Anticholinergic syndrome

Abstract

The aim of this review is to disclose the anticholinergic syndrome and the systemic effects that could resulted from topical eye drops. A 1% solution of atropine contains 1 g dissolved in 100 mL, or 10 mg/ml. Eyedroppers vary in the number of drops formed per milliliter of solution but average 20 drops/ ml. Therefore, one drop usually contains 0.5 mg of atropine. Absorption by vessels in the conjunctive sac is similar to subcutaneous injection. Anticholinergic syndrome is produced by the inhibition of cholinergic neurotrans- mission at muscarinic receptor sites. Clinical manifestations of anticholinergic syndrome are caused by the peripheral and central nervous system effects. Systemic manifestations include dry mouth, tachycardia, atropine flush, atropine fever and impaired vision. The degree of central manifestations are related to the drug’s ability to cross the blood-brain barrier. No specific diagnostic studies exist for anticholinergic overdoses. Laboratory tests like blood and urine cultures in febrile patients, serum electrolyte analysis, arterial blood gas analysis and ECG may be helpful. Patients presenting with anticholinergic toxicity should be treated according to ad- vanced life support algorithm. Physostigmine effectively reverses central anti- cholinergic toxicity. An initial dose of 0.01–0.03 mg/kg may have to be repeated after 15–30 min.