Physostigmine is superior to non-antidote therapy in the management of antimuscarinic delirium: a prospective study from a regional poison center.

CONTEXT: Poison centers (PCs) frequently manage patients with antimuscarinic delirium. However, controversy surrounds the antidotal use of physostigmine for its treatment. The aim of this study was to prospectively investigate physostigmine versus non-antidote therapy for the management of antimuscarinic delirium in a single regional PC. METHODS: This was a prospective observational analysis of patients diagnosed with antimuscarinic delirium and treated in consultation with a regional PC. Certified Specialists in Poison Information (CSPIs) use a clinical guideline to recommend the use of physostigmine. Using a previously derived altered mental status score, we quantified the rate of delirium improvement with physostigmine compared to non-antidote therapy two hours after initial patient identification. We also recorded adverse events (defined a priori as bradycardia, vomiting, seizures) and resource utilization (intubation and physical restraint). RESULTS: We identified 245 patients and included 154 in the analysis. The most common exposure classes were antihistamines (68%), analgesics (19%), and antipsychotics (19%). CSPIs recommended physostigmine in 81% (125) of cases and the treatment team administered it in 37% (57) of these. We observed delirium control in 79% of patients who received physostigmine versus 36% of those who did not. The odds of delirium control were six times greater for patients receiving physostigmine than for patients treated with non-antidote therapy (OR 6.6). Adverse events were rare and did not differ significantly between the groups. Physostigmine was not associated with changes in the incidence of intubation or restraint. CONCLUSIONS: This study provides further evidence of both the safety and efficacy of physostigmine in the treatment of antimuscarinic delirium.

Factors affecting the flight capacity of Tetrastichus planipennisi (Hymenoptera: Eulophidae), a classical biological control agent of Agrilus planipennis (Coleoptera: Buprestidae).

The dispersal characteristics of a biological control agent can have direct implications on the ability of that agent to control populations of a target host. Tetrastichus planipennisi Yang (Hymenoptera: Eulophidae) is a parasitic wasp native to eastern Asia that has been introduced into the United States as part of a classical biological control program against the emerald ash borer Agrilus planipennis Fairmaire (Coleoptera: Buprestidae). We used computer-monitored flight mills to investigate the role of age, feeding status, mating status, and size on the flight capacity of female T. planipennisi over a 24-h period. We also compared flight capacity between sexes. Flight distance of female T. planipennisi representative of populations released in the biological control program averaged 1.26 km in 24 h with a maximum flight of just over 7 km. Median flight distance, however, was 422 m. The flight capacity of females fed a honey-water solution was 41× that of females provided only water, who flew very little. Larger females were capable of flying farther distances, but age did not affect the flight capacity of females up to 70 d posteclosion. Females dispersed 6× farther than did their smaller, male counterparts. The implications of our findings to host-parasitoid interactions and release protocols for distributing T. planipennisi are discussed.