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These intoxications can be diagnosed based on a combination of an anticholinergic toxidrome plus ekg findings of sodium channel blockade (more on that here) It results from the accumulation of excessive levels of acetylcholine in the synapses, glands, smooth muscles, and motor end plates where cholinergic receptors are found. Of course, in some cases the diagnosis may also be based upon a known history of ingesting a specific agent.
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The basic mechanisms, presentation, and management of anticholinergic poisoning are reviewed here The cholinergic toxidrome represents the acute phase of cholinesterase inhibitor poisoning Discussions of specific agents that can cause an anticholinergic toxidrome and the general approach to the poisoned patient are found separately.
Medications with anticholinergic properties include antidepressants, antihistamines, antiparkinson drugs, antipsychotics, antispasmodics, and mydriatics
Many medications possess anticholinergic activity as their primary pharmacologic effect, while others exhibit these properties as adverse effects. Anticholinergic toxidrome was one of the first flashcards i designed I wanted to make a play on the old mnemonic Mad as a hatter, hot as hell, red as a beet, dry as a bone, and blind as a bat.
Exposure to an anticholinergic chemical may result in under stimulation of cholinergic receptors leading to dilated pupils (mydriasis), decreased sweating, elevated temperature, rapid heart beat, and mental. The anticholinergic toxidrome consists of both central and peripheral effects It is common for the peripheral effects to abate before the central effects, meaning that later in the course of the toxidrome, patients may present with delirium as the main or sole effect. Diagnosis is based on a history of ingestion/exposure to one or more anticholinergic agents and the presence of characteristic symptoms and physical signs
The characteristic feature of toxicity at central receptors is agitated delirium.
