Anticholinergic Syndrome

There is strong evidence to suggest a significant relationship between anticholinergic side effects of medications and the presence of symptoms of delirium (Maldonado 2008; Tune et al. 1993). The term anticholinergic syndrome (ACS) is commonly used to describe the constellation of symptoms noted in these patients (see Table 30-6). Central anticholin-ergic side effects include agitation or lethargy, hallucinations, respiratory depression, and coma. Peripheral anticholinergic side effects, by contrast, include tachycardia, mydriasis and associated blurring of vision, flushed skin, increased temperature, decreased or absent bowel sounds, urinary retention, and dry mucous membranes. Although some drugs—for example, diphenhydramine and atropine—are commonly identified as having a high anticholinergic load, there is a long list of agents with potential anticholinergic activity (Maldonado 2008). Studies have demonstrated a direct relationship between a drug's anticholinergic potential (assessed on the basis of serum anticholinergic activity) and its anticholinergic toxicity (Tune et al. 1992). Physostigmine may be used to control agitation and delirium symptoms in patients with ACS and is generally safe, provided that the electrocardiogram does not show evidence of cardiac conduction disturbances (Granacher and Baldessarini 1975). Symptoms of agitation associated with ACS may also be treated with benzodiazepines.

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