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The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity.
J Med Toxicol. 2015 Jun; 11(2):179-84.JM

Abstract

The anticholinergic toxidrome is well described and relatively common. Despite controversy, studies have shown that physostigmine is relatively safe and effective in reversing this toxidrome. We would expect toxicologists would be liberal in its use. We retrospectively analyzed data in the Toxicology Investigators Consortium (ToxIC) registry, representing data from medical toxicologists in multiple institutions nationwide, searching for patients who exhibited an anticholinergic toxidrome, determining what treatment(s) they received, and classifying the treatments as physostigmine, benzodiazepines, physostigmine and benzodiazepines, antipsychotics, or no definitive treatment. The causal agents of the toxidrome were as reported by the treating toxicologist. Eight hundred fifteen consecutive patients with anticholinergic toxidromes were analyzed. Benzodiazepines alone were given in 28.7 %, 12.4 % were given physostigmine alone, 8.8 % received both physostigmine and benzodiazepines, 2.7 % were given antipsychotics, and 47.4 % were given no definitive treatment. In patients who received only physostigmine, there was a significant difference in the rate of intubation (1.9 vs. 8.4 %, OR 0.21, 95 % CI 0.05-0.87) versus other treatment groups. Physostigmine was given at varying rates based on causative agent with use in agents with mixed or unknown effects (15.1 %) being significantly lower than those with primarily anticholinergic effects (26.6 %) (p < 0.001). Patients with anticholinergic toxicity were more likely to receive benzodiazepines than physostigmine. Those patients who received only physostigmine had a significantly lower rate of intubation. Physostigmine was more likely to be used with agents exerting primarily anticholinergic toxicity than in those agents with multiple actions.

Authors+Show Affiliations

Division of Emergency Medicine, Washington University in St Louis, 660 S. Euclid Ave., Campus Box 8072, St. Louis, MO, 63110, USA, watkinsjo@wusm.wustl.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

25510306

Citation

Watkins, Joseph W., et al. "The Use of Physostigmine By Toxicologists in Anticholinergic Toxicity." Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, vol. 11, no. 2, 2015, pp. 179-84.
Watkins JW, Schwarz ES, Arroyo-Plasencia AM, et al. The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity. J Med Toxicol. 2015;11(2):179-84.
Watkins, J. W., Schwarz, E. S., Arroyo-Plasencia, A. M., & Mullins, M. E. (2015). The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity. Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, 11(2), 179-84. https://doi.org/10.1007/s13181-014-0452-x
Watkins JW, et al. The Use of Physostigmine By Toxicologists in Anticholinergic Toxicity. J Med Toxicol. 2015;11(2):179-84. PubMed PMID: 25510306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity. AU - Watkins,Joseph W, AU - Schwarz,Evan S, AU - Arroyo-Plasencia,Anna M, AU - Mullins,Michael E, AU - ,, PY - 2014/12/17/entrez PY - 2014/12/17/pubmed PY - 2016/3/24/medline SP - 179 EP - 84 JF - Journal of medical toxicology : official journal of the American College of Medical Toxicology JO - J Med Toxicol VL - 11 IS - 2 N2 - The anticholinergic toxidrome is well described and relatively common. Despite controversy, studies have shown that physostigmine is relatively safe and effective in reversing this toxidrome. We would expect toxicologists would be liberal in its use. We retrospectively analyzed data in the Toxicology Investigators Consortium (ToxIC) registry, representing data from medical toxicologists in multiple institutions nationwide, searching for patients who exhibited an anticholinergic toxidrome, determining what treatment(s) they received, and classifying the treatments as physostigmine, benzodiazepines, physostigmine and benzodiazepines, antipsychotics, or no definitive treatment. The causal agents of the toxidrome were as reported by the treating toxicologist. Eight hundred fifteen consecutive patients with anticholinergic toxidromes were analyzed. Benzodiazepines alone were given in 28.7 %, 12.4 % were given physostigmine alone, 8.8 % received both physostigmine and benzodiazepines, 2.7 % were given antipsychotics, and 47.4 % were given no definitive treatment. In patients who received only physostigmine, there was a significant difference in the rate of intubation (1.9 vs. 8.4 %, OR 0.21, 95 % CI 0.05-0.87) versus other treatment groups. Physostigmine was given at varying rates based on causative agent with use in agents with mixed or unknown effects (15.1 %) being significantly lower than those with primarily anticholinergic effects (26.6 %) (p < 0.001). Patients with anticholinergic toxicity were more likely to receive benzodiazepines than physostigmine. Those patients who received only physostigmine had a significantly lower rate of intubation. Physostigmine was more likely to be used with agents exerting primarily anticholinergic toxicity than in those agents with multiple actions. SN - 1937-6995 UR - https://wwww.unboundmedicine.com/medline/citation/25510306/The_Use_of_Physostigmine_by_Toxicologists_in_Anticholinergic_Toxicity_ DB - PRIME DP - Unbound Medicine ER -