Isther
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A 18 yo F, ingested an unknown quantity of Raid after a discussion with her boyfriend. She presented to the ER diaphoretic, drowsy, smelling like urine and feces. PE shows myosis, bibasal rales, bradycardia and fasciculation. You start treatment as indicated and 20 min later, she wakes up and start to scream saying that a goat is trying to eat her toes. She becames aggresive and tryes to escape. What is the best next step in treatment?
- benzodiazepines
- haloperidol
- restrains and observation
- physiostigmine
- neostigmine
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| MAZI
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this is delirium due to ATROPIN treatment for anticholinesterase toxicity
3.restrains and observation
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| sachida
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I will agree- restrain and observation for atropine overdose.
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| sachida
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Also I will try to re-confirm what she actually was poisoned with. Just too be sure.
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| drk1980
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Aggressive and esp coz shes trying to escape, how abt a small dose of benzo?
BTW, what is the active ingredient in Raid? Wud it cause any drug interactions?
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| drk1980
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oops! i just reread MAZI's post.....Raid is anticholinesterase!
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| achilles
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thanks guys. i had no clue about this question. as always good questions isther.
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| Isther
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Thanks Achilles, for your support. Enjoy the question...
The answer is 1. Benzodiazepienes.
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| Isther
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Yes! the patient has atropine intoxication... what is called ANTICHOLINERGIC SYNDROME. The presentation at ER was suggestive of irreversible anticholisterase substances (organophosphates and carbamates) typically found in insectisides. The presentantion is a severe cholinergic effect manifested as the classic DUMBELS (Defecation, Urination, Myosis, Bradycardia, Emesis, Lacrimation, Salivation) and fasciculation as nicotinic manifestation, the treatment is atropine to rapid reverse the muscarinic symptoms and pralidoxime as a definitive antidote.
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| Isther
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If during atropine administration the patients presents with delirium, redness, dry mucosas, must suspect of anticholinergic syndrome. The definitive antidote for anticholinergic syndrome is an anticholinesterase drug like physiostigmine (neostigmine too, but it doesn't cross blood-brain barrier so won't stop central symptoms).
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| Isther
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Now current guidelines states that due to the potential side effects, is better to use benzos and wait until the atropine half life is reached. So therefore the best answere would be 1.
Haloperidol has nothing to do. And restrain and observation could be a nice option but you will have a crazy young lady screaming her lungs out loud for seveal hours, and that can be disturbing for her family and for the personnel.
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| MAZI
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thank u isther
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| karusmle
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thank u isther, where did u get this question from ????
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| Isther
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Thanks to you! Those were cases during my internship. I know its not high yield, but who knows, may be you face a question alike.
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