Dry as bone mad as hatter3/17/2023 ![]() This is exactly why most of the symptoms seen with anticholinergic toxicity mimic a sympathetic response, and the patient will appear to be in a fight or flight state. Simply put, anticholinergic toxicity inhibits the parasympathetic system and leaves only the sympathetic response present. Inhibiting the cholinergic receptors of the parasympathetic nervous system, as seen in anticholinergic toxicity, will lead to unopposed sympathetic activity and activation of the adrenergic receptors. Therefore, blocking either the sympathetic or parasympathetic system will result in overactivity of the other. Therefore, the parasympathetic nervous system will increase digestion, urination, defecation, salivation, and lacrimation while decreasing the heart rate and constricting the bronchi.Īs discussed above, the sympathetic and parasympathetic nervous systems counteract one another and are constantly producing responses. The critical actions for immediate survival are downregulated while bodily functions less critical are upregulated. The parasympathetic nervous system is essentially the opposite, and it is often referred to as the rest and digest state.Īcetylcholine binds to cholinergic muscarinic receptors. Therefore, the sympathetic nervous system will dilate the pupils, increase heart rate and cardiac output, dilate the bronchi, increase blood pressure, increase gluconeogenesis, and cause diaphoresis while decreasing salivation, lacrimation, digestion, defecation, and urination. The critical body actions for immediate survival are upregulated while the bodily functions less critical are downregulated. Norepinephrine and epinephrine is released and binds to alpha adrenergic receptors and beta adrenergic receptors. The sympathetic nervous system is involved in the fight or flight response. The autonomic nervous system has 2 main components: the sympathetic and parasympathetic nervous system. I’m going to briefly discuss the autonomic nervous system as this will help to better understand the symptoms and treatment for anticholinergic toxicity. This post will provide you with an easy method for recalling anticholinergic symptoms. However, today we are going to focus on anticholinergic toxicity.Īs with every EZmed blog, you will learn easy tricks to remember the content. To complicate matters, she recently had neck pain and meningitis would be very reasonable to have high on the differential (and should be). Therefore, it is important to always keep medications, adverse pharmacologic reactions, and toxicologic etiologies in mind when creating a differential.įor example, in the case above it would be easy to prematurely conclude an infectious etiology since the patient is febrile, tachycardic, and altered. Third, we often do not initially think of toxicology as a cause to the patient’s symptoms unless there is an obvious presentation. Second, anticholinergic toxicity can mimic other disease states. ![]() Dosing: 0.Anticholinergic toxicity can be challenging to manage.įirst, many patients are unable provide a history due to their symptoms or altered mental status, and family members are not always present to give additional information.Crosses blood brain barrier, can be used to help make dx.Physostigmine - strongly consider poison control consult before giving.Relatively contraindicated in asthma or ileus.Consider GI decon with Activated Charcoal if patient presents 100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma.Sympathomimetic toxicity ( cocaine, amphetamine, ketamine).^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan Withdrawal from substances have the opposite effect Altered mental status and fever Red, dry skin and absent bowel sounds favors anticholinergic toxicity.And the heart runs alone: Tachycardia (HR 120-160) and decreased/absent bowel sounds.Dry as a bone: anhidrosis (esp axillae, mouth).Hot as a hare: anhydrotic hyperthermia (may become severe w/ agitation).Mad as a hatter: delirium attention deficit hallucinations dysarthria lethargy.Blind as a bat: nonreactive mydriasis (often delayed 12-24hr).Selective serotonin reuptake inhibitor toxicity.Tricyclic antidepressant (TCA) toxicity.Background Anticholinergic toxicity Causes
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