Category: International EM
Keywords: Anticholinergic, Beers Criteria, mushrooms (PubMed Search)
A patient presents with altered mental status for unclear reasons- could it be anticholinergic syndrome?
There are many medications (e.g. Beers Criteria, see pearl from March 5, 2017) and plants (e.g.: certain mushrooms) that can cause this life-threatening toxidrome.
The quick mnemonic for anticholinergic poisoning is:
· Hot as a hare (hyperthermia)
· Red as a beet (flushed)
· Cry as a bone (decreased secretions)
· Blind as a bat (mydriasis)
· Mad as a hatter (delirium)
· Full as a flask (urinary retention)
Bottom line: Keep anticholinergic syndrome within your differential for a patient with altered mental status without a clear cause.
Note: An earlier version of this pearl incorrectly listed organophospahtes, which cause cholingeric toxicity.
The clinical manifestations of anticholinergic syndrome can be extensive. Additional symptoms can include:
· “Sinus tachycardia
· Decreased bowel sounds
· Functional ileus
· Urinary retention
· Myoclonic jerking
Patients with central anticholinergic syndrome may present with the following:
· Short-term memory loss
· Hallucinations (visual, auditory)
· Agitated delirium
· Seizures (rare)
· Respiratory failure
· Cardiovascular collapse”1