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Anticholinergic poisoning

Authors
Mark Su, MD, MPH
Matthew Goldman, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

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)) [1]. 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).

ANTICHOLINERGIC POISONS

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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Literature review current through: Jul 2017. | This topic last updated: Apr 27, 2017.
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