Anticholinergic Overdose

Anticholinergic poisoning results from many different medications with antihistamines being the most common. Certain plants (jimson weed, red sage, and angel's trumpet) can also cause the syndrome. The symptoms are well described by the pneumonic: "red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare.

Symptoms

Red as a beet (red skin), dry as a bone (the skin is dry), blind as a bat (inability to accommodate the eyes causes blurry vision), mad as a hatter (patients are confused), hot as a hare (fever), fast heart rate, tremors, jerking motions.

Tests

A history and physical exams will be performed. Lab and radiology tests are done to rule out other causes of the symptoms.

Treatment

The patient is supported with supplemental oxygen and intravenous fluids. Sedation with benzodiazepines (valium, ativan) are sometimes necessary. If the symptoms are severe physostigmine may be administered. (Physostigmine may be indicated to clarify diagnosis or mitigate symptoms in severe cases but should be asministered in consultation with a medical toxicologist). Consider calling the National Poison Control Phone Number for further information or assistance: 1-800-222-1222.