3-Quinuclidinyl Benzilate Poisoning Follow-up

  • Author: Christopher P Holstege, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
 
Updated: Apr 10, 2015
 

Further Inpatient Care

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  • Inpatient care is no different than that discussed in Emergency Department Care. Keep symptomatic patients who were exposed to QNB in a monitored setting until their symptoms completely resolve. Use of maintenance intravenous fluids and sedatives such as benzodiazepines may be necessary. Prolonged intoxication may occur depending on the dose of QNB absorbed.
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Transfer

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  • Any health care facility that is unable to adequately monitor a patient intoxicated with an anticholinergic should consider transfer to a facility that can care for such patients.
  • Smaller health care facilities may be overwhelmed if a large-scale terrorist attack with multiple victims occurs. Disaster plan implementation and appropriate transfer of patients to less stressed facilities may be necessary.
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Complications

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  • Rhabdomyolysis: If a person exposed to QNB develops marked agitation or profound somnolence, tissue necrosis may occur and rhabdomyolysis may develop. If this remains undiagnosed, myoglobinuric renal failure may develop.
  • Anoxic brain injury: If an exposed person becomes comatose and loses his or her ability to maintain ventilatory function, hypoxia may develop and lead to anoxic brain injury.
  • Aspiration pneumonia: Inability of exposed patients to maintain their airway may result in aspiration of gastric contents into the lungs.
  • Ileus: The prolonged anticholinergic effects of QNB may lead to development of an ileus.
  • Angle-closure glaucoma: Those patients predisposed may be at risk due to the mydriasis induced by QNB.
  • Bleeding diathesis: Disseminated intravascular coagulation may develop in patients with shock and marked hyperthermia.
  • Hepatic injury: Hepatic injury may accompany antimuscarinic agent toxicity that involves hyperthermia or shock.
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Prognosis

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  • The prognosis is good for QNB-exposed patients if they do not develop a secondary injury such as the complications noted above. Once they are removed from the exposure and the absorbed QNB is metabolized, they should become more lucid. Full recovery is expected within 4 days. No long-term effects are expected from QNB itself.
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Patient Education

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Contributor Information and Disclosures
Author

Christopher P Holstege, MD Professor of Emergency Medicine and Pediatrics, University of Virginia School of Medicine; Chief, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Center

Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, Medical Society of Virginia, Society of Toxicology, Wilderness Medical Society, European Association of Poisons Centres and Clinical Toxicologists, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Duane C Caneva, MD, MSc Senior Medical Advisor to Customs and Border Protection, Department of Homeland Security (DHS) Office of Health Affairs; Federal Co-Chair, Health, Medical, Responder Safety Subgroup, Interagency Board (IAB)

Disclosure: Nothing to disclose.

Additional Contributors

Suzanne White, MD Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, Michigan State Medical Society

Disclosure: Nothing to disclose.

References
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  2. US Army Center for Health Promotion and Preventive Medicine. Psychodelic Agent 3 - Quinuclidinyl Benzilate (BZ). The Deputy for Technical Services' Publication: Detailed Chemical Facts Sheets. 1998. [Full Text].

  3. Byrd GD, Paule RC, Sander LC, et al. Determination of 3-quinuclidinyl benzilate (QNB) and its major metabolites in urine by isotope dilution gas chromatography/mass spectrometry. J Anal Toxicol. 1992 May-Jun. 16(3):182-7. [Medline].

  4. Gibson RE, Rzeszotarski WJ, Jagoda EM, et al. [125I] 3-quinuclidinyl 4-iodobenzilate: a high affinity, high specific activity radioligand for the M1 and M2-acetylcholine receptors. Life Sci. 1984 Jun 4. 34(23):2287-96. [Medline].

  5. Glendenning KK. Distribution of muscimol, QNB, and 5HT binding in the vertebrate diencephalon: a comparative study of eight mammals and three non-mammals. Microsc Res Tech. 2003 Oct 15. 62(3):247-61. [Medline].

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  8. Holstege CP, Bechtel LK, Reilly TH, Wispelwey BP, Dobmeier SG. Unusual but potential agents of terrorists. Emerg Med Clin North Am. 2007 May. 25(2):549-66; abstract xi. [Medline].

  9. Hull LA, Rosenblatt DH, Epstein J. 3-Quinuclidinyl benzilate hydrolysis in dilute aqueous solution. J Pharm Sci. 1979 Jul. 68(7):856-9. [Medline].

  10. J R Army Med Corps. Chemical casualties. Centrally acting incapacitants. J R Army Med Corps. 2002 Dec. 148(4):388-91. [Medline].

  11. Ketchum JS, Sidell FR. Incapacitating agents. Textbook of Military Medicine. 1997. 287-305.

  12. McDonough JH Jr, Shih TM. A study of the N-methyl-D-aspartate antagonistic properties of anticholinergic drugs. Pharmacol Biochem Behav. 1995 Jun-Jul. 51(2-3):249-53. [Medline].

  13. Sorger D, Kampfer I, Schliebs R. Iodo-QNB cortical binding and brain perfusion: effects of a cholinergic basal forebrain lesion in the rat. Nucl Med Biol. 1999 Jan. 26(1):9-16. [Medline].

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