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Anticholinergic Toxicity Workup

  • Author: Mityanand Ramnarine, MD, FACEP; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Jul 28, 2016
 

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, screening for acetaminophen and salicylate is indicated in all intentional poisonings because combination medication preparations and multiple ingestions often occur. In addition, studies that may be helpful include the following:

  • Blood and urine cultures in febrile patients
  • Serum chemistry and electrolyte analysis, which may provide clues to the intoxicating agents and co-ingestants
  • Creatine kinase (CK) level in patients with psychomotor agitation, to rule out associated rhabdomyolysis
  • 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
  • Urine pregnancy test on all females of childbearing age.
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Imaging Studies

Consider a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain in patients with altered mental status that is insufficiently explained by the ingested agent or in patients that are unresponsive to appropriate intervention.

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Other Tests

 

Immediately perform an electrocardiogram (ECG) on all patients with suspected toxic ingestions.

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Procedures

 

Consider lumbar puncture (LP) in all patients with fever and altered mental status.

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Contributor Information and Disclosures
Author

Mityanand Ramnarine, MD, FACEP Assistant Professor of Emergency Medicine, Program Director, Emergency/Internal Medicine/Critical Care, Hofstra Northwell School of Medicine at Hofstra University; Attending Physician, Department of Emergency Medicine, Long Island Jewish Medical Center

Mityanand Ramnarine, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Danish A Ahmad, MD Resident Physician, Departments of Emergency Medicine and Internal Medicine, Long Island Jewish Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

David C Lee, MD Research Director, Department of Emergency Medicine, Associate 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
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  2. Madhuvrata P, Singh M, Hasafa Z, Abdel-Fattah M. Anticholinergic Drugs for Adult Neurogenic Detrusor Overactivity: A Systematic Review and Meta-analysis. Eur Urol. 2012 Feb 25. [Medline].

  3. Quizon A, Colin AA, Pelosi U, Rossi GA. Treatment of Disorders Characterized by Reversible Airway Obstruction in Childhood: are Anti-cholinergic Agents the Answer?. Curr Pharm Des. 2012 Feb 27. [Medline].

  4. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015. 53 (10):962-1147. [Medline]. [Full Text].

  5. Anderson P. Pain patients at cognitive risk from anticholinergic burden? Medscape Medical News. April 15, 2013. Available at http://www.medscape.com/viewarticle/782520. Accessed: April 22, 2013.

  6. Anderson PA. Just 2 Months' Exposure to Anticholinergics Affects Cognition. Medscape Medical News. Available at http://www.medscape.com/viewarticle/804558. Accessed: May 27, 2013.

  7. Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2012 Nov 22. [Medline].

  8. Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000 Apr. 35(4):374-81. [Medline].

  9. Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium - theory, evidence and practice. Br J Clin Pharmacol. 2016 Mar. 81 (3):516-24. [Medline].

  10. Wilson ME, Lee GK, Chandra A, Kane GC. Central anticholinergic syndrome following dobutamine-atropine stress echocardiography. Echocardiography. 2011 Nov. 28(10):E205-6. [Medline].

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