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Anticholinergic toxidrome

L Garcin, M Le Roch, C-A Agbessi, J-B Lobut, A Lecoeur, G Benoist
"Purple drank" is a dangerous hallucinogenic cocktail commonly used by teenagers, made popular by American rappers and social networks. It combines codeine-based cough syrup, antihistamines such as promethazine, and soda. Unknown by caregivers, it may be responsible for serious neuropsychological complications. We report the effects of this new risky behavior in three patients: a 14-year-old girl and her boyfriend, both found in an initial state of drowsiness, followed by hallucinations and anticholinergic toxidrome; and another teenager whose chronic use led to addiction with increasing doses...
September 23, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
N A F Verheijden, B C Koch, Z Brkic, J Alsma, S C E Klein Nagelvoort-Schuit
Intentional or accidental intoxications are common in the emergency department, but are not always sufficiently recognised. When intoxication is suspected, the causative agent or combination of agents often remain unclear, making these patients a diagnostic challenge. We present here a 45-year-old woman who was admitted due to altered consciousness. The clinical presentation fitted the anticholinergic toxidrome and an intoxication with venlafaxine (her known prescribed medication) was suspected. Plasma venlafaxine concentrations, however, were very low...
March 2016: Netherlands Journal of Medicine
Sebastian Kummer, Annette Rickert, Thomas Daldrup, Ertan Mayatepek
UNLABELLED: We report on two patients who ingested psychoactive scopolamine that was synthesized at home from butylscopolamine (Buscopan®), which is available as over-the-counter antispasmodic in nearly 100 countries worldwide. Patient 1 presented with severe central anticholinergic toxidrome, while patient 2 suffered from minor symptoms. An empty blister of Buscopan® was found in the patients' home, but initially was not suspected to be causative for the observed central anticholinergic symptoms, as Buscopan® is not able to pass the blood-brain barrier in its native form...
July 2016: European Journal of Pediatrics
Ahmet Kağan Özkaya, Ekrem Güler, Nihal Karabel, Ali Rıza Namlı, Yalçın Göksügür
Hallucinogenic plant poisoning in children is a significant problem for the emergency physician. We describe the case of a boy who had slurred speech, fever, hallucinations, tachycardia, dilated pupils, confusion and disorientation. He had no history of drug use or toxin intake. All signs and symptoms were improved by supportive therapy within 48 hours. It turned out that the patient had ingested seeds of Datura stramonium in a neighbor's garden two days previously. The medical history should be taken repeatedly in cases of unknown etiology, and physicians should keep in mind the possibility that unexplained anticholinergic toxidromes could be the result of exposure to toxic plants, in particular those containing atropine and atropine derivates...
January 2015: Turkish Journal of Pediatrics
Diana M Gerardi, Tanya K Murphy, Megan Toufexis, Camille Hanks
OBJECTIVE: The aim of this study was to report an acute onset of symptoms erroneously attributed to serotonin syndrome in a child who had been given both anticholinergic and serotonergic agents. CASE SUMMARY: A 9-year-old girl with chronic anxiety and gastrointestinal problems was prescribed oral sertraline 6.25 mg daily, as well as hyoscyamine, ondansetron, montelukast, and a course of nitazoxanide. She was also routinely given diphenhydramine and omeprazole. Three days after increasing sertraline to 12...
December 2015: Pediatric Emergency Care
Samantha W Gee, Ada Lin, Joseph D Tobias
Dexmedetomidine is an α2-adrenergic agonist approved by the US Food and Drug Administration for the sedation of adults who are intubated on mechanical ventilation and in non-intubated adults who are undergoing surgical procedures. However, it has also recently become a commonly used sedative agent in varied clinical settings for the pediatric patient as well. We present the use of dexmedetomidine for sedation in a unique clinical scenario, the severely agitated and combative patient following the intentional misuse of anticholinergic drugs...
July 2015: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Joseph W Watkins, Evan S Schwarz, Anna M Arroyo-Plasencia, Michael E Mullins
The anticholinergic toxidrome is well described and relatively common. Despite controversy, studies have shown that physostigmine is relatively safe and effective in reversing this toxidrome. We would expect toxicologists would be liberal in its use. We retrospectively analyzed data in the Toxicology Investigators Consortium (ToxIC) registry, representing data from medical toxicologists in multiple institutions nationwide, searching for patients who exhibited an anticholinergic toxidrome, determining what treatment(s) they received, and classifying the treatments as physostigmine, benzodiazepines, physostigmine and benzodiazepines, antipsychotics, or no definitive treatment...
June 2015: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Ashley Walker, Andrew Delle Donne, Elizabeth Douglas, Kristine Spicer, Thomas Pluim
INTRODUCTION: We report the case of an adolescent with anticholinergic toxidrome from diphenhydramine overdose, whose symptoms were treated with a novel application of dexmedetomidine. CASE REPORT: A 13-year-old female developed an anticholinergic toxidrome after intentionally ingesting 9.5 mg/kg of diphenhydramine. Despite routine supportive therapies, to include appropriate doses of lorazepam, she continued to have significant agitation, psychosis, and hallucinations...
December 2014: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Miguel Glatstein, Fatoumah Alabdulrazzaq, Dennis Scolnik
The belladonna alkaloids can be isolated from a number of plants, which contain hallucinogens that represent a serious danger to infants, children, and adolescents. Roots, leaves, and fruits of the plant contain the alkaloids atropine, hyoscyamine, and scopolamine, which can lead to an anticholinergic toxidrome; however, not all characteristics of the toxidrome are necessarily present in each case of poisoning. A retrospective chart review of all children seen following anticholinergic ingestions, between April 2001 and November 2010, at the Hospital for Sick Children in Toronto...
January 2016: American Journal of Therapeutics
Miguel Glatstein, Dana Danino, Ido Wolyniez, Dennis Scolnik
Atropa belladonna is a poisonous plant that can cause anticholinergic effects when ingested. Roots, leaves, and fruits of the plant contain the alkaloids atropine, hyoscyamine, and scopolamine, which can lead to an anticholinergic toxidrome; however, not all characteristics of the toxidrome are necessarily present in each case of poisoning. We present an infant who suffered serious seizures after ingestion of a homeopathic agent containing A. belladonna. The 20-day-old infant arrived at the emergency department with fever and generalized seizures for 30 minutes, 2 hours after ingesting the correct dose of a homeopathic medication agent used for infantile colic...
November 2014: American Journal of Therapeutics
Harold Andrew Sloas, Thomas C Ence, Donna R Mendez, Andrea T Cruz
Ornithine transcarbamylase (OTC) deficiency is a genetic disorder involving a mutation of the ornithine transcarbamylase gene, located on the short arm of the X chromosome (Xp21.1). This makes the expression of the gene most common in homozygous males, but heterozygous females can also be affected and may be more likely to suffer from serious morbidity. Most males present early in the neonatal period with more devastating outcomes than their female counterparts. Up to 34% will present in the first 30 days of life (J Pediatr 2001;138:S30)...
September 2013: American Journal of Emergency Medicine
Chip Gresham, Jennifer Wilbeck
General assessment, resuscitation strategies, and risk assessment of the poisoned patient are explored in this article, including specific interventions for unresponsive patients and seizures. Sympathomimetic and anticholinergic toxidromes are described in terms of clinical presentation and treatment strategies and are compared with other common toxidromes. Controversies in gastric decontamination are also outlined, including consensus panel and national organizational recommendations. Despite available methods for toxin elimination, advances in medicine, and pharmacotherapy options, the cornerstone of toxicology remains supportive care...
January 2012: Advanced Emergency Nursing Journal
Jon B Cole, Samuel J Stellpflug, Eric A Gross, Stephen W Smith
INTRODUCTION: Diphenhydramine is an antihistamine commonly implicated in overdose. It has many pharmacologic effects, including sodium channel blockade. Overdoses in toddlers causing QRS prolongation are only rarely reported and never with effective use of sodium bicarbonate. We report a diphenhydramine overdose in a toddler with multiple markers of sodium channel blockade effectively treated with sodium bicarbonate. METHODS: A 13-month-old infant girl was brought in by the emergency medical service for a witnessed tonic-clonic seizure...
December 2011: Pediatric Emergency Care
Kristen L Ochs, Michele Zell-Kanter, Mark B Mycyk
The elderly are particularly sensitive to delirium-inducing medications. We report a case of a 93-year-old woman who developed anticholinergic delirium from subcutaneous diphenhydramine that she received in the emergency department. This patient was reportedly allergic to “caine” anesthetic agents, and thus, subcutaneous diphenhydramine was administered as an alternative local anesthetic, as recommended in emergency medicine textbooks. Within 20 minutes of administration, the patient developed agitation, tachycardia, dilated pupils, and dry skin, consistent with a classic anticholinergic toxidrome...
March 2012: American Journal of Emergency Medicine
Miguel Marcelo Glatstein, Fatoumah Alabdulrazzaq, Facundo Garcia-Bournissen, Dennis Scolnik
The objective of this study was to utilize a case report to review the use of physostigmine for jimsonweed intoxication. A 15-year-old girl was found at school hallucinating and incoherent. Upon presentation to the emergency department, she was found to be tachycardic and confused with dilated pupils and dry, flushed, hot skin. She was admitted to our institution. Hallucinations and symptoms resolved after the use of physostigmine. She subsequently admitted to ingesting 'moonflower seeds,' which are derived from Jimsonweed (Datura stramonium)...
September 2012: American Journal of Therapeutics
Wojciech Piekoszewski, Ewa Florek, Dorota Szpak, Lucyna Kramer, Wojciech Jawień
Carbamazepine is frequently administrated to alcohol addict patients. The aim of this study was to evaluate the influence of alcohol addiction on carbamazepine pharmacokinetics and severity of drug intoxication. The total of 158 carbamazepine intoxicated patients participated in the study (76 non-alcohol-dependent, and 82 alcohol-dependent subjects). The results of the study indicate that the level of unconsciousness depends on carbamazepine concentration. The frequency of anticholinergic toxidrome was higher in alcohol-dependent patients (88...
March 2010: Pharmacological Reports: PR
Ivar L Frithsen, William M Simpson
Poisoning is a common cause of morbidity and mortality in the United States, with several million episodes reported annually. Acute medication poisonings account for nearly one half of all poisonings reported in the United States and should be considered in persons with an acute change in mental status. The initial approach to a person who has been poisoned should be to assess the airway, breathing, and circulation, and to take a thorough history. Less than 1 percent of poisonings are fatal; therefore, management in most cases is supportive unless a specific antidote is available...
February 1, 2010: American Family Physician
Tzeng Jih Lin, Lewis S Nelson, Jin Lian Tsai, Dong Zong Hung, Sheng Chuan Hu, Hon Man Chan, Jou-Fang Deng
OBJECTIVE: To describe the toxidromes associated with plant poisonings in Taiwan. METHODS: Retrospective review of acute single-plant exposures with clinical signs and symptoms reported between January 1987 and December 2006 by hospitals to the network of Taiwan Poison Control Centers. Recorded data included demographic data, intent of exposures, exposure routes, clinical findings, and therapeutic strategies. RESULTS: There were 389 cases that met the criteria...
February 2009: Clinical Toxicology
Sean P Spina, Anthony Taddei
We report 2 cases of teenagers who were poisoned with Jimson weed (Datura stramonium) and presented to the emergency department with a severe acute anticholinergic toxidrome after ingestion of several hundred seeds. The patients presented with visual hallucinations, disorientation, incomprehensible and nonsensical speech, and dilated sluggish pupils. Both patients required restraints for combativeness until adequate sedation with lorazepam and haloperidol was achieved. Jimson weed is found in southern Canada and the United States and can cause acute anticholinergic poisoning and death in humans and animals...
November 2007: CJEM
Charles L Taylor, Shawn F Taylor
Atropine autoinjectors are used by the U.S. military as pre-hospital first-line therapy for nerve agent exposure. This case report examines the misuse of these devices in a suicide attempt. An anticholinergic toxidrome resulted from this misuse. The patient was successfully treated.
May 2008: Journal of Emergency Medicine
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