Flush, atropine

The peripheral nervous system effects are considered as under-stimulation of the end organs. This decreased stimulation of eccrine and apocrine sweat glands in the skin results in dry skin and a dry mouth, and is considered dry as a bone . The reduction in the ability to dispel heat by evaporative cooling decreases sweating, and the compensatory cutaneous vasodilation causes the skin to become warm or hot as a hare and red as a beet . This is similar to the atropine flush. The decreased heat loss also results in an increased core temperature. 

Circulation Atropine, alone, has httle effect on blood pressure, an expected result since most vessels lack chohnergic innervation. However, in clinical doses, atropine completely counteracts the peripheral vasodilation and sharp fall in blood pressure caused by chohne esters. Atropine in toxic, and occasionally therapeutic, doses can dilate cutaneous blood vessels, especially those in the blush area (atropine flush). 

Atropine flush Marked cutaneous vasodilation of the arms and upper torso and head by antimuscarinic drugs mechanism unknown... 

Adverse effects with atropine therapy include dry mouth, myosis, loss of visual accommodations, constipation, and urinary retention. The dmg can also produce flushing, hyperthermia, delirium, tachycardia, and exacerbate glaucoma (85). 

Early-onset diarrhea occurs 2 to 6 hours after administration and is characterized by lacrimation, diaphoresis, abdominal cramping, flushing, and/or diarrhea. These cholinergic symptoms respond to IV or subcutaneous atropine 0.25 to 1 mg. 

Diphenoxylate + Atropine (Lomotil, Lonox) [C V] [Opioid Antidiarrheal] Uses D Action Constipating m CTidine congener, X GI motihty Dose Adults. Initial, 5 mg PO tid—qid until controlled, then 2.5-5 mg PO bid 20 mg/d max Peds >2 y. 0.3-0.4 mg/kg/24 h (of diphenoxylate) bid-qid, 10 mg/d max Caution [C, +] Contra Obstructive jaundice, D d/t bacterial Infxn children <2 y Disp Tabs, Liq SE Drowsiness, dizziness, xCTostomia, blurred vision, urinary retention, constipation Interactions T Effects W/ CNS depressants, opioids, EtOH, T risk HTN crisis W7 MAOIs EMS Monitor for Sxs of electrolyte disturbances and hypovolemia d/t D OD May cause Szs, hypotension, and anticholinergic effects (xerostomia [dry mouth], urine retention, flushed skin) activated charcoal may be effective for OD... 

Overdose may result in cholinergic crisis, characterized by severe nausea, increased salivation, diaphoresis, bradycardia, hypotension, flushed skin, abdominal pain, respiratory depression, seizures, and cardiorespiratory collapse, increasing muscle weakness may result in death if respiratory muscles are involved. The antidote is 1 -2 mg IV atropine sulfate with subsequent doses based on therapeutic response. 

Parenteral overdose produces a cholinergic crisis manifested as abdominal discomfort or cramps, nausea, vomiting, diarrhea, flushing, facial warmth, excessive salivation, diaphoresis, urinary urgency, and blurred vision. If overdose occurs, stop all anticholinergic drugs and immediately administer 0.6-1.2 mg atropine sulfate IM or IV. 

The skin often appears flushed, hot, and dry in poisoning with atropine and other antimuscarinics. Excessive sweating occurs with organophosphates, nicotine, and sympathomimetic drugs. Cyanosis may be caused by hypoxemia or by methemoglobinemia. Icterus may suggest hepatic necrosis due to acetaminophen or Amanita phalloides mushroom poisoning. 

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