Hard Question #5

[MarkSeve808]

A 30 year old female is brought to the emergency department after a suicide attempt. According to

paramedics, she took an overdose of antipsychotic medications. After examining her, you are concerned

that she might have features of the anticholinergic toxidrome.

 

Features of anticholinergic overdose include each of the following except?

 

A. Fever

B. Agitation

C. Increased bowel sounds

D. Tachycardia

E. Urinary retention

 

???????????

[Medlor2010]

The answer is D.

[RyanMaverick]

I'm pretty sure that anticholinergics cause an increase in heart rate. It's one of the reasons we caution their use in cardiovascular disease patients.

 

My answer would be C. Constipation is a frequent side effect of anticholinergic medication.

 

Of course, this is all coming from a pharmacist.

[A-Stark]

It's absolutely C. Just need to think of anything that wouldn't happen with blocked parasympathetic/increased sympathetic outflow.

[MarkSeve808]

Hmmm. Seems like C is the popular answer. Medlor would you care to explain your reasoning in choosing D?

[moo]

Remember: red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare. Probably the only thing I remember from med school.

[thebouque]

Parasympathetic increases the GI activty. You block that with an anticholinergic, and you get less intestinal activity, thus less bowel sounds. Answer is C.

[MarkSeve808]

Great discussion guys and kudos to Moo remembering the anticholinergic toxidrome quotation, which is word for word in this answer!

 

The correct answer is choice C.

 

The anticholinergic toxidrome has been described as "hot as a hare, red as a beet, dry as a bone, and mad as a hatter."

 

Anticholinergic syndrome can be caused by antihistamines, antipsychotics, atropine, antidepressants, and antiparkinsonian

medications. Plants such as nightshade and jimson weed are also known to cause anticholinergic effects.

 

Symptoms include fever (choice A), agitation (choice , decreased bowel sounds, mydriasis, urinary retention (choice E),

and tachycardia (choice D).

 

Treatment is predominantly supportive, although benzodiazepines and the antidote physostigmine can both improve

symptoms.

 

Suggested References

Hack, Jason B and Hoffman, Robert S. General Management of the Poisoned Patient. Chapter 156 in Emergency Medicine: A

Comprehensive Study Guide, Tintinalli, Judith (editor). 6th Edition. New York : McGraw Hill, 2004.

[MarkSeve808]

I am going to post Hard Question #6 right now!

[bloh]

I am going to post Hard Question #6 right now!

 

Hopefully in a consolidated thread so you aren't diluting useful topics in this forum.