Anticholinergic Syndrome
Anticholinergic Syndrome
Anticholinergic syndrome is an uncommon but often underdiagnosed condition caused by excessive anticholinergic medication or ingestion. It is characterized by symptoms such as dryness of the skin and mucous membranes, fever, tachycardia, confusion, dryness of mouth and eyes, and a distinctive facial flush. Treatment options are available but may depend on the specific cause of the syndrome.
Anticholinergic syndrome is classified as either primary or secondary. Primary anticholinergic syndrome is caused by excessive anticholinergic medication or ingestion. Common medications associated with anticholinergic syndrome include antihistamines, mature tricyclic antidepressants, and drugs used to treat gastrointestinal and urinary symptoms, including antispasmodics, antacids, and antidiarrheal drugs.
Symptoms
The symptoms of anticholinergic syndrome include:
- retarded mental status
- a distinctive red skin flush
- dryness of the skin and mucous membranes
- fever
- tachycardia
- agitation and delirium
- dryness of the eyes and mouth
- urinary retention
- urinary incontinence
- blurred vision
- abdominal pain
- nausea and vomiting
- constipation
Diagnosing Anticholinergic Syndrome
The diagnosis of anticholinergic syndrome usually requires a comprehensive evaluation by a healthcare professional. The evaluation should include a thorough review of the patient's history, physical examination, laboratory tests, and imaging tests. The diagnosis may also involve an electrocardiogram (ECG) and a urine analysis to detect elevated anticholinergic medication levels.
Treatment
Treatment of anticholinergic syndrome may involve discontinuing the medication that produced the condition and replacing it with a safer alternative. Special attention should be paid to medications that are potentially toxic and must be discontinued immediately. In some cases, medications with anticholinergic action can be decreased gradually to minimize the risk of an acute reaction. It is also important to identify and treat any underlying conditions, such as hypothyroidism or hepatic disease.
Treatment of anticholinergic syndrome may also involve the administration of supportive medications such as antihistamines or anti-nausea medications. For more severe cases, a variety of treatments, including intravenous fluids, medications to stimulate the sympathetic nervous system, and injections of muscle relaxants, may be used.