Treatment of Anticholinergic Delirium with Oral Rivastigmine: A Case Report

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Christopher Karousatos MD, Lauren Murphy MD
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引用次数: 0

Abstract

Background

Anticholinergic toxicity is commonly encountered in the emergency department. However, the availability of physostigmine, a central acetylcholinesterase inhibitor used to reverse anticholinergic delirium, has been significantly limited due to national drug shortages in the United States. Several articles have explored the viability of rivastigmine as an alternative treatment in these patients.

Case Report

A 33-year-old man presented to the emergency department after a suspected suicide attempt. The patient was found with an empty bottle of diphenhydramine at the scene. On arrival, he was tachycardic and delirious, with dilated and nonreactive pupils and dry skin. As the clinical picture was highly suggestive of anticholinergic toxicity, the patient was treated with oral rivastigmine at a starting dose of 4.5 mg to reverse his anticholinergic delirium. Although a repeat dose was required, his delirium resolved without recurrence. Why Should an Emergency Physician Be Aware of This? Oral rivastigmine has been applied successfully here and in other case reports to reverse anticholinergic delirium with the benefit of prolonged agitation control. Emergency physicians may consider this medication in consultation with a specialist, with initial doses starting at 4.5–6 mg, if encountering anticholinergic delirium when physostigmine is not available.

口服利伐斯的明治疗抗胆碱能谵妄:病例报告
背景抗胆碱能药物中毒在急诊科很常见。然而,由于美国全国性的药物短缺,用于逆转抗胆碱能谵妄的中枢乙酰胆碱酯酶抑制剂--波司替明的供应受到了很大限制。多篇文章探讨了利巴斯的明作为此类患者替代治疗药物的可行性。患者在现场被发现有一个苯海拉明的空瓶。到达医院时,他心动过速、神志不清、瞳孔散大且无反应、皮肤干燥。由于临床表现高度提示抗胆碱能药物中毒,患者接受了口服利巴斯的明治疗,起始剂量为 4.5 毫克,以逆转其抗胆碱能谵妄。虽然需要重复给药,但他的谵妄症状已经缓解,没有复发。为什么急诊医生应该了解这一点?在本病例和其他病例报告中,口服利巴斯的明已成功逆转了抗胆碱能谵妄,并延长了躁动控制时间。如果遇到抗胆碱能谵妄而又无法使用波司替明的情况,急诊医生可以在咨询专科医生后考虑使用这种药物,初始剂量为4.5-6毫克。
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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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