Anticholinergic Syndrome
| Classification according to ICD-10 | |
|---|---|
| T44 | Poisoning from drugs that primarily affect the autonomic nervous system |
| T44.8 | Centrally acting and adrenergic neuron blockers, not elsewhere classified |
| T62 | Toxic effect of other harmful substances ingested with food |
| T62.1 | Consumed berries |
| T62.2 | Other consumed plant (s) or part (s) thereof |
| ICD-10 online (WHO version 2019) | |
Anticholinergic syndrome (also antimuscarinic syndrome ) is a pathological condition of the autonomic nervous system in which the nervus vagus ( parasympathetic nerve ) has been largely deactivated in its braking and dampening function.
The syndrome usually occurs as a result of undesirable drug effects or poisoning with atropine or hyoscyamine , antidepressants , neuroleptics , antihistamines or after taking poisonous plants from the nightshade family ( deadly nightshade , henbane , thorn apple , angel's trumpet ).
Contrary to popular claims, the ingredients of fly agaric and panther mushrooms (namely ibotenic acid and muscimol ) do not have an anticholinergic effect and therefore do not cause an anticholinergic syndrome.
Pathophysiology
The cholinergic neurotransmitter acetylcholine is involved in various cerebral functions, including consciousness. If this effect is antagonized by anticholinergic substances such as those mentioned above, this leads to a number of neurological symptoms. This antagonistic effect is achieved by competitive displacement from the acetylcholine receptor .
Symptoms
A distinction is made between peripheral and central symptoms. Central symptoms are those that affect the central nervous system (brain and spinal cord). There are two types of progression.
1. Delirious form with
- Fear, restlessness
- Confusion, disorientation
- visual or auditory hallucinations
- Movement disorders ( myoclonus , dysarthria )
- Seizures
2. Somnolent form
- delayed awakening after anesthesia
- Drowsiness ( somnolence ) up to coma
- in extreme cases up to respiratory arrest
The following peripheral symptoms can occur in both forms:
- dry, hot, reddened skin through
- Decreased sweat production
- Fever (hyperthermia)
- Dilated pupils ( mydriasis )
- Glaucoma attack
- Disorders of accommodation , i.e. essentially blurred vision, especially in the vicinity
- Dry mouth, thirst through
- Decreased saliva production
- Decreased tracheobronchial secretion
- Difficulty swallowing
-
Cardiac arrhythmias
- Heart rate too fast ( tachycardia )
- Supraventricular extrasystoles
- Rarely (at high dose) AV conduction disorders
- Gastrointestinal atony
- Urinary retention (due to bladder atony )
therapy
Patients with severe anticholinergic syndrome must be monitored in an intensive care unit. If a delirious syndrome with pronounced restlessness and hallucinations develops, symptom-oriented measures are indicated, such as B. sedation or possibly also fixations. One possible antidote is physostigmine , which can be given if the side effects (e.g. bradycardia) are taken into account. Sometimes an attempt is made to achieve a faster elimination of the causative substance from the body by means of forced diuresis. Gastric lavage is recommended only in exceptional cases, as the risk of aspiration usually outweighs the potential benefit. This is especially true if the patient is clouded and not intubated . Activated charcoal , which is administered as an adsorbent to prevent poison from being absorbed in the digestive tract, plays a special role in therapy .
See also
Individual evidence
- ↑ H. Prange: Neurological Intensive Care Medicine: Practical Guide for Neurological Intensive Care Units and Stroke Units. Georg Thieme Verlag, 2004, ISBN 3-13-129821-9 , pp. 211ff. (online) .
