Potentially life-threatening emergency
Anticholinergic syndrome
Alerts and Notices
Synopsis
Commonly implicated medications include anticholinergics such as benztropine and scopolamine, antihistamines such as meclizine and diphenhydramine, antipsychotics such as clozapine and olanzapine, antispasmodics such as dicyclomine and oxybutynin, cyclic antidepressants such as amitriptyline and imipramine, and mydriatics such as cyclopentolate.
Many plants also have anticholinergic properties, including wild mushrooms, nightshade, and Jimson weed.
Treatment includes supportive care and, in select cases, gastric decontamination and/or antidote treatment with physostigmine salicylate.
Codes
ICD10CM:T44.3X1A – Poisoning by other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, accidental (unintentional), initial encounter
SNOMEDCT:
216593002 – Accidental poisoning by anticholinergic
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Drug intoxication (eg, cocaine, amphetamines, ecstasy)
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Hypoglycemia
- Central nervous system infection (meningitis [viral, bacterial, fungal], encephalitis)
- Anti-NMDA receptor encephalitis
- Head trauma
- Pheochromocytoma
- Thyrotoxicosis
- Heat stroke
- Malignant hyperthermia
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/26/2019
Last Updated:03/26/2019
Last Updated:03/26/2019