The clinician must be familiar with the anticholinergic toxidrome as a reliable history is not always obtainable. ![]() Young children may be brought in by a caretaker/parent with suspected ingestion of unknown etiology. Patients may present after a suicide attempt and be unwilling or unable to disclose what they ingested. Patients may present with a history of intentional ingestion of common anticholinergic agents such as antihistamines or jimson weed however, the history is often less straightforward. Ī thorough history and physical exam are critical to the identification of patients with anticholinergic poisoning. Toxicity has also been reported with topical application. Illicit drugs, including cocaine and heroin, have been known to be contaminated with anticholinergics such as hyoscine or atropine. Plants that contain belladonna alkaloids are often abused due to their hallucinogenic properties. Plants are also a common source of accidental and intentional anticholinergic ingestion. The most common source of an anticholinergic drug overdose is antihistamines. This is especially important for elderly patients on numerous medications. Ingestion of multiple medications with anticholinergic properties is synergistic. Many medications possess anticholinergic activity as their primary pharmacologic effect, while others exhibit these properties as adverse effects. Medications with anticholinergic properties include antidepressants, antihistamines, antiparkinson drugs, antipsychotics, antispasmodics, and mydriatics. Atropine is an antidote for cholinergic toxicity from organophosphates and nerve agents and acute treatment of bradyarrhythmias. The vast majority of these agents are orally ingested. The naturally occurring compounds atropine, hyoscyamine, and hyoscine are the prototypical anticholinergics from which others are synthesized. Toxicity typically occurs secondary to an overdose of compounds with anticholinergic properties, although mild toxicity can even be seen as a side effect when the medication is taken appropriately. Substances with anticholinergic activity are used and misused extensively worldwide.
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