Anticholinergic toxicity associated with lupine seeds as a home remedy for diabetes mellitus. Ann. Emerg. Med. 33, 715-717. Tsumara, A. 1991. Kampo, How the Japanese Updated Traditional Herbal Medicine . Japan Publications, Inc., Tokyo and New York. 

Explain the use of physostigmine in the treatment of tricyclic-induced anticholinergic toxicity. 

IV. Diagnosis is based on a history of exposure and the presence of typical features such as dilated pupils and flushed skin. A trial dose of physostigmine (see below) can be used to confirm the presence of anticholinergic toxicity rapid reversal of signs and symptoms is consistent with the diagnosis. 

B. Central nervous system effects. These result in part from anticholinergic toxicity (eg, sedation and coma), but seizures are probably a result of inhibition of reuptake of norepinephrine or serotonin in the brain or other central effects. 

A. Some adverse effects include dry mouth, blurred vision, cycloplegia, mydriasis, palpitations, tachycardia, aggravation of angina, and constipation. Urinary retention is common, and a Foley catheter may be needed. Duration of effects may be prolonged (several hours). Additionally, CNS anticholinergic toxicity (delirium) may occur with large doses of atropine needed to treat cholinesterase inhibitor poisoning. 

Benazzi F, Anticholinergic toxic syndrome withvenlafaxine-desipramine combination. Pharmacopsychiatry (1998) 31, 36-7. 

---