Anticholinergic

Epidemiology and Risk Factors

Pathophysiology

Aetiology

Clinical Manifestations

Peripheral toxicity:

Peripheral features are essentially parasympatholytic.

The classic mnemonic for anticholinergic toxicity:

  • Blind as a bat
    Mydriasis, dilated pupils without accomodation.
  • Mad as a hatter Delirium.
  • Dry as a bone
    Anhydrosis.
  • Red as a beet
    Erythema due to vasodilation.
  • Hot as a hare
    Warm to touch.
  • ↑ HR
  • Cutaneous vasodilation
  • Anhydrosis
  • Mydriasis
  • Ileus
  • Urinary retention
  • ↓ Sweating

Central toxicity:

  • Tremor
  • Hyperthermia
  • Delirium
  • Seizures

Diagnostic Approach and DDx

Investigations

Bedside:

Laboratory:

Imaging:

Other:

Management

Resuscitation:

ABC approach. Comment on team coordination and clinical priorities. Specific therapy:

  • Pharmacological
  • Procedural
  • Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

  • E
    • Hyperthermia
  • F
    • Rhabdomyolysis
  • H
    • DIC

Prognosis

Key Studies

References

  1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.