Template:Anticholinergic Toxicity Treatement - Revision history

Ostermayer: Marked this version for translation

2026-01-23T09:02:53Z

Marked this version for translation

← Revisión anterior		Revisión del 09:02 23 ene 2026
Línea 2:		Línea 2:
	<translate>		<translate>

	==Treatment==		==Treatment== <!--T:1-->

			<!--T:2-->
	*Consider GI decon with [[Special:MyLanguage/Activated Charcoal\|Activated Charcoal]] if patient presents <2 hours after ingestion and remains cooperative		*Consider GI decon with [[Special:MyLanguage/Activated Charcoal\|Activated Charcoal]] if patient presents <2 hours after ingestion and remains cooperative

	===Sedation===		===Sedation=== <!--T:3-->

			<!--T:4-->
	*Decreases the risk of [[Special:MyLanguage/hyperthermia\|hyperthermia]], [[Special:MyLanguage/rhabdo\|rhabdo]], traumatic injuries		*Decreases the risk of [[Special:MyLanguage/hyperthermia\|hyperthermia]], [[Special:MyLanguage/rhabdo\|rhabdo]], traumatic injuries
	*[[Special:MyLanguage/Benzos\|Benzos]] are agents of choice especially increase seizure threshold<ref>Burns MJ, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000:35(4):374-381.</ref>		*[[Special:MyLanguage/Benzos\|Benzos]] are agents of choice especially increase seizure threshold<ref>Burns MJ, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000:35(4):374-381.</ref>
Línea 13:		Línea 15:
	**Goal: QRS duration < 110 msec		**Goal: QRS duration < 110 msec

	===Cholinesterase inhibition===		===Cholinesterase inhibition=== <!--T:5-->

			<!--T:6-->
	*Indicated for severe agitation or delirium (esp if unresponsive to [[Special:MyLanguage/benzos\|benzos]])		*Indicated for severe agitation or delirium (esp if unresponsive to [[Special:MyLanguage/benzos\|benzos]])
	*Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma		*Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma
Línea 29:		Línea 32:
	**'''Contraindicated''' in [[Special:MyLanguage/TCA toxicity\|TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block		**'''Contraindicated''' in [[Special:MyLanguage/TCA toxicity\|TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block

	===Other therapies===		===Other therapies=== <!--T:7-->

			<!--T:8-->
	*[[Special:MyLanguage/Sodium bicarbonate\|Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)		*[[Special:MyLanguage/Sodium bicarbonate\|Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)
	**2 mEq/kg bolus (typically 2-3 amps of bicarb)		**2 mEq/kg bolus (typically 2-3 amps of bicarb)

Ostermayer at 09:02, 23 January 2026

2026-01-23T09:02:40Z

← Revisión anterior		Revisión del 09:02 23 ene 2026
Línea 1:		Línea 1:
	<languages/>		<noinclude><languages/></noinclude>
	<translate>		<translate>

Ostermayer: Prepared the page for translation

2026-01-23T09:02:26Z

Prepared the page for translation

← Revisión anterior		Revisión del 09:02 23 ene 2026
Línea 1:		Línea 1:
			<languages/>
			<translate>

	==Treatment==		==Treatment==
	*Consider GI decon with [[Activated Charcoal]] if patient presents <2 hours after ingestion and remains cooperative
			*Consider GI decon with [[Special:MyLanguage/Activated Charcoal\|Activated Charcoal]] if patient presents <2 hours after ingestion and remains cooperative

	===Sedation===		===Sedation===
	*Decreases the risk of [[hyperthermia]], [[rhabdo]], traumatic injuries
	*[[Benzos]] are agents of choice especially increase seizure threshold<ref>Burns MJ, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000:35(4):374-381.</ref>		*Decreases the risk of [[Special:MyLanguage/hyperthermia\|hyperthermia]], [[Special:MyLanguage/rhabdo\|rhabdo]], traumatic injuries
			*[[Special:MyLanguage/Benzos\|Benzos]] are agents of choice especially increase seizure threshold<ref>Burns MJ, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000:35(4):374-381.</ref>
	**Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation		**Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation
	**Goal: QRS duration < 110 msec		**Goal: QRS duration < 110 msec

	===Cholinesterase inhibition===		===Cholinesterase inhibition===
	*Indicated for severe agitation or delirium (esp if unresponsive to [[benzos]])
			*Indicated for severe agitation or delirium (esp if unresponsive to [[Special:MyLanguage/benzos\|benzos]])
	*Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma		*Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma
	*Relatively contraindicated in asthma or ileus		*Relatively contraindicated in asthma or ileus
	*[[Physostigmine]] - strongly consider poison control consult before giving		*[[Special:MyLanguage/Physostigmine\|Physostigmine]] - strongly consider poison control consult before giving
	**Crosses blood brain barrier, can be used to help make dx		**Crosses blood brain barrier, can be used to help make dx
	**Dosing: 0.5mg-1mg IV over 5min (repeat dosing up to 2mg in first hour)<ref>Rosenbaum C and Bird SB. Timing and frequency for physostigmine redosing for antimuscarininc toxicity. J Med Toxicol. 2010;6:386-92.</ref>		**Dosing: 0.5mg-1mg IV over 5min (repeat dosing up to 2mg in first hour)<ref>Rosenbaum C and Bird SB. Timing and frequency for physostigmine redosing for antimuscarininc toxicity. J Med Toxicol. 2010;6:386-92.</ref>
Línea 18:		Línea 26:
	**Stop infusion every 12 hours to determine resolution of the toxidrome		**Stop infusion every 12 hours to determine resolution of the toxidrome
	**Side effects: bradycardia, dysrhythmias, cholinergic excess<ref>Pentel P and Peterson CD. Aystole complicating physostigmine treatment of tricyclic antidepressant overdose. Ann Emerg Med. 1980 Nov;9(11):588-90.</ref>		**Side effects: bradycardia, dysrhythmias, cholinergic excess<ref>Pentel P and Peterson CD. Aystole complicating physostigmine treatment of tricyclic antidepressant overdose. Ann Emerg Med. 1980 Nov;9(11):588-90.</ref>
	**Always have [[atropine]] at the bedside for bradycardia or cholinergic excess</ref><ref>Nguyen TT, et al. Adverse events from physostigmine: an observational study. Am J Emerg Med. 2018;36:141-2.</ref>		**Always have [[Special:MyLanguage/atropine\|atropine]] at the bedside for bradycardia or cholinergic excess</ref><ref>Nguyen TT, et al. Adverse events from physostigmine: an observational study. Am J Emerg Med. 2018;36:141-2.</ref>
	**'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block		**'''Contraindicated''' in [[Special:MyLanguage/TCA toxicity\|TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block

	===Other therapies===		===Other therapies===
	*[[Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)
			*[[Special:MyLanguage/Sodium bicarbonate\|Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)
	**2 mEq/kg bolus (typically 2-3 amps of bicarb)		**2 mEq/kg bolus (typically 2-3 amps of bicarb)
	**Begin continuous NaCO3 infusion at 250mL/hr if bolus effective		**Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
	**Solution preparation = 1L D5W mixed with 3 ampules NaHCO3		**Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
			</translate>

Ostermayer: /* Treatment */

2020-10-02T21:19:30Z

Treatment

@@ Línea 1: / Línea 1: @@
 ==Treatment==
 *Consider GI decon with [[Activated Charcoal]] if patient presents <2 hours after ingestion and remains cooperative
-*Sedation
+===Sedation===
-**Decreases the risk of [[hyperthermia]], [[rhabdo]], traumatic injuries
+*Decreases the risk of [[hyperthermia]], [[rhabdo]], traumatic injuries
-**[[Benzos]] are agents of choice especially increase seizure threshold
+*[[Benzos]] are agents of choice especially increase seizure threshold<ref>Burns MJ, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000:35(4):374-381.</ref>
 **Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation
 *[[Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)
 **2 mEq/kg bolus (typically 2-3 amps of bicarb)
 **Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
 **Solution preparation = 1L D5W mixed with 3 ampules NaHCO3

Beren85: /* Treatment */

2019-09-01T12:32:13Z

Treatment

← Revisión anterior		Revisión del 12:32 1 sep 2019
Línea 1:		Línea 1:
	==Treatment==		==Treatment==
	*Consider GI decon with [[Activated Charcoal]]		*Consider GI decon with [[Activated Charcoal]] if patient presents <2 hours after ingestion and remains cooperative
	*Sedation		*Sedation
	**Decreases the risk of [[hyperthermia]], [[rhabdo]], traumatic injuries		**Decreases the risk of [[hyperthermia]], [[rhabdo]], traumatic injuries
	**[[Benzos]] are agents of choice especially increase seizure threshold		**[[Benzos]] are agents of choice especially increase seizure threshold
			**Repeat boluses every 5-15 minutes as needed to halt seizures and provide adequate sedation
	*[[Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)		*[[Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)
	**2 mEq/kg bolus (typically 2-3 amps of bicarb)		**2 mEq/kg bolus (typically 2-3 amps of bicarb)
	**Begin continuous NaCO3 infusion at 250mL/hr if bolus effective		**Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
	**Solution preparation = 1L D5W mixed with 3 ampules NaHCO3		**Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
			**Goal: QRS duration < 110 msec
	*Cholinesterase inhibition		*Cholinesterase inhibition
	**Indicated for severe agitation or delirium (esp if unresponsive to [[benzos]])		**Indicated for severe agitation or delirium (esp if unresponsive to [[benzos]])
	**Contraindicated in QRS>100 or Na blockade signs (R' in aVR)		**Contraindicated in QRS>100 or Na blockade signs (R' in aVR) and in narrow angle glaucoma
	**Relatively contraindicated in asthma or ileus		**Relatively contraindicated in asthma or ileus
	**[[Physostigmine]] - strongly consider poison control consult before giving		**[[Physostigmine]] - strongly consider poison control consult before giving
	***Crosses blood brain barrier, can be used to help make dx		***Crosses blood brain barrier, can be used to help make dx
	***Dosing: ~~0.5~~-2mg IV over 5min		***Dosing: 1-2mg IV over 5min
	***Onset of action: 15-~~20min~~		***Onset of action: 5-10min
			***If partial response, repeat x3
			***If 3 or more administrations are needed over a 6-hour period, start IV infusion (bolus 1-2 mg followed by 1 mg/hour)
			***Stop infusion every 12 hours to determine resolution of the toxidrome
	***Side effects: bradycardia, dysrhythmias, cholinergic excess		***Side effects: bradycardia, dysrhythmias, cholinergic excess
	***Always have [[atropine]] at the bedside for bradycardia or cholinergic excess		***Always have [[atropine]] at the bedside for bradycardia or cholinergic excess
	***'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block		***'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block

Beren85: /* Treatment */

2019-09-01T12:16:25Z

Treatment

← Revisión anterior		Revisión del 12:16 1 sep 2019
Línea 18:		Línea 18:
	***Side effects: bradycardia, dysrhythmias, cholinergic excess		***Side effects: bradycardia, dysrhythmias, cholinergic excess
	***Always have [[atropine]] at the bedside for bradycardia or cholinergic excess		***Always have [[atropine]] at the bedside for bradycardia or cholinergic excess
	***'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest)		***'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest) and in the presence of bradycardia or AV block

Mholtz at 11:36, 24 February 2019

2019-02-24T11:36:36Z

← Revisión anterior		Revisión del 11:36 24 feb 2019
Línea 1:		Línea 1:
	==Treatment==		==Treatment==
	#GI decon		*Consider GI decon with [[Activated Charcoal]]
	#*[[Activated Charcoal]] ~~may be effective even >1hr after ingestion (decreased GI motility)~~		*Sedation
	#Sedation		**Decreases the risk of [[hyperthermia]], [[rhabdo]], traumatic injuries
	#*Decreases the risk of [[hyperthermia]], [[rhabdo]], traumatic injuries		**[[Benzos]] are agents of choice especially increase seizure threshold
	#*[[Benzos]] are agents of choice especially increase seizure threshold		*[[Sodium bicarbonate]] for conduction abnormalities (QRS prolongation)
	~~#Conduction abnormalities (QRS prolongation)~~		**2 mEq/kg bolus (typically 2-3 amps of bicarb)
	#*[[Sodium bicarbonate]]		**Begin continuous NaCO3 infusion at 250mL/hr if bolus effective
	#**~~Should be given at~~ 2 mEq/kg		**Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
	~~#**Typically~~ 2-3 amps of bicarb		*Cholinesterase inhibition
	#**Begin continuous NaCO3 ~~infusions~~ if bolus effective		**Indicated for severe agitation or delirium (esp if unresponsive to [[benzos]])
	#**Solution preparation = 1L D5W mixed with 3 ampules NaHCO3		**Contraindicated in QRS>100 or Na blockade signs (R' in aVR)
	#**~~Run NaHCO3 solutions at 250 mL/hr~~		**Relatively contraindicated in asthma or ileus
	#Cholinesterase inhibition		**[[Physostigmine]] - strongly consider poison control consult before giving
	#*Indicated for severe agitation or delirium (esp if unresponsive to [[benzos]])		***Crosses blood brain barrier, can be used to help make dx
	#*Contraindicated in QRS>100 or Na blockade signs (R' in aVR)		***Dosing: 0.5-2mg IV over 5min
	#*~~Relative~~ contraindicated in asthma or ileus		***Onset of action: 15-20min
	#*[[Physostigmine]] - strongly consider poison control consult before giving		***Side effects: bradycardia, dysrhythmias, cholinergic excess
	#**Crosses blood brain barrier, can be used to help make dx		***Always have [[atropine]] at the bedside for bradycardia or cholinergic excess
	#**Dosing: 0.5-2mg IV over 5min		***'''Contraindicated''' in [[TCA toxicity]] (associated with cardiac arrest)
	#**Onset of action: 15-20min
	#**Side effects: bradycardia, dysrhythmias, cholinergic excess
	#**Always have [[atropine]] at the bedside for bradycardia or cholinergic excess
	#**'''Contraindicated''' in [[TCA toxicity]], associated with cardiac arrest

Kxl328: /* Treatment */

2018-11-09T03:08:59Z

Treatment

← Revisión anterior		Revisión del 03:08 9 nov 2018
Línea 16:		Línea 16:
	#*Contraindicated in QRS>100 or Na blockade signs (R' in aVR)		#*Contraindicated in QRS>100 or Na blockade signs (R' in aVR)
	#*Relative contraindicated in asthma or ileus		#*Relative contraindicated in asthma or ileus
	#*[[Physostigmine]]		#*[[Physostigmine]] - strongly consider poison control consult before giving
	#**Crosses blood brain barrier, can be used to help make dx		#**Crosses blood brain barrier, can be used to help make dx
	#**Dosing: 0.5-2mg IV over 5min		#**Dosing: 0.5-2mg IV over 5min

Rossdonaldson1: /* Treatment */

2017-05-22T07:12:32Z

Treatment

← Revisión anterior		Revisión del 07:12 22 may 2017
Línea 6:		Línea 6:
	#*[[Benzos]] are agents of choice especially increase seizure threshold		#*[[Benzos]] are agents of choice especially increase seizure threshold
	#Conduction abnormalities (QRS prolongation)		#Conduction abnormalities (QRS prolongation)
	#*Sodium ~~Bicarbonate~~		#*[[Sodium bicarbonate]]
	#**Should be given at 2 mEq/kg		#**Should be given at 2 mEq/kg
	#**Typically 2-3 amps of bicarb		#**Typically 2-3 amps of bicarb

Lisayee25: /* Treatment */

2017-05-08T21:35:53Z

Treatment

← Revisión anterior		Revisión del 21:35 8 may 2017
Línea 22:		Línea 22:
	#**Side effects: bradycardia, dysrhythmias, cholinergic excess		#**Side effects: bradycardia, dysrhythmias, cholinergic excess
	#**Always have [[atropine]] at the bedside for bradycardia or cholinergic excess		#**Always have [[atropine]] at the bedside for bradycardia or cholinergic excess
			#**'''Contraindicated''' in [[TCA toxicity]], associated with cardiac arrest