![]() Complications include hypertension, tachycardia, and tachypnea. The symptoms of a hallucinogenic toxidrome include disorientation, hallucinations, hyperactive bowel sounds, panic, and seizures. Substances that may cause this toxidrome include carbamates, mushrooms, and organophosphates.Ī mnemonic device to remember the signs/symptoms of organophosphate toxicity is SLUDGE- Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, and Emesis. Complications include bradycardia, hypothermia, and tachypnea. The symptoms of a cholinergic toxidrome include bronchorrhea, confusion, defecation, diaphoresis, diarrhea, emesis, lacrimation, miosis, muscle fasciculations, salivation, seizures, urination, and weakness. Substances that may cause this toxidrome include antihistamines, atropine, benztropine, datura, tricyclic antidepressants, and scopolamine.ĭue to the characteristic appearance and behavior of patients with this toxidrome, they are colloquially described as "Hot as a Hare, Dry as a Bone, Red as a Beet, Mad as a Hatter, Blind as a Bat". Complications include hypertension, hyperthermia, and tachycardia. ![]() I am interested in any questions you would like answered in the Question of the Week.The symptoms of an anticholinergic toxidrome include blurred vision, choreoathetosis, coma, decreased bowel sounds, delirium, dry skin, fever, flushing, hallucinations, ileus, memory loss, mydriasis (dilated pupils), myoclonus, psychosis, seizures, and urinary retention. Bladder rupture can occur-don’t forget the need for a urinary catheter. Although one would expect the patient to complain, the delirium overrides his discomfort. I’ve seen it missed because the top of the bladder was at the umbilicus. Prepared by Donna Sainato, Certified Poison Specialist, Tennessee Poison CenterĪlthough we are quite adept at treating anticholinergic toxicity, one of the more frequently overlooked signs is enlarged urinary bladder. Second-generation antihistamines: A study of poisoning in children. Verdu, E., Blanc Brisset I, Meyer Geraldine et al.Typical observation time is 4-6 hours or until asymptomatic. Monitor EKG for widening QRS and consider alkalinizing the serum with sodium bicarbonate if heart rate is 120 bpm and QRS duration greater than 120 milliseconds. Treatment is based on symptoms with IV fluids for tachycardia, benzo’s for agitation and seizures, urinary catheter for urinary retention, and cooling measures for hyperthermia (wet and windy). Diphenhydramine ingestions can cause QRS widening due to blocking of cardiac sodium channels. Tachycardia can be quite impressive, especially if the patient is agitated. Typical clinical presentation of 1 st generation antihistamines is an anticholinergic toxidrome that can be remembered by the following mnemonic: Dry as a bone (dries up secretions) Red as a beet (flushing) Blind as a bat (mydriasis, blurred vision) Mad as a hatter (agitation, hallucinations, seizures, delirium, drowsiness) Hot as hades (elevated temperature) and Full as a flask (urinary retention, distended bladder). The Poison Center recommends evaluation in a health care facility if amount ingested of diphenhydramine (one of the most frequently ingested) is 7.5mg/kg or greater than 150 mg. Toxicity occurs after 3-5 times the usual daily dose. Antihistamines also inhibit the binding of acetylcholine to muscarinic receptors (therefore called antimuscurinic) which causes anticholinergic signs and symptoms. ![]() H1 blocker antagonizes (counteracts) the effects of histamine on H1 receptor sites. There are two primary mechanisms of action that cause toxicity in antihistamines overdose. 2 nd generation antihistamines tend to be non-sedating and include: Loratadine (Claritin), Cetirizine (Zyrtec), and Fexofenadine (Allegra). Antihistamines are one of the most common OTC medications used to help alleviate allergy symptoms and allergic reactions.ġ st generation antihistamines tend to be sedating and include: Diphenhydramine (Benadryl), Chlorpheniramine (Chlor-Trimeton), and Brompheniramine (Dimetapp). 2020 is a unique year in that, Tennesseans are spending more time outside working in their yards, walking and exercising due to the quarantine and social distancing mandates. Allergy season is in full swing in Tennessee and the use of allergy medication increases as a result.
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