eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Anticholinergic: Follow-up

Author: John J Bruns, Jr, MD, Clinical Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Mar 26, 2008

Follow-up

Further Inpatient Care

  • Admission decisions are based on patient symptomatology. Asymptomatic patients without anticholinergic signs or symptoms can be discharged after a 4-6 hour observation period. Individuals with initial mild toxicity that resolve during initial observation also may be discharged.
  • Admit and monitor symptomatic patients, usually in an ICU setting, until a symptom-free period of 4 hours without the aid of antidotes or supportive therapy is documented.
 


More on Toxicity, Anticholinergic

Overview: Toxicity, Anticholinergic
Differential Diagnoses & Workup: Toxicity, Anticholinergic
Treatment & Medication: Toxicity, Anticholinergic
Follow-up: Toxicity, Anticholinergic
References

References

  1. 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].

  2. Bryson P. Comprehensive Review in Toxicology. Hemisphere Publishing; 1989:3-11, 75-83, 566-7.

  3. 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].

  4. Daunderer M. Physostigmine salicylate as an antidote. Int J Clin Pharmacol Ther Toxicol. Dec 1980;18(12):523-35. [Medline].

  5. 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.

  6. Goldfrank L, Flomenbaum N, Lewin N, et al. Anticholinergic poisoning. J Toxicol Clin Toxicol. Mar 1982;19(1):17-25. [Medline].

  7. Haddad LM, Winchester JF, eds. Clinical Management of Poisoning and Drug Overdose. 2nd ed. WB Saunders Co; 1990:861-7, 83, 231, 385.

  8. 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.

  9. Lu F. Basic Toxicology: Fundamentals, Target Organs, and Risk Assessment. 3rd ed. Taylor & Francis; 1996:52-4, 65, 279-84.

  10. McFarland KA. Anticholinergic poisoning. In: Emergency Medicine. 1998.

  11. 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

anticholinergic toxicity, anticholinergic syndrome, ACS, anticholinergic drug ingestions, anticholinergic drug overdose, anticholinergic poisoning, antihistamines, antipsychotics, antispasmodics, cyclic antidepressants, mydriatics, atropine, scopolamine, glycopyrrolate, benztropine, trihexyphenidyl, chlorpheniramine, cyproheptadine, doxylamine, hydroxyzine, dimenhydrinate, diphenhydramine, meclizine, promethazine, chlorpromazine, clozapine, mesoridazine, olanzapine, quetiapine, thioridazine, clidinium, dicyclomine, hyoscyamine, oxybutynin, propantheline, amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, cyclopentolate, homatropine, tropicamide, Amanita muscaria, fly agaric, Amanita pantherina, panther mushroom, Arctium lappa, burdock root, Atropa belladonna, deadly nightshade, Cestrum nocturnum, night blooming jessamine, Datura suaveolens, angel's trumpet, Daturastramonium, jimson weed, Hyoscyamus niger, blackhenbane, Lantana camara, red sage, Solanum carolinensis, wild tomato, Solanum dulcamara, bittersweet, Solanum pseudocapsicum, Jerusalem cherry, Solanum tuberosum, potato, carbamazepine, cyclobenzaprine, orphenadrine

Contributor Information and Disclosures

Author

John J Bruns, Jr, MD, Clinical Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

David C Lee, MD, Research Director, Department of Emergency Medicine, Assistant Professor, North Shore University Hospital and New York University Medical School
David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael J Burns, MD, Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center
Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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