Anticholinergic Syndrome

Anticholinergic Syndrome – General Information

Anticholinergic Syndrome – Symptoms

The first thing that doctors should do when a person is suspected of suffering from Anticholinergic Syndrome is to determine the exact substances which were ingested, the quantity and the duration of the ingestion as well as the co-ingestants and the reasons for consuming such products. Then the patients should provide the doctors all the information about the medical history of their family, the drugs they took recently (both those prescribed by a doctor and those they took individually, including herbal or other natural products) as many of these can lead to extra toxicity. Patients usually describe the symptoms of this disease in the following way: “dry as a bone, red as a beet, blind as a bat, hot as a hare and mad as a hatter.” 

We can deduce then that the main symptoms are the loss of accommodation, dry skin, dry mucous membranes, fever and changed mental status. Further manifestations of the Anticholinergic Syndrome are represented by a decrease of hearing, sinus tachycardia, urinary retention, tremulousness, hypertension and functional disorders. The sufferers of central development of this disease are probably to also experience disorientation, ataxia, confusion, memory loss, psychosis, hallucinations, agitated delirium, respiratory failure, coma and even cardiovascular collapse. fever, the most common symptom of this illness, is characterized by an increase of the body temperature which exceeds the normal level and the normal variation. In contrast, in a small number of cases, patients can suffer from hyperthermia, which leads to the impossibility of losing heat.

Anticholinergic Syndrome – Treatment

When a person is suspect of suffering from Anticholinergic Syndrome, the first thing which must be done is to transport him to the nearest hospital or any other kind of medical centre which can provide him the first aid. The first procedures should focus on the respiratory, circulatory and neurological systems. The patient’s condition should then be permanently monitored for vital signs and, if there are signs of mental disorders he should be administered thiamine and naloxone. If a seizure is necessary, use benzodiazepines. In what concerns the pre-hospital setting, the use of physostigmine is totally inadmissible and so is the administration of ipecac syrup and activated charcoal; though, these are suggested if it is expected a long transport to the hospital. Once arrived at the hospital, the patients diagnosed with Anticholinergic Syndrome must benefit of assessment and stabilization and, after the arrival of the ED, they must be assured an adequate airway and doctors should permanently check the breathing.

There can appear an insufficiency in what concerns the respiration and, if this happen, the doctors should provide oxygen. Further on, in order to control the evolution of the Anticholinergic Syndrome, the specialists must initiate pulse and cardiac oximetry and asses circulation as well as examine the sufferer’s body. After the ED results are available, if the patient suffers from sinus tachycardia he does not need special treatment but he should be given sodium bicarbonate supplements if he is diagnosed with QRS prolongation. The next test should be a blood test in order to measure the level of glucose. On the other hand, if the patients are suspected of any kind of trauma or they are agitated, it may help if somebody talks to them and assure them they everything will be alright. If the reason for developing Anticholinergic Syndrome is ingestion then a GI decontamination is vital after the initial stabilization. For most of the patients, a single dose of ipecac syrup is enough in order to activate charcoal and it is best to be administrated by nasal-gastric tube or by mouth. This is a recommended procedure even if the sufferers present a long period after post-ingestion. In what concern the anticholinergic substances, these involve large quantities of distribution so they are not recommended; mostly, they are considered totally ineffective methods of treatment. For the patients who suffer GI decontamination as well as for those who experience hallucinations, supportive care is prescribed. They react very well if they get permanently reassurance. Moreover, for those who suffer from hallucinations, doctors can prescribe small doses of physostigmine, drug which proved to be quite useful in such cases. In order to get over this disease and to receive the right treatment is extremely important to consult a doctor and to follow his instructions exactly. After getting the first aid in treating Anticholinergic Syndrome, you must keep in touch with the local poison centre as well as with a toxicologist, in order to find out everything you need to know about therapeutic interventions, assistance and the usage of certain drugs and their further implications on your life.