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1.
J Med Case Rep ; 13(1): 322, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31665073

RESUMO

BACKGROUND: Brugmansia suaveolens is the commonest species under the Solanacea ("Angels Trumpet" in English; "Attana" in Sinhalese) plant family in Sri Lanka. It contains alkaloids like scopolamine, atropine and hyoscyamine which can cause an anticholinergic toxindrome. There have been a few reported cases of accidental ingestion of Brugmansia seeds among children, seeds being the most toxic part, but no such reported cases of Brugmansia leaves poisoning among adults. CASE PRESENTATION: A 60-year-old-female Sinhalese presented with acute confusion, delirium, and agitation. She had ingested a herbal drink made from leaves of an unknown plant from her garden prior to onset of symptoms. She had urinary retention, mydriasis and sinus tachycardia. She was managed supportively with activated charcoal and hydration and the delirium completely resolved within 15 hours. The presented unkown plant leaves were identified as Brugmansia suaveolens. CONCLUSION: Although seeds are the most toxic plant part in most cases of Brugmansia poisoning, leaves also have a significant degree of toxicity. It is important that medical professionals promptly recognize the features of anticholinergic syndrome, and have a high index to suspect Brugmansia poisoning and start prompt treatment. It is also important to improve awareness of toxic plants among the general community to prevent toxicities and fatalities.


Assuntos
Síndrome Anticolinérgica/etiologia , Bebidas/envenenamento , Brugmansia/envenenamento , Folhas de Planta/envenenamento , Feminino , Humanos , Pessoa de Meia-Idade
2.
Lakartidningen ; 1162019 Sep 25.
Artigo em Sueco | MEDLINE | ID: mdl-31573667

RESUMO

Sometimes it is suspected that people have been involuntary exposed to drugs, usually by spiked drinks. A young woman was transported to an emergency department by ambulance. Her clinical symptoms (decreased consciousness, mydriasis, confusion, hallucinations and urine retention) indicated anticholinergic syndrome that was effectively treated with the antidote physostigmine. A urine sample tested negative for common narcotic drugs and alcohol, but an extended toxicological analysis of the urine revealed the presence of the alkaloid scopolamine. Scopolamine occurs naturally in Solanaceae plants and is used in some medications. The woman reported that the symptoms had appeared soon after she was offered tea by a male acquaintance. The analytical results along with the woman's story indicated that she had been subjected to a drug-facilitated crime. The results further demonstrate that in suspected cases of involuntary drug exposure, testing should cover a wide panel of relevant drugs, otherwise poisoning may be missed.


Assuntos
Antagonistas Colinérgicos , Escopolamina , Detecção do Abuso de Substâncias , Adolescente , Adulto , Síndrome Anticolinérgica/tratamento farmacológico , Síndrome Anticolinérgica/etiologia , Antídotos/uso terapêutico , Antagonistas Colinérgicos/envenenamento , Antagonistas Colinérgicos/urina , Cromatografia Líquida de Alta Pressão , Vítimas de Crime , Feminino , Humanos , Espectrometria de Massas , Fisostigmina/uso terapêutico , Escopolamina/envenenamento , Escopolamina/urina , Detecção do Abuso de Substâncias/métodos , Detecção do Abuso de Substâncias/normas , Adulto Jovem
3.
Geriatr Gerontol Int ; 19(7): 628-634, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31033150

RESUMO

AIM: The aim of this study was to develop the Korean Anticholinergic Burden Scale through assessment of previously developed tools, a literature review and a modified Delphi process. METHODS: We carried out a systematic review to identify previously published anticholinergic burden tools. A composite medication list was made by extracting medications and their quantitative grading from the existing tools, after excluding the medications not distributed in Korea and topical agents. We also added medications available in Korea that had not been rated. For medications with conflicting anticholinergic scores or no anticholinergic score, we determined the final score from 0 ("no anticholinergic effect") to 3 ("strong anticholinergic effect") with a literature review and expert consensus through a two-round Delphi process. RESULTS: A composite list of 655 medications with anticholinergic scores was extracted from 10 existing tools. A total of 38 medications available in Korea were added to the list. A total of 494 medications were deemed suitable for a Korean-specific scale. We confirmed the anticholinergic scores of 352 medications from existing scales, and 142 underwent the Delphi process. The final scores graded by experts showed high reliability among experts with an intra-class correlation of 0.98 (95% confidence interval 0.97-0.98). Finally, 56 medications were categorized as strong anticholinergics, 23 as moderate, 59 as weak and 356 as having no anticholinergic activity. CONCLUSIONS: This newly created consensus-driven anticholinergic burden scale designed specifically for the Korean healthcare system might be a practical tool for assessing anticholinergic burden in older adults with polypharmacy in routine medication reviews and in research. Geriatr Gerontol Int 2019; 19: 628-634.


Assuntos
Envelhecimento/efeitos dos fármacos , Síndrome Anticolinérgica , Antagonistas Colinérgicos/farmacologia , Prescrição Inadequada/prevenção & controle , Lista de Medicamentos Potencialmente Inapropriados , Pesos e Medidas , Idoso , Síndrome Anticolinérgica/etiologia , Síndrome Anticolinérgica/prevenção & controle , Antagonistas Colinérgicos/classificação , Assistência à Saúde/métodos , Assistência à Saúde/normas , Técnica Delfos , Humanos , Polimedicação , República da Coreia
4.
Pediatr Crit Care Med ; 19(10): 917-924, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30284995

RESUMO

OBJECTIVES: It is important to describe and understand the prevalence and risk factors for the syndrome of delirium in critical illness. Since anticholinergic medication may contribute to the development of delirium in the PICU, we have sought to quantify anticholinergic medication exposure in patients with prolonged admission. We have used Anticholinergic Drug Scale scores to quantify the magnitude or extent of this burden. DESIGN: Retrospective cohort study, January 2011 to December 2015. SETTING: Single academic medical center PICU. PATIENTS: Children under 18 years old with a PICU admission of 15 days or longer, requiring mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Daily Anticholinergic Drug Scale scores for the first 15 days of admission, in each of 88 subjects (total of 1,320 PICU days), were collected and assessed in relation to demographic data, severity of illness, and medication use. Median (interquartile range) of daily Anticholinergic Drug Scale score was 5 (interquartile range, 3-7). Anticholinergic Drug Scale score was not associated with age, sex, medical history, presenting Severity of Illness score, PICU length of stay, ventilator hours, or hospital mortality. Medications most frequently associated with high Anticholinergic Drug Scale score were low potency anticholinergic drugs such as morphine, midazolam, vancomycin, steroids, and furosemide, with the exception of ranitidine (Anticholinergic Drug Scale score 2). Patients receiving high doses of midazolam infusion had significantly higher Anticholinergic Drug Scale scores compared with those receiving lower or no midazolam dosing. CONCLUSIONS: A high number of medications with anticholinergic effects are administered to PICU patients receiving prolonged mechanical ventilation. These exposures are much higher than those reported in adult intensive care patients. Since anticholinergic drug exposure is associated with delirium, further study of this exposure in PICU patients is needed.


Assuntos
Síndrome Anticolinérgica/epidemiologia , Antagonistas Colinérgicos/efeitos adversos , Delírio/epidemiologia , Uso de Medicamentos/estatística & dados numéricos , Adolescente , Síndrome Anticolinérgica/etiologia , Criança , Pré-Escolar , Antagonistas Colinérgicos/administração & dosagem , Estado Terminal/mortalidade , Delírio/induzido quimicamente , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
5.
Ann Cardiol Angeiol (Paris) ; 67(3): 215-218, 2018 Jun.
Artigo em Francês | MEDLINE | ID: mdl-29759800

RESUMO

OBJECTIVE: To identify a hypertensive clinical form of atropine or anticholinergic toxidrome secondary to accidental consumption of Datura seeds. PATIENTS AND METHODS: We report two cases of Datura intoxication in two children who presented marked anticholinergic syndrome whose diagnosis was made by the anamnesis and the clinic. RESULT: Patient 1: A 5-year-old boy, returns home agitated with balance disorders. He was admitted to pediatric resuscitation unit. His Glasgow score was 11/15. The child made inconsistent remarks. The neurological examination revealed mydriasis. Hemodynamically, the blood pressure was 145/91mmHg, the heart rate was 145 bpm. The rest of the examination noted a temperature of 37.5°, a bladder globe. Standard biological tests were normal. ECG found sinus tachycardia. Urine analysis revealed a positive alkaloid reaction with the presence of atropine. The evolution was favorable after 48hours. Patient 2: 45-month-old boy admitted to a state of severe agitation of toxic origin. The clinical examination showed a central and peripheral anticholinergic symptomatology with severe hallucinations, severe hypertension, and a heart rate at 190 bpm. The rest of the examination found erythema in the thorax and upper limbs, bilateral mydriasis. The toxicological report confirmed the presence of alkaloids. The evolution was favorable. CONCLUSION: Hypertension crisis and other anticholinergic clinical signs of Datura stramonium intoxication achieve favorable outcomes in children.


Assuntos
Síndrome Anticolinérgica/etiologia , Datura stramonium/envenenamento , Hipertensão/induzido quimicamente , Intoxicação por Plantas , Síndrome Anticolinérgica/diagnóstico , Pré-Escolar , Humanos , Hipertensão/diagnóstico , Masculino , Intoxicação por Plantas/diagnóstico
6.
Sao Paulo Med J ; 136(6): 591-593, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29116302

RESUMO

CONTEXT: The seeds from Lupinus mutabilis Sweet, also called "chocho", are an important part of the diet in several countries in South America. Prior to consumption, processing is required to remove toxic alkaloids. These alkaloids are known to have pharmacological properties as antiarrhythmics, antimuscarinics and hypoglycemics. CASE REPORT: We report a case in which a one-year-old male initially presented with altered mental status and respiratory distress and subsequently developed symptoms of anticholinergic toxicity, after ingesting a large amount of chocho seeds. CONCLUSION: In spite of going through a difficult clinical condition, the subject evolved favorably through receiving supportive treatment. The seeds from Lupinus mutabilis provide nutritional benefits when consumed, but people need to know their risks when these seeds are consumed without proper preparation.


Assuntos
Síndrome Anticolinérgica/etiologia , Ingestão de Alimentos , Doenças Transmitidas por Alimentos/etiologia , Lupinus/envenenamento , Alcaloides/envenenamento , Síndrome Anticolinérgica/sangue , Síndrome Anticolinérgica/diagnóstico , Antagonistas Colinérgicos , Doenças Transmitidas por Alimentos/sangue , Doenças Transmitidas por Alimentos/diagnóstico , Humanos , Hipoglicemiantes , Lactente , Masculino
9.
Alzheimers Res Ther ; 9(1): 58, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28764796

RESUMO

BACKGROUND: Drugs with anticholinergic properties may be associated with various adverse clinical effects. The relationship between the anticholinergic (AC) burden and functional, global cognitive performance and behavior disturbances was assessed among elderly patients. METHODS: A cross-sectional study was conducted between January 2012 and June 2014 in a memory clinic among outpatients living at home and with subjective cognitive decline (SCD) or neurocognitive disorders (NCD). The AC burden was measured using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden (ACB), Chew's score, Han's score, and the number of drugs with AC activity. Functional, cognitive performance and behavior disturbances were assessed using the Instrumental Activities of Daily Living (IADL) scale (IADL), the Mini Mental State Examination (MMSE), and the Neuropsychiatric Inventory (NPI). RESULTS: Among 473 included patients, 46.3% were at major NCD. Patients took on average 5.3 ± 2.6 drugs. MMSE was lower when Han's score (p = 0.04) and number of AC drugs were higher (p < 0.001). IADL was lower when AC burden was higher, whatever the AC measurement. NPI was higher when ACB, Han's score, and number of AC drugs were higher. After adjustment, all AC scores remained associated with IADL, while Han's score and number of drugs with AC remained associated with the MMSE. CONCLUSIONS: In patients with SCD or NCD, AC burden is associated with lower functional score, whereas the cross-sectional association between AC burden and cognitive performance or behavioral disturbance varies according to AC scores. Particular attention should be paid when prescribing drugs with AC properties, especially among patients with memory complaints.


Assuntos
Síndrome Anticolinérgica/etiologia , Antagonistas Colinérgicos/efeitos adversos , Transtornos Cognitivos/tratamento farmacológico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Testes Neuropsicológicos , Estudos Retrospectivos , Índice de Gravidade de Doença
10.
J Emerg Med ; 53(4): 520-523, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28756934

RESUMO

BACKGROUND: Scopolamine is a potent anticholinergic compound used commonly for the prevention of postoperative nausea and vomiting. Scopolamine can cause atypical anticholinergic syndromes due to its prominent central antimuscarinic effects. CASE REPORT: A 47-year-old female presented to the emergency department (ED) 20 h after hospital discharge for a right-knee meniscectomy, with altered mental status (AMS) and dystonic extremity movements that began 12 h after her procedure. Her vital signs were normal and physical examination revealed mydriasis, visual hallucinations, hyperreflexia, and dystonic movements. Laboratory data, lumbar puncture, and computed tomography were unrevealing. The sustained AMS prompted a re-evaluation that revealed urinary overflow with 500 mL of retained urine discovered on ultrasound and a scopolamine patch hidden behind her ear. Her mental status improved shortly after patch removal and physostigmine, with complete resolution after 24 h with discharge diagnosis of scopolamine-induced anticholinergic toxicity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although therapeutically dosed scopolamine transdermal patches rarely cause complications, incomplete toxidromes can be insidiously common in polypharmacy settings. Providers should thoroughly evaluate the skin of intoxicated patients for additional adherent medications that may result in a delay in ED diagnosis and curative therapies. Our case, as well as rare case reports of therapeutic scopolamine-induced anticholinergic toxicity, demonstrates that peripheral anticholinergic effects, such as tachycardia, dry mucous membranes, and hyperpyrexia are often not present, and incremental doses of physostigmine may be required to reverse scopolamine's long duration of action. This further complicates identification of the anticholinergic toxidrome and diagnosis.


Assuntos
Síndrome Anticolinérgica/diagnóstico , Antagonistas Colinérgicos/envenenamento , Síndrome Anticolinérgica/etiologia , Antagonistas Colinérgicos/uso terapêutico , Distonia/etiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Alucinações/etiologia , Humanos , Meniscectomia/efeitos adversos , Meniscectomia/normas , Pessoa de Meia-Idade , Midríase/etiologia , Período Pós-Operatório , Escopolamina/envenenamento , Escopolamina/uso terapêutico , Adesivo Transdérmico
11.
Ned Tijdschr Geneeskd ; 161: D1261, 2017.
Artigo em Holandês | MEDLINE | ID: mdl-28612694

RESUMO

BACKGROUND: Despite good manufacturing practice and quality control, consumer products can become contaminated. In some cases, this can result in severe and life-threatening intoxication with potentially fatal consequences. CASE DESCRIPTION: A 27-year-old man and a 28-year-old pregnant woman presented to the Emergency Department with severe anticholinergic syndrome after using a marshmallow root (Althaea officinalis) herbal remedy, mixed into hot chocolate drink, to reduce symptoms of common cold. After a short stay in Intensive Care, the symptoms diminished and the patients could be released from hospital. The herbs were found to be contaminated with atropine, most probably derived from deadly nightshade (Atropa belladonna). Analyses of the contaminated product indicated that the patients were exposed to 20-200 mg atropine, while a dose of 2 mg is already considered mildly toxic. CONCLUSION: Consultation of the Dutch National Poisons Information Center resulted in rapid detection of the contamination; close collaboration with the Netherlands Food and Consumer Product Safety Authority and the manufacturer of the product allowed rapid identification of the source of contamination and facilitated the prevention of an epidemic.


Assuntos
Síndrome Anticolinérgica/etiologia , Atropina/efeitos adversos , Contaminação de Medicamentos , Chás de Ervas , Adulto , Animais , Atropa belladonna/efeitos adversos , Atropa belladonna/química , Atropina/análise , Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/análise , Feminino , Humanos , Masculino , Países Baixos , Chás de Ervas/efeitos adversos , Chás de Ervas/análise
13.
Arch Pediatr ; 23(11): 1165-1168, 2016 Nov.
Artigo em Francês | MEDLINE | ID: mdl-27670723

RESUMO

"Purple drank" is a dangerous hallucinogenic cocktail commonly used by teenagers, made popular by American rappers and social networks. It combines codeine-based cough syrup, antihistamines such as promethazine, and soda. Unknown by caregivers, it may be responsible for serious neuropsychological complications. We report the effects of this new risky behavior in three patients: a 14-year-old girl and her boyfriend, both found in an initial state of drowsiness, followed by hallucinations and anticholinergic toxidrome; and another teenager whose chronic use led to addiction with increasing doses. It is important to identify signs of such intoxication and to inform patients about the risks of respiratory depression, drowsiness, and delirium linked to acute medication misuse.


Assuntos
Antitussígenos/efeitos adversos , Bebidas/efeitos adversos , Codeína/efeitos adversos , Antagonistas dos Receptores Histamínicos/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/complicações , Adolescente , Síndrome Anticolinérgica/etiologia , Feminino , Alucinações/induzido quimicamente , Humanos , Masculino
14.
Lakartidningen ; 1132016 07 28.
Artigo em Sueco | MEDLINE | ID: mdl-27483400

RESUMO

In this case report we illustrate how incorrectly prepared and cooked seeds from white lupin - a common snack among people from parts of the Mediterranean and Middle East - caused an anticholinergic syndrome in a previously healthy man. The symptoms subsided without treatment and the patient was discharged from the hospital in good health. Anticholinergic syndrome results from inhibition of the parasympatic nervous system. The symptoms commonly include dry mouth, confusion, hallucinations, fever, tachycardia, and urine retention. The syndrome may most frequently be provoked by overdose of drugs such as prometazin, hyoscyamin, and biperidin or by ingestion of plants such as belladonna, datura and henbane. The aim of this report is to increase clinicians' awareness of white lupin's anticholinergic effects.


Assuntos
Síndrome Anticolinérgica/etiologia , Lupinus/envenenamento , Síndrome Anticolinérgica/diagnóstico , Humanos , Lupinus/química , Masculino , Pessoa de Meia-Idade , Lanches
15.
Forensic Sci Int ; 261: e17-21, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26952786

RESUMO

Datura poisonings have been previously described but remain rare in forensic practice. Here, we present a homicide case involving Datura poisoning, which occurred during a robbery. Toxicological results were obtained by second autopsy performed after one previous autopsy and full body embalmment. A 35-year-old man presented with severe stomach and digestive pain, became unconscious and ultimately died during a trip in Asia. A first autopsy conducted in Asia revealed no trauma, intoxication or pathology. The corpse was embalmed with methanol/formalin. A second autopsy was performed in France, and toxicology samples were collected. Scopolamine, atropine, and hyoscyamine were found in the vitreous humor, in addition to methanol. Police investigators questioned the local travel guide, who admitted to having added Datura to a drink to stun and rob his victim. The victim's death was attributed to disordered heart rhythm due to severe anticholinergic syndrome following fatal Datura intoxication. This is a recent case of a rare homicide involving Datura that highlights general information on Datura and discusses forensic interpretation after a previous autopsy and body embalmment.


Assuntos
Datura/envenenamento , Homicídio , Adulto , Síndrome Anticolinérgica/etiologia , Atropina/análise , Toxicologia Forense , Humanos , Hiosciamina/análise , Masculino , Escopolamina/análise , Corpo Vítreo/química
16.
Neth J Med ; 74(3): 133-5, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27020994

RESUMO

Intentional or accidental intoxications are common in the emergency department, but are not always sufficiently recognised. When intoxication is suspected, the causative agent or combination of agents often remain unclear, making these patients a diagnostic challenge. We present here a 45-year-old woman who was admitted due to altered consciousness. The clinical presentation fitted the anticholinergic toxidrome and an intoxication with venlafaxine (her known prescribed medication) was suspected. Plasma venlafaxine concentrations, however, were very low. After 24 hours the patient recovered completely. Further testing after discharge revealed high concentrations of promethazine, confirming the suspected diagnosis. This case illustrates the importance of knowledge of toxidromes and good collaboration with the hospital pharmacist. Because of the thorough testing the patient could receive proper treatment.


Assuntos
Síndrome Anticolinérgica/diagnóstico , Antagonistas Colinérgicos/efeitos adversos , Serviço Hospitalar de Emergência , Síndrome Anticolinérgica/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade
17.
Z Gerontol Geriatr ; 49(5): 416-22, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26286077

RESUMO

This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms "delirogenity" and "delirogenic" to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care.


Assuntos
Síndrome Anticolinérgica/etiologia , Delírio/induzido quimicamente , Técnica Delfos , Tratamento Farmacológico/normas , Prova Pericial/normas , Guias de Prática Clínica como Assunto , Europa (Continente) , Prova Pericial/métodos , Humanos
18.
Acta Anaesthesiol Scand ; 60(2): 270-3, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26471203

RESUMO

A 58-year-old male was scheduled to undergo radical gastrectomy for cancer under general anesthesia. The patient developed agitation and irregular breathing after receiving a single dose of atropine (0.5 mg) to treat bradycardia immediately prior to induction of anesthesia. Within 5 min after the atropine injection, the patient became unresponsive with facial flushing and diaphoresis. When a drop in oxygen saturation was observed, a laryngeal mask airway was inserted after administering a small bolus dose of propofol (80 mg) and the patient was ventilated with 100% oxygen. Physostigmine was not administered because of the relatively low dose of atropine and the fact that his symptoms were not totally consistent with central anticholinergic syndrome (CAS). The differential diagnosis at the time also included an acute cardiovascular event and an idiosyncratic reaction to atropine. The patient fully recovered within 80 min from this highly unusual reaction to a single 0.5 mg IV dose of atropine.


Assuntos
Síndrome Anticolinérgica/etiologia , Atropina/efeitos adversos , Síndrome Anticolinérgica/diagnóstico , Bradicardia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
19.
A A Case Rep ; 6(2): 22-4, 2016 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-26513676

RESUMO

Anesthesia-related central anticholinergic syndrome (CAS) is most commonly associated with administration of atropine or scopolamine, whereas glycopyrrolate is an extremely rare cause of CAS. Here, we report a case of CAS in a 5-year-old boy admitted to the intensive care unit. Immediately after the administration of glycopyrrolate, he became agitated and developed apnea, hypertension, tachycardia, and anuria. Although the present case describes a rare cause of CAS, it is an important reminder of an iatrogenic condition that is presumably underdiagnosed in the operating theater as well as the intensive care unit.


Assuntos
Síndrome Anticolinérgica/etiologia , Glicopirrolato/efeitos adversos , Síndrome Anticolinérgica/patologia , Pré-Escolar , Evolução Fatal , Glicopirrolato/administração & dosagem , Humanos , Masculino
20.
J Clin Neuromuscul Dis ; 17(2): 72-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26583494

RESUMO

Dok-7 myasthenia is an autosomal recessive congenital myasthenic syndrome due to DOK7 mutations. Anticholinesterase therapy is ineffective and may worsen the weakness in patients with Dok-7 myasthenia or few other forms of congenital myasthenic syndromes. We describe a 31-year-old man previously diagnosed with seronegative myasthenia gravis. Repetitive stimulation of the right spinal accessory nerve showed 51% decrement. Needle electromyography revealed myopathic changes in clinically affected muscles. Muscle biopsy was normal. The patient was referred to us for worsening weakness after taking pyridostigmine. We searched for DOK7 mutations and identified compound heterozygous mutations of a common c.1124_1127dupTGCC mutation and a novel splice site mutation, c.772+2_+4delinsCCGGGCAGGCGGGCA. Discontinuation of pyridostigmine improved weakness. He further regained strength with oral albuterol therapy and decrement was reduced to 25%. Worsening of symptoms with anticholinesterase therapy in patients with "seronegative myasthenia gravis" should prompt clinicians to consider a possibility of congenital myasthenic syndromes to avoid unnecessary use of immunosuppressive therapy. Patients with Dok-7 myasthenia respond well to oral albuterol treatment.


Assuntos
Síndrome Anticolinérgica/etiologia , Inibidores da Colinesterase/efeitos adversos , Proteínas Musculares/genética , Mutação/genética , Miastenia Gravis/tratamento farmacológico , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Adulto , Eletromiografia , Humanos , Masculino , Debilidade Muscular/induzido quimicamente , Miastenia Gravis/genética
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