Anticholinergic Syndrome


Serotonin Syndrome Anti-cholinergic Syndrome Neuroleptic malignant syndrome (NMS)
Temp, HR, BP, Tachypnea Temp, HR, BP, Tachypnea Temp, HR, BP, Tachypnea
Pupils: Dilated Pupils: Dilated Pupils: Normal
Skin: Diaphoretic Skin: flushed Skin: Diaphoretic
Mucous Membrane: Drooling/ Salivation Mucous Membrane: Dry Mucous Membrane: Drooling/ Salivation
Tone in extremities, w/ hyper-reflexia & clonus Normal muscle tone  reflexes "lead-pipe" rigidity & reflexes
Treatment Treatment Treatment
Emergency/Severe:
- Midazolam 1-5mg/hr IV infusion and Morphine sulfate 1-5mg/hr IV infusion

Moderate:
- Diazepam 5-10 mg po x1, may repeat in 30-60 min
OR
- Cyproheptadine 12 mg PO x1, may repeat x1.

PLUS
Chlorpromazine 12.5-50mg IV ove 30-60 min. May repeat 4-8 hr according to response.
PLUS/Minus
Muscle paralysis (if rhabdo present)
GI symptoms:
 - Zofran + Bismuth, +/- IV Fluids

Tachycardia:
 - Lorazepam

Bradycardia:
- Atropine 0.5 mg IM/IV

Seizure:
- Lorazepam




 
Acute:
- Stop anti-psychotic meds
- IV Fluids
- Hyperthermia: Physical measures. (Tylenol, IBU do not work)
- Dysphasia: NG Tube.

Pharmacologic Therapy:
- Lorazepam 1-4 mg PO/IV x1
- Dandroline:
 Load: 2.5mg/kg IV Bolus, repeat PRN.
 Maintenance: 0.25mg/kg/hr IV infusion x36 hr.

 

Background

  1. A toxic syndrome or toxidrome that results from the blockade of cholinergic receptors
  2. Usually induced by medications

Pathophysiology

  1. Mechanism
  2. Etiology/Risk Factors
  3. Epidemiology

Diagnostics

  1. History/Symptoms
  2. Physical Exam/Signs
  3. Labs/Tests
  4. Imaging
  5. Other Tests
  6. Differential Diagnosis

Treatment

  1. Initial Therapy/Prep
  2. Medicine/Pharmaceuticals
  3. Avoid
  4. Indications for NICU Transfer

Disposition/Follow Up

  1. Admit all patients, even if reversed with physostigmine
  2. Prognosis: complete resolution with treatment

Patient Education

  1. Patients may need to be educated regarding medication safety or receive treatment for substance abuse
  2. Psychiatric consultation is recommended for suicidal intentions