[Physostigmine for the immediate treatment of a patient with the central anticholinergic syndrome induced by cocaine cut with atropine]. / Fysostigmine als acute behandeling van een patiënt met het centraal anticholinerg syndroom na gebruik van cocaïne versneden met atropine

A 34-year-old man was admitted in a coma after a nightlong abuse of cocaine and alcohol, whereupon he fell and convulsed at home. There was a fracture of the nose, hyperpyrexia, tachycardia and hypertension. Dry mouth and mydriasis were suggestive of anticholinergic poisoning. Physostigmine 3 mg were slowly administered intravenously, followed by complete neurological recovery and normalisation of the body temperature. There was no brain damage. Cocaine and atropine were found in the patient's urine. Several users of cocaine in various European countries have recently developed a central anticholinergic syndrome due to adulteration of cocaine with atropine. In the presence of indications for such an intoxication, physostigmine is the antidote of first choice.