Hyperthermia, atropine

Tachycardia and a rise in blood pressure are occasionally seen. Other supraventricular and ventricular dysrhythmias are much less common. Ventricular fibrillation associated with suxamethonium is usually the result of hyperkalemia, but has also been reported in hypercalcemia (22) and is often seen in the course of malignant hyperthermia. Atropine, especially when given intravenously just before suxamethonium, is the most effective agent for the prevention of dysrhythmias. Hexafluorenium, D-tubocurarine, pancuronium, and other non-depolarizer blockers have also been reported as being effective in prevention. Severe hypotension can occur in patients with anaphylactoid reactions. 

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). 

The answer is e, (Katzungf p JI . High concentrations of atropine block all parasympathetic function. The patient usually presents with an array of symptoms and signs that include dry mouth, dilated pupils, tachycardia, red and hot skin, and delirium. Hyperthermia may occur, particularly in very young children. 

When sweating is inhibited due to poisoning with anticholinergics (e.g., atropine), cutaneous blood flow increases. If insufficient heat is dissipated through this route, overheating occurs (hyperthermia). 

Rarely did the intramuscular or intravenous doses exceed 1.5 times the Incapacitating dose. Inhalation doses were higher, but potencies were lower by this route (usually about 60 percent of that by the Intravenous or intramuscular route). Compared with doses described in the scientific literature on atropine coma therapy 18-23 or scopolamine therapy, the BZ doses to which volunteers were exposed appear modest. As much as 20 times the ID50 of atropine and 30-40 times the ID50 of scopolamine have been administered in the past by clinicians—often to older and less robust patients. Many patients received multiple exposures of this magnitude over a period of days or weeks. These therapeutic procedures, reported several decades ago in refereed journals, actually stressed and advocated the benefits of such treatment, despite occasional deaths (most of which appear to have been caused by hyperthermia). 

Incidental and accidental intake of atropine and scopolamine, which are the main tropane alkaloids in plants of the solanecae family, may provoke poisoning of man and livestock [11,13-15, 55, 57,119-122] causing agitation, aggression, hallucinations, dry mouth and skin, mydriasis, loss of consciousness followed by coma combined with tachycardia, hypotension, and hyperthermia [57, 121], A detailed statistical analysis of paediatric plant exposures in Germany within the years 1998-2004 has been provided by Pietsch et al. [123], They found that most prevalent victims of accidental plant exposures are children in the age of 1-6 years presumably being misled by the attractive plump berries. 

Atropine is an antidotal treatment. It is used to reverse the muscarinic signs, but it will not reverse the nicotinic effects (muscular weakness, diaphragmatic weakness, etc.). Atropine blocks the effects of accumulated acetylcholine (ACh) at the synapse and should be continued until the nerve agent is metabohzed (Midthng et al, 1985). Over-atropinization can cause hyperthermia, tachycardia, agitation, mydriasis, and ileus, which can be life threatening in the horse (Meerstadt, 1982). 

In a series of about 500 patients treated with large doses of atropine, with about 10,000 individual inductions of coma, there was one death (21). This fatality was attributed to the replacement, without notification of the physician, of the specially trained nursing and technical personnel on the treatment ward with persons who were not thoroughly familiar with the procedures for caring for comatose patients, and particularly the procedures for controlling febrile reactions. The patient died of uncontrolled hyperthermia. 

Atropine was thought to have produced hypothermia in a boy aged 14 who was being treated with paracetamol (acetaminophen) and cooling blankets for hyperthermia (7). As atropine can cause hypothermia in animals, a causal relation cannot be excluded, even if a concomitant action with paracetamol is assumed. 

Atropine and muscarinic blockers t HR, T BP, hyperthermia (hot, dry skin), delirium, hallucinations Control CV symptoms and hyperthermia + physostigmine (crosses BBB) ... 

The elderly are particularly prone to develop dangerous hyperthermia when given atropine Atropine often causes excessive vasodilation and hypotension in tlie elderly 11. When a dose-response study of atropine is car ried out in young adults, which of the following effects may be observed ... 

Choices (B), (D), and (E) are possible effects of the atropine group. In small children, however, the most dangerous effect is hyperthermia. Deaths with body temperatures in excess of 42 °C have occurred after the use of atropine-containing eye drops in children. The answer is... 

Antimuscarinic dmgs (atropine, some antidepressarts and antihistaminics, jimsonweed, etc) Delirium, hallucinations, seizures, coma, tachycardia, hypertension, hyperthermia, mydriasis, decreased bowel sounds, urinary retention Control hyperthenaia physostigmine may be helpful, but not for tricyclic overdose... 

Anticholinergic (antimuscarinic) syndrome. Tachycardia with mild hypertension is common. The pupils are widely dilated. The skin is flushed, hot, and dry. Peristalsis is decreased, and urinary retention is common. Patients may have myoclonic jerking or choreoathetoid movements. Agitated delirium is common, and hyperthermia may occur. (Examples atropine, scopolamine, benztropine, antihistamines, and antidepressants all of these dmgs are primarily antimuscarinic.)... 

---