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Toxicity, Anticholinergic: Differential Diagnoses & Workup
Updated: Mar 26, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Workup
Laboratory Studies
- No specific diagnostic studies exist for anticholinergic overdoses.
- Serum drug concentrations are not helpful and results rarely are available to aid in initial management. However, perform screening for acetaminophen and salicylate in all intentional poisonings because combination medication preparations and multiple ingestions often occur.
- Consider blood and urine cultures in febrile patients.
- Serum chemistry and electrolyte analysis may provide clues to the intoxicating agents and co-ingestants. Obtain a creatine kinase (CK) in patients with psychomotor agitation to rule out associated rhabdomyolysis.
- Perform electrolyte and arterial blood gas (ABG) analysis when bicarbonate therapy has been instituted for agents that also produce type 1A cardiac conduction disturbances; blood pH should be 7.45-7.55.
- Perform a urine pregnancy test on all women of childbearing age.
Imaging Studies
- Consider CT scan of the head and MRI imaging in patients with altered mental status that is insufficiently explained by the ingested agent or in patients that are unresponsive to appropriate intervention.
Other Tests
- Immediately perform electrocardiogram (ECG) analysis on all patients with suspected toxic ingestions.
Procedures
- Consider lumbar puncture (LP) in all patients with fever and altered mental status.
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Differential Diagnoses & Workup: Toxicity, Anticholinergic |
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References
Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline]. [Full Text].
Bryson P. Comprehensive Review in Toxicology. Hemisphere Publishing; 1989:3-11, 75-83, 566-7.
Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. Apr 2000;35(4):374-81. [Medline].
Daunderer M. Physostigmine salicylate as an antidote. Int J Clin Pharmacol Ther Toxicol. Dec 1980;18(12):523-35. [Medline].
Ellenhorn MJ, Barceloux D. Medical toxicology. In: Elsevier Applied Science. Elsevier Science; 1988:16, 25-31, 83, 93, 106-9, 117, 407, 472, 474, 592, 666.
Goldfrank L, Flomenbaum N, Lewin N, et al. Anticholinergic poisoning. J Toxicol Clin Toxicol. Mar 1982;19(1):17-25. [Medline].
Haddad LM, Winchester JF, eds. Clinical Management of Poisoning and Drug Overdose. 2nd ed. WB Saunders Co; 1990:861-7, 83, 231, 385.
Kaye S. Handbook of Emergency Toxicology: A Guide for the Identification, Diagnosis and Treatment of Poisoning. 5th ed. Charles C Thomas Pub Ltd; 1988:31-44.
Lu F. Basic Toxicology: Fundamentals, Target Organs, and Risk Assessment. 3rd ed. Taylor & Francis; 1996:52-4, 65, 279-84.
McFarland KA. Anticholinergic poisoning. In: Emergency Medicine. 1998.
Nice A, Leikin JB, Maturen A, et al. Toxidrome recognition to improve efficiency of emergency urine drug screens. Ann Emerg Med. Jul 1988;17(7):676-80. [Medline].
Further Reading
Keywords
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Differential Diagnoses & Workup: Toxicity, Anticholinergic