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Potentially life-threatening emergency
Anticholinergic syndrome
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Potentially life-threatening emergency

Anticholinergic syndrome

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Contributors: Joon B. Kim BS, Christine Osborne MD, Jamie Adams MD, Abhijeet Waghray MD
Other Resources UpToDate PubMed

Synopsis

Anticholinergic syndrome commonly follows the ingestion of implicated prescription and over-the-counter medications and is caused by the inhibition of cholinergic neurotransmission at the muscarinic receptor sites. Symptoms include flushing, dry mucous membranes and skin, fever, and altered mental status. Physical examination reveals tachycardia, hypertension, mydriasis with loss of accommodation, urinary retention, myoclonic jerking, decreased bowel sounds, and functional ileus.

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

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.

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References

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Last Reviewed: 03/27/2019
Last Updated: 03/27/2019
Copyright © 2019 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Anticholinergic syndrome
Print 1 Images
Anticholinergic syndrome : Agitation, Flushing, Delirium, Tachycardia, Antipsychotic, Antihistamine, Mydriasis, Hyperthermia, Anhidrosis, Anticholinergic
Copyright © 2019 VisualDx®. All rights reserved.