- Mark Su, MD, MPH
Mark Su, MD, MPH
- Clinical Associate Professor of Emergency Medicine
- New York University School of Medicine
- Matthew Goldman, MD
Matthew Goldman, MD
- Clinical Assistant Professor
- Hofstra North Shore - LIJ School of Medicine
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
According to the American Association of Poison Control Centers (AAPCC), there were approximately 20,000 exposures to anticholinergic drugs and plants with 46 major outcomes, but no deaths recorded in 2009 . This demonstrates a significant improvement in outcomes compared to previous data in which there were 51 deaths reported [2-9]. Anticholinergic toxicity is commonly encountered, and familiarity with the management of this syndrome is essential for the emergency clinician.
The basic mechanisms and management of anticholinergic poisoning is reviewed here. Discussions of specific agents that can cause an anticholinergic toxidrome and the general approach to the poisoned patient are found separately. (See "General approach to drug poisoning in adults".)
A summary table to facilitate emergent management of anticholinergic overdose is provided (table 1).
Over 600 compounds have anticholinergic properties, including prescription drugs, over-the-counter medications, and plants (table 2).
Examples of classes of medications with anticholinergic properties include: antihistamines (eg, diphenhydramine), tricyclic antidepressants (eg, amitriptyline), sleep aids (eg, doxylamine), cold preparations, scopolamine, and tainted illicit street drugs (eg, heroin "cut" with scopolamine). Atropine, a belladonna alkaloid, is a commonly used anticholinergic medication for the treatment of bradyarrhythmias.
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- Sharma AN, Hexdall AH, Chang EK, et al. Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate. Am J Emerg Med 2003; 21:212.
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- ANTICHOLINERGIC POISONS
- PHARMACOLOGY AND CELLULAR TOXICOLOGY
- CLINICAL FEATURES OF OVERDOSE
- DIFFERENTIAL DIAGNOSIS
- LABORATORY EVALUATION
- Initial treatments
- Antidotal therapy with physostigmine
- PEDIATRIC CONSIDERATIONS
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS
- Pharmacology and presentation