Accidental acute clidinium toxicity.

Clidinium bromide (N-methyl-quinuclidinyl-benzylate) is a rarely used antimuscarinic drug that is marketed in combination with chlordiazepoxide as an antispasmodic for use in irritable bowel syndrome. A case is reported of an accidental staggered overdose of clidinium bromide 50 mg in a patient using illicit chlordiazepoxide. The presenting features were mildly dilated pupils and palpitation secondary to sinus tachycardia that persisted for 11 h after the time of first ingestion. Emergency physicians should be aware of the potential for antimuscarinic toxicity in patients using illicit chlordiazepoxide.

Acute angle-closure glaucoma precipitated by local tiotropium absorption.

Acute angle-closure glaucoma is a rare form of glaucoma occurring when the filtration mechanism for the aqueous humor is obstructed by apposition of the peripheral iris to the trabecular meshwork. It may be precipitated by pupillary dilatation in a predisposed eye. In this case report, a possible relationship between local tiotropium absorption and acute angle-closure glaucoma attack is presented.

Love potions and the ointment of witches: historical aspects of the nightshade alkaloids.

BACKGROUND: Nightshade plants (Solanaceae) have been utilized as hallucinogenic drugs since antiquity in nearly every culture. The Solanaceae alkaloids, atropine and scopolamine, were the active substances in ointment of witches and medieval anesthetics, and in modern poisons. They are still currently used as hallucinogenic drugs. In poisonings, a dosage- and substance-dependent clinical picture occurs, with central and peripheral symptoms. Hallucinations are predominant in the middle dose range, which explains the drugs' earlier utilization for religious and prophetic purposes. Respiratory depression and arrest at high doses confirm the use of scopolamine as a lethal poison. Despite this, the nightshade alkaloids were utilized in clinical medicine in the 19th century. This is an overview of the cultural history of the nightshade alkaloids.

Systemic toxicity from ocular homatropine.

Toxidromes are well known to emergency physicians. An unclear or incomplete history and subtle findings on physical examination make the diagnosis of poisonings challenging. This article reports a patient who had an acute onset of visual hallucinations, pressured speech, and mania. Although she denied taking any medications, she was ultimately diagnosed as having anticholinergic toxicity. On further questioning of family members, it was discovered that she was being treated for anterior uveitis with 5% homatropine. This case illustrates the potential role of ocular medications in systemic toxicity. Patients often do not consider eyedrops to be medications, and their use may be overlooked in the medical history. It also is important to educate patients and medical staff in methods to minimize systemic toxicity when using ocular medication.

[Encephalopathy following poisoning with an anticholinergic agent]. / Enzephalopathie nach Intoxikation mit einem Anticholinergikum.

A 55-year-old chemical laboratory technician developed mydriasis and ocular hypertension, which lasted for 6 weeks, after synthesizing several kilograms of a scopolamine-related test agent with anticholinergic action and then decanting a powdery intermediary substance, the dust of which he may have inhaled. Six weeks later he suddenly had symptoms of an acute intoxication while synthesizing a scopolamine-related substance. The anticholinergic delirium regressed completely within one day requiring no treatment. But subsequently he developed symptoms of a toxic encephalopathy. This only partially regressed over the following 3 years. Its probable cause is thought to have been either the manifestation of an already existing organic cerebral psychiatric syndrome or an as yet unknown effect of the test substance.