Overview
The management priority in anticholinergic toxidrome is to control CNS effects such as delirium, hallucinations, agitation and aggression. Management of anticholinergic delirium includes close observation and supportive care in a low-stimulus environment.
Physostigmine is the first-line antidote for severe anticholinergic toxidrome caused by a pure anticholinergic drug, but it is not widely available in Australia1. If physostigmine is not available, parenteral sedation with droperidol or a benzodiazepine can be used for patients with severe anticholinergic toxidrome to control their behavioural disturbance. Large doses of intravenous sedation may be required for adequate control.
Some patients with mild symptoms may only require observation. Cooperative patients with mild to moderate agitation may only require sedation with an oral benzodiazepine. For patients with acute urinary retention, insertion of a urinary catheter may alleviate agitation and obviate the need for benzodiazepines.
Airway and breathing complications are unlikely in anticholinergic toxidrome. If the patient’s level of consciousness compromises the airway or breathing, manage urgently according to Support of airway and breathing in poisoning.
If the drug or toxin causing anticholinergic toxidrome is known, see also the relevant monograph for management.