{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Episode 911: Anticholinergic Toxicity","description":"Contributor: Taylor Lynch MD Educational Pearls:   Anticholinergics are found in many medications, including over-the-counter remedies   Medications include:   Diphenhydramine   Tricyclic antidepressants like amitriptyline   Atropine   Antipsychotics like olanzapine   Antispasmodics - dicyclomine   Jimsonweed   Muscaria mushrooms     Mechanism of action involves competitive antagonism of the muscarinic receptor   Symptomatic presentation is easily remembered via the mnemonic:   Dry as a bone - anhidrosis due to cholinergic antagonism at sweat glands   Red as a beet - cutaneous vasodilation leads to skin flushing   Hot as a hare - anhidrotic hyperthermia   Blind as a bat - pupillary dilation and ineffective accommodation   Mad as a hatter - anxiety, agitation, dysarthria, hallucinations, and others     Clinical management   ABCs   Benzodiazepines for supportive care, agitation, and seizures   Sodium bicarbonate for TCA toxicity due to widened QRS   Activated charcoal if patient present &amp;lt; 1 hour after ingestion   Temperature monitoring   Contact poison control with questions     Physostigmine controversy   Physostigmine is a reversible cholinesterase inhibitor that can cross the blood-brain barrier so in theory it would be a useful antidote BUT\u2026   There is a black box warning for asystole and seizures when physostigmine is used this way   Therefore it is contraindicated in TCA overdoses   However, it is still indicated in certain anticholinergic overdoses with delirium     Disposition   Admission criteria include: symptoms &amp;gt;6 hours, CNS findings, QRS prolongation, hyperthermia, and rhabdomyolysis   ICU admission criteria include: delirium, dysrhythmias, seizures, coma, or requirement for physostigmine drip     References 1. Arens AM, Shah K, Al-Abri S, Olson KR, Kearney T. Safety and effectiveness of physostigmine: a 10-year retrospective review&amp;lt;sup\/&amp;gt;. Clin Toxicol (Phila). 2018;56(2):101-107. doi:10.1080\/15563650.2017.1342828 2. Nguyen TT, Armengol C, Wilhoite G, Cumpston KL, Wills BK. Adverse events from physostigmine: An observational study. Am J Emerg Med. 2018;36(1):141-142. doi:10.1016\/j.ajem.2017.07.006 3. Scharman E, Erdman A, Wax P, et al. Diphenhydramine and dimenhydrinate poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2006;44(3):205-223. doi:10.1080\/15563650600585920 4. Shervette RE 3rd, Schydlower M, Lampe RM, Fearnow RG. Jimson &quot;loco&quot; weed abuse in adolescents. Pediatrics. 1979;63(4):520-523. 5. Woolf AD, Erdman AR, Nelson LS, et al. Tricyclic antidepressant poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2007;45(3):203-233. doi:10.1080\/15563650701226192 Summarized by Jorge Chalit, OMSIII | Edited by Jorge Chalit &amp;nbsp; ","author_name":"Emergency Medical Minute","author_url":"https:\/\/www.emergencymedicalminute.com","html":"<iframe title=\"Libsyn Player\" style=\"border: none\" src=\"\/\/html5-player.libsyn.com\/embed\/episode\/id\/32042752\/height\/90\/theme\/custom\/thumbnail\/yes\/direction\/forward\/render-playlist\/no\/custom-color\/fa102a\/\" height=\"90\" width=\"600\" scrolling=\"no\"  allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen><\/iframe>","thumbnail_url":"https:\/\/assets.libsyn.com\/secure\/item\/32042752"}