Anticholinergic Syndrome

Question 1

Anticholinergic/ antimuscarinic syndrome: Clinical features

Answer 1

Central
-Agitated delirium
    * fluctuating mental status
    * confusion
    * restlessness
    * fidgeting
    * visual hallucinations
    * picking at objects in air
    * mumbling slurred speech
    * disruptive behaviour
Tremor
Myoclonus
coma
Seizure
PERIPHERAL
-mydriasis
- tachycardia
-dry mouth
-dry skin
-Flushing
-hyperthermia
-sparse or absent bowel sounds
-urinary retention

Question 2

Anticholinergic agents

Answer 2

Antiparkinsons drugs
-amantadine
-benztropine
Antihistamine
-chlorpheniramine
-cyproheptadine
-diphenhidramine
-doxylamine
-promethazine
Antitussive
-dextromethorphan
Antidepressants
-TCA
Antipsychotic
- chlorpromazine
-droperidol
-haloperidol

Antipsychotic
-Olanzapine
-quetiapine
Anticonvulsants
-Carbamazepine
Motion sickness agent
-hyoscine
Antimuscarinic
-atropine
-glycopyrrolate
Urinary antispasmodic
-oxybutynin
-muscle relaxant
Plants
-mushrooms datura

Question 3

Anticholinergic DDx

Answer 3

Encephalitis
Hypoglycaemia
Hyponatremia
Ictal phenomenon
NMS
Neuro trauma
Sepsis
Serotonin syndrome
SAH
Wernicke's encephalopathy

Question 4

Anticholinergic Mx

Answer 4

Resus:
ABC
Hyperthermia
Hypoglycaemia
Sz
Risk assess: onset within few hours last upto 5 days
Supportive:
-quiet well lit area
-reassurance
-IV fluids: dehydrated
-IDC- urinary retention
-Agitation: diazepam/ beware over sedation
- one-one nursing
- avoid anticholinergic drugs

Question 5

Investigations

Answer 5

Screening
Drug level: carbamazepine
UEC
CK
DDx

Question 6

Antidote

Answer 6

Physostigmine: centrally acting acetylcholinesterase inhibitor
0.5-1mg (paeds 0.02mg/kg) IV slow push