Anticholinergic Toxicity

Roy Perlis

A. Signs and symptoms

· Dry mouth

· Hyperpyrexia

· Dry, flushed skin

· Tachycardia

· Blurred vision

· Urinary retention, Constipation

· Delirium

B. Physostigmine challenge

when anticholinergic toxicity is suspected:

· Have atropine 0.4mg at bedside (antidote)

· Push physostigmine 1mg IV over 2-3min.

· Monitor vitals, EKG (for bradycardia)

source: Hyman SE and Tesar GE (1994) Manual of Psychiatric Emergencies. Little, Brown.