a Department of Emergency Medicine , United Hospital , Minneapolis , MN , USA.
b Minnesota Poison Control System , Minneapolis , MN , USA.
Clin Toxicol (Phila). 2019 Jan;57(1):50-55. doi: 10.1080/15563650.2018.1485154. Epub 2018 Jun 29.
Poison centers (PCs) frequently manage patients with antimuscarinic delirium. However, controversy surrounds the antidotal use of physostigmine for its treatment. The aim of this study was to prospectively investigate physostigmine versus non-antidote therapy for the management of antimuscarinic delirium in a single regional PC.
This was a prospective observational analysis of patients diagnosed with antimuscarinic delirium and treated in consultation with a regional PC. Certified Specialists in Poison Information (CSPIs) use a clinical guideline to recommend the use of physostigmine. Using a previously derived altered mental status score, we quantified the rate of delirium improvement with physostigmine compared to non-antidote therapy two hours after initial patient identification. We also recorded adverse events (defined a priori as bradycardia, vomiting, seizures) and resource utilization (intubation and physical restraint).
We identified 245 patients and included 154 in the analysis. The most common exposure classes were antihistamines (68%), analgesics (19%), and antipsychotics (19%). CSPIs recommended physostigmine in 81% (125) of cases and the treatment team administered it in 37% (57) of these. We observed delirium control in 79% of patients who received physostigmine versus 36% of those who did not. The odds of delirium control were six times greater for patients receiving physostigmine than for patients treated with non-antidote therapy (OR 6.6). Adverse events were rare and did not differ significantly between the groups. Physostigmine was not associated with changes in the incidence of intubation or restraint.
This study provides further evidence of both the safety and efficacy of physostigmine in the treatment of antimuscarinic delirium.
中毒急救中心（PC）经常治疗出现抗毒蕈碱谵妄的患者。然而，对于使用毒扁豆碱解毒治疗抗毒蕈碱谵妄，仍存在争议。本研究旨在前瞻性调查毒扁豆碱与非解毒剂治疗在一个区域性 PC 中毒急救中心治疗抗毒蕈碱谵妄的效果。
这是一项前瞻性观察性分析，研究对象为经区域 PC 会诊诊断为抗毒蕈碱谵妄并接受治疗的患者。认证毒理信息专家（CSPIs）使用临床指南来推荐使用毒扁豆碱。使用之前得出的改变精神状态评分，我们量化了与非解毒剂治疗相比，在初始患者识别后两小时内使用毒扁豆碱治疗的谵妄改善率。我们还记录了不良反应（定义为先期为心动过缓、呕吐、癫痫发作）和资源利用（插管和身体约束）。
我们共确定了 245 名患者，其中 154 名纳入分析。最常见的暴露类别是抗组胺药（68%）、镇痛药（19%）和抗精神病药（19%）。CSPIs 在 81%（125 例）的病例中推荐使用毒扁豆碱，在这些病例中，治疗团队仅在 37%（57 例）的病例中使用了毒扁豆碱。我们观察到接受毒扁豆碱治疗的患者中有 79%的患者控制了谵妄，而未接受毒扁豆碱治疗的患者中只有 36%的患者控制了谵妄。接受毒扁豆碱治疗的患者控制谵妄的可能性是接受非解毒剂治疗的患者的六倍（OR 6.6）。不良反应罕见，两组之间无显著差异。毒扁豆碱的使用与插管或约束的发生率变化无关。
本研究进一步提供了毒扁豆碱治疗抗毒蕈碱谵妄的安全性和疗效证据。
