Zekhtser Mitchell, Carroll Erin, Boyd Molly, Ambati Shashikanth
Department of Emergency Medicine, Albany Medical Center, Albany, New York, USA.
Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA.
Case Rep Crit Care. 2021 Aug 28;2021:7590960. doi: 10.1155/2021/7590960. eCollection 2021.
We report two pediatric cases of anticholinergic toxidrome, including the youngest reported to date, in which standard therapeutic strategies were either contraindicated or ineffective, while treatment with dexmedetomidine was rapidly efficacious with no adverse effects. Moreover, with the recent shortage of physostigmine, we highlight an alternative treatment in this clinical setting. . In case 1, a two-year-old had an overdose presenting with an anticholinergic toxidrome. However, his hypopnea precluded the use of benzodiazepines due to the high likelihood of intubation. In case 2, a 14-year-old had a polypharmacy overdose inducing agitated delirium that was refractory to high-dose benzodiazepines. Due to the unknown ingestion, physostigmine was avoided. In both cases, dexmedetomidine helped the patient remain calm and metabolize the ingestions.
Our experience suggests that dexmedetomidine may be a useful adjunct in anticholinergic presentations in the setting of polypharmacy, when standard therapy is proven ineffective, contraindicated, or unavailable.
我们报告了两例儿童抗胆碱能中毒综合征病例，其中包括迄今为止报告的最年幼患者。在这两例病例中，标准治疗策略要么禁忌使用，要么无效，而右美托咪定治疗迅速有效且无不良反应。此外，鉴于近期毒扁豆碱短缺，我们强调了在这种临床情况下的替代治疗方法。病例1为一名两岁儿童，因过量服药出现抗胆碱能中毒综合征。然而，由于其呼吸浅慢，因插管可能性高而禁忌使用苯二氮䓬类药物。病例2为一名14岁儿童，因多种药物过量导致躁动性谵妄，对高剂量苯二氮䓬类药物无效。由于服药情况不明，避免使用毒扁豆碱。在这两例病例中，右美托咪定帮助患者保持冷静并代谢摄入的药物。
我们的经验表明，当标准治疗被证明无效、禁忌或无法使用时，右美托咪定可能是多药合用情况下抗胆碱能表现的一种有用辅助药物。
