Signs of Anticholinergic overdose

Description

Can result 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. Drugs that can cause this disorder include scopolamine, benztropine, diphenhydramine, chlorpheniramine, doxylamine, hydroxyzine, diphenhydramine, and meclizine. This overdose can be intentional or accidental since many of these medications are commonly found in over the counter medications.

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.

Standard Workup

CBC
Chem 12
UA
EKG
CT Scan
Troponin
BHCG
X-Ray

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 administered in consultation with a medical toxicologist). For more information and help call your local poison center at 1-800-222-1222.