We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Template:Anticholinergic Toxicity Treatement
From WikEM
Treatment
- GI decon
- Activated Charcoal may be effective even >1hr after ingestion (decreased GI motility)
- Sedation
- Decreases the risk of hyperthermia, rhabdo, traumatic injuries
- Benzos are agents of choice especially increase seizure threshold
- Conduction abnormalities (QRS prolongation)
- Sodium Bicarbonate
- Should be given at 2 mEq/kg
- Typically 2-3 amps of bicarb
- Begin continuous NaCO3 infusions if bolus effective
- Solution preparation = 1L D5W mixed with 3 ampules NaHCO3
- Run NaHCO3 solutions at 250 mL/hr
- Sodium Bicarbonate
- Cholinesterase inhibition
- Indicated for severe agitation or delirium (esp if unresponsive to benzos)
- Contraindicated in QRS>100 or Na blockade signs (R' in aVR)
- Relative contraindicated in asthma or ileus
- Physostigmine
- Crosses blood brain barrier, can be used to help make dx
- Dosing: 0.5-2mg IV over 5min
- 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
