Yakey Brandtly, Vohra Varun, Martin Amarilis, King Andrew M
Department of Emergency Medicine, Detroit Medical Center, Detroit, MI, USA.
Michigan Poison & Drug Information Center, Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Oxf Med Case Reports. 2023 Sep 25;2023(9):omad096. doi: 10.1093/omcr/omad096. eCollection 2023 Sep.
Antimuscarinic drug toxicity is a common pediatric emergency, which produces central and peripheral symptoms. Treatment of agitation and hyperactive antimuscarinic delirium, with first-line agents like cholinesterase inhibitors or benzodiazepines, is imperative to prevent severe toxicity. Intravenous physostigmine salicylate is a cholinesterase inhibitor that is commonly used to treat central antimuscarinic delirium. Its chemical structure facilitates crossing of the blood-brain barrier. Overlapping nationwide physostigmine and benzodiazepine shortages have prompted consideration of therapeutic alternatives. Rivastigmine is a long-acting cholinesterase inhibitor with a similar chemical structure to physostigmine. It represents a potential therapeutic option for antimuscarinic delirium. Rivastigmine offers potential benefits over physostigmine including a longer duration of action, slower rate of central nervous system penetration, more favorable side effect profile, and availability in multiple formulations. A paucity of literature exists describing the use of rivastigmine for central antimuscarinic delirium. We describe the effective use of oral rivastigmine in a child with central antimuscarinic delirium.
抗毒蕈碱药物中毒是一种常见的儿科急症，可产生中枢和外周症状。使用胆碱酯酶抑制剂或苯二氮䓬类药物等一线药物治疗躁动和抗毒蕈碱亢进性谵妄对于预防严重中毒至关重要。静脉注射水杨酸毒扁豆碱是一种常用于治疗中枢性抗毒蕈碱谵妄的胆碱酯酶抑制剂。其化学结构有助于穿过血脑屏障。全国范围内毒扁豆碱和苯二氮䓬类药物的短缺促使人们考虑治疗替代方案。卡巴拉汀是一种长效胆碱酯酶抑制剂，其化学结构与毒扁豆碱相似。它是抗毒蕈碱谵妄的一种潜在治疗选择。与毒扁豆碱相比，卡巴拉汀具有潜在优势，包括作用持续时间更长、中枢神经系统渗透速度较慢、副作用谱更有利以及有多种剂型可供使用。关于卡巴拉汀用于中枢性抗毒蕈碱谵妄的文献较少。我们描述了口服卡巴拉汀在一名中枢性抗毒蕈碱谵妄患儿中的有效应用。
