Anticholinergic Poisoning
Description Diagnostic Criteria General and supportive measures Medicine treatment Referral ICD-10 code: T44.3 DESCRIPTION Various plant species and pharmaceutical preparations can cause anti-cholinergic toxicity. Plants: Datura stramonium , e.g. ‘stinkblaar' and 'malpitte'. Medicines: atropine, diphenoxylate with atropine and diphenhydramine. Other classes of medicines include antiparkinso
Description
Diagnostic Criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: T44.3
DESCRIPTION
Various plant species and pharmaceutical preparations can cause anti-cholinergic toxicity.
Plants: Datura stramonium, e.g. ‘stinkblaar' and 'malpitte'.
Medicines: atropine, diphenoxylate with atropine and diphenhydramine. Other classes of medicines include antiparkinsonism agents, antispasmodics, antipsychotics, antihistamines and tricyclic antidepressants.
DIAGNOSTIC CRITERIA
Clinical
- Alteration of mental status, including delirium, hallucinations, agitation and seizures.
- Peripheral anticholinergic effects include:
- dilated pupils,
- urinary retention,
- tachycardia and arrhythmias,
- decreased GIT motility,
- flushing,
- dry skin and mucous membranes
Investigations
- ECG and continuous cardiac monitoring
- Pulse oximetry.
GENERAL AND SUPPORTIVE MEASURES
- Stabilise patient, i.e. airway, breathing and circulation.
- Cooling for hyperthermia.
- Perform decontamination depending on route of exposure.
MEDICINE TREATMENT
- Activated charcoal, see: Poisoning, Treatment.
For agitation:
- Diazepam, IV/oral, 0.1–0.2 mg/kg.
- Maximum dose: 10 mg.
For seizures:
See: The Nervous System, Status epilepticus (convulsive).
REFERRAL
- Cardiac dysrhythmia.
- No response to treatment.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 18: Poisoning, 18.1 Poisoning, 18.1.1 Anticholinergic Poisoning