- 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
Anticholinergic toxicity is frequently encountered in the emergency department, and thus it is essential that emergency clinicians be familiar with this toxidrome. According the American Association of Poison Control Centers (AAPCC) Annual Report, there were almost 14,000 exposures to anticholinergic substances including plants, drugs and antispasmodics in 2015 (624 plants (5 major, or severe, exposures), 10,345 drugs (21 major), and 2879 antispasmodics (13 major)) . Despite the large number of recorded cases, only 39 of these anticholinergic exposures were associated with major effects and there were no fatalities. This demonstrates a significant improvement in outcomes compared to previous data in which there were 51 deaths reported [2-9].
The basic mechanisms, presentation, and management of anticholinergic poisoning are 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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- 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