Anticholinergic syndrome

a. Findings. Elevated temperature; delirium; mumbling speech; tachycardia; dry, flushed skin; dry mucous membranes; urinary retention; decreased to absent bowel sounds; mydriasis; and blurred vision. Seizures and coma may also occur.

b. Mnemonic for many of the features of this toxidrome: "Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter, bloated as a bladder."

c. Agents. Drugs and toxins that block acetylcholine at mus-carinic receptors; especially, atropine and atropine-like agents. These include several commonly used over-the-counter cold medications containing antihistamines, antiparkinson medications (benztropine, trihexyphenidyl, topical mydriatics), antispasmodics (Donnatal, dicyclomine), muscle relaxants (cyclobenzaprine, orphenadrine), and belladonna alkaloids (scopolamine, hyoscyamine). Cyclic antidepressants also cause anticholinergic symptoms. Plants that contain belladonna alkaloids include jimson weed (Datura stramonium), deadly nightshade (Atropa belladonna), and henbane (Hyoscyamus nigei).

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