Anticholinergic Toxicity Workup
- Author: John J Bruns Jr, MD, MPH,†; Chief Editor: Asim Tarabar, MD more...
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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