Atropine poisoning and

Suggested Alternatives for Differential Diagnosis Encephalitis, Herpes Simplex, tetanus, Guillain-Barre syndrome, poliomyelitis, transverse myelitis, cerebrovascular accident, psychosis, intracranial mass, epilepsy, atropine poisoning, and Creutzfeldt-Jacob disease. 

Pilocarpine occurs in the leaves of various species of pilocarpus. It is used as an antidote for atropine poisoning and in ophthalmology to produce contraction of the pupil. 

Differential Diagnosis With single cases, rather than clearly epidemic cases, the illness could be confused with Guillain-Barre syndrome, myasthenia gravis, or tick paralysis. Other possible considerations may include enteroviral infections, as well as nerve agent and atropine poisoning. 

Recovery of Cholinesterase Activity in Parotid Glands, Gastrocnemius Muscles, and Brains of Rats Poisoned with Subcutaneous VX at 40 ug/kg and Treated 20 Min Later with Intraperitoneal Atropine Sulfate at 7 mg/kg or with Intraperitoneal Atropine Sulfate and 2-PAM I at 17.5 mg/kga... 

Naturally occurring compounds with antimuscarinic effects have been known and used for millennia as medicines, poisons, and cosmetics. Atropine is the prototype of these drugs. Many similar plant alkaloids are known, and hundreds of synthetic antimuscarinic compounds have been prepared. 

Wadia RS, Ichaporia RN, Kamik VM, et al. 1972. Cholinesterase levels in diazinon poisoning and after atropine treatment. J Indian Med Assoc 59(6) 234-238. 

At higher concentrations, atropine causes block of all parasympathetic functions. However, atropine is a remarkably safe drug in adults. Atropine poisoning has occurred as a result of attempted suicide, but most cases are due to attempts to induce hallucinations. Poisoned individuals manifest dry mouth, mydriasis, tachycardia, hot and flushed skin, agitation, and delirium for as long as a week. Body temperature is frequently elevated. These effects are memorialized in the adage, "dry as a bone, blind as a bat, red as a beet, mad as a hatter."... 

Atropine interacts with antipsychotics, antihistamines, phenothiazines, and antidepressant drugs. Benzhexol, orphenadrine, and oxybutynin hydrochloride are drugs of potential abuse poisoning and withdrawal symptoms are reported.150... 

Atropine poisoning. Parasympatholytics have a wide therapeutic margin. Rarely life-threatening, poisoning with atropine is characterized by the following peripheral and centtal effects. 

Standard therapy of OP poisoning consists of the administration of a combination of atropine, oxime, and diazepam with other supportive measures when necessary. However, the possibility of addition of purified enzymes such as AChE, ChE, CarbE, and A-esterases to this therapeutic scheme has been considered and preliminary experiments in animals have shown much better protective effect after addition of exogenous enzymes. In this respect, protective effects of AChE, ChE, and CarbE are based on formation of covalent conjugates or phosphory-lated enzymes in the stoichiometric ratio 1 1. Capacity for binding of these enzymes is limited by the number of active sites on the enzyme to which OP molecules can be bound. This means that more enzymes have to be administered in order to achieve better detoxification of OPs which may not always be possible due to adverse effects. This can also be infiuenced by differences in the extent of spontaneous reactivation of these enzymes inhibited by OP. 

Pharmacokinetics. Atropine is readily absorbed from the gastrointestinal tract and may also be injected by the usual routes. The occasional cases of atropine poisoning following use of eye drops are due to the solution rurming down the lacrimal ducts into the nose and being swallowed. Atropine is in part destroyed in the liver and in part excreted unchanged by the kidney (t 2 h). 

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

Another condition that could be confused with botulism is nerve agent and/or atropine poisoning (28). Unlike botulinum toxin, which results in decreased secretions, nerve agent poisoning (see Chap. 3) causes patients to develop copious respiratory secretions and miotic pupils. As compared to the clear sensorium of botulism patients, atropine overdose causes nervous system excitation, including hallucinations and delirium, even though the mucous membranes are dry and patients have mydriasis (see Chap. 3). 

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