3/20/2023 0 Comments Dry as bone mad as hatterThese patients may not present with all the traditional signs and symptoms of anticholinergic toxicity, and their presentation may be wrongly attributed to a different diagnosis. It is important for you to be aware of the classes of medications with anticholinergic properties.Īnticholinergic poisoning should be considered in all patients presenting with an altered mental status and physical exam findings consistent with anticholinergic toxicity. Patients treated with multiple medications that possess anticholinergic effects may present with more elusive symptoms consistent with anticholinergic toxicity, like altered mental status. In addition, you need to recognize chronic anticholinergic toxicity. Decreased or absent bowel sounds and tachycardia are the first indications of acute anticholinergic toxicity.4 Patients with central CNS toxicity require longer observation and more aggressive care. Central effects often develop together with peripheral effects but may persist longer or appear after peripheral effects resolve. While peripheral signs alone are less concerning, the presence of central findings is consistent with a moresevereclinical picture. Peripheral adverse effects result from the antagonism of exocrine glandular secretion, muscle contraction, and end-organ targets of the peripheral parasympathetic nervous system.4 The onset of anticholinergic toxicity varies depending on the toxin but typically begins within one to two hours of oral ingestion.Īnticholinergic toxicity is characterized as peripheral, central, or both. The adverse effects of anticholinergics can be divided into central and peripheral effects.Ĭentral effects result from excess blockade of muscarinic receptors within the CNS. The useful memory aid "red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, and full as a flask" helps to remember the common signs and symptoms of anticholinergic toxicity. Musculoskeletal: diminished muscle contraction Skin: Dry skin through the inhibition of sweating 7 HEENT: blurry vision, mydriasis, narrow-angle glaucoma, potential vision loss4 Gastrointestinal: decreased gut motility, constipation, vomiting, decreased saliva and tear production Cardiovascular: tachycardia, flushing, and dysrhythmias 4,5 In an overdose, anticholinergics antagonize muscarinic receptors, which can lead to the following clinical manifestations 2: Muscarinic receptors are present on the target organ cells of the parasympathetic nervous system and sweat glands in the sympathetic nervous system. Teenagers and young adults may ingest certain compounds for hallucinogenic properties (like jimson weed) or suicide.3 Children and adults have very similar presentations and management, with the only difference being that in children the most common cause is unintentional ingestions. This review will cover the pathophysiology, presentation, and management of anticholinergic toxicity. More than 600 compounds with anticholinergic activity have been identified, and there were nearly 14,000 exposures to these substances in 2015.1 Anticholinergic can be employed for a variety of different medical conditions, including urinary incontinence, chronic obstructive pulmonary disease, motion sickness, cholinergic toxicity, and Parkinson's disease, just to name a few.2 Anticholinergic toxicity is encountered relatively frequently in the emergency department, so it is important that emergency providers promptly and efficiently recognize the toxidrome. Anticholinergics are substances that antagonize the actions of the neurotransmitter acetylcholine at the muscarinic receptors. Peer editors: Travis Smith, DO, Blake Briggs, MD, Mary Claire O’Brien, MDĪcetylcholine is a familiar neurotransmitter with many different roles. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here:
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