Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Philadelphia.
J Emerg Med. 2024 May;66(5):e589-e591. doi: 10.1016/j.jemermed.2024.03.017. Epub 2024 Mar 16.
Anticholinergic toxicity is commonly encountered in the emergency department. However, the availability of physostigmine, a central acetylcholinesterase inhibitor used to reverse anticholinergic delirium, has been significantly limited due to national drug shortages in the United States. Several articles have explored the viability of rivastigmine as an alternative treatment in these patients.
A 33-year-old man presented to the emergency department after a suspected suicide attempt. The patient was found with an empty bottle of diphenhydramine at the scene. On arrival, he was tachycardic and delirious, with dilated and nonreactive pupils and dry skin. As the clinical picture was highly suggestive of anticholinergic toxicity, the patient was treated with oral rivastigmine at a starting dose of 4.5 mg to reverse his anticholinergic delirium. Although a repeat dose was required, his delirium resolved without recurrence. Why Should an Emergency Physician Be Aware of This? Oral rivastigmine has been applied successfully here and in other case reports to reverse anticholinergic delirium with the benefit of prolonged agitation control. Emergency physicians may consider this medication in consultation with a specialist, with initial doses starting at 4.5-6 mg, if encountering anticholinergic delirium when physostigmine is not available.
抗胆碱能毒性在急诊科中很常见。然而，由于美国全国性的药物短缺，作为逆转抗胆碱能谵妄的中枢乙酰胆碱酯酶抑制剂的毒扁豆碱的供应已经大大受限。有几篇文章探讨了使用rivastigmine 作为这些患者的替代治疗方法的可行性。
一名 33 岁男子在疑似自杀未遂后被送到急诊科。在现场发现了一个苯海拉明的空瓶子。到达时，他心动过速且神志不清，瞳孔扩大且无反应，皮肤干燥。由于临床表现高度提示抗胆碱能毒性，因此给予患者口服 rivastigmine，起始剂量为 4.5mg，以逆转他的抗胆碱能谵妄。尽管需要重复给药，但他的谵妄没有复发就得到了缓解。
为什么急诊医生应该了解这一点？在本病例和其他病例报告中，口服 rivastigmine 已成功用于逆转抗胆碱能谵妄，并具有延长激动控制的益处。如果遇到毒扁豆碱不可用时的抗胆碱能谵妄，急诊医生可以在与专家协商后考虑使用这种药物，初始剂量为 4.5-6mg。
