see also: > [!Key Points] > - Causes:: atropine, [[TCA overdose]], antihistamines, deadly nightshade, Benztropine (PKD drug), some mushrooms, others... > - Antidote:: Benzos, [[Physostigmine]] > - **mnemonic**: Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter ![[Pasted image 20230626221320.png]] ![[Pasted image 20230627114954.png]] # Causes **GNOOTI** - glycopyrolate - nightshade - oxybutynin - olanzapine - TCA - ipatropium - Atropine - [[TCA overdose|Tricyclic antidepressants]] - older antihistamines - anti-PKD drugs eg benztropine - some antipsychotics - hyoscine - Glycopyrolate - scopolamine - ipatropium - oxybutynin - some toxic plants - mushrooms - atropine-containing plants - **deadly nightshade** - jimsonweed - mandrake ![[Pasted image 20230701122032.png]] # Risk assessment - look out for urinary retention, rhabdomyolysis, ventricular arrhythmias - # Toxic Mechanism # Clinical features - Dry skin, warm skin, erythema - delerium, hallucinations, rarely violent - tachycardia, mild hypertension, mild hyperthermia - pupils: dilated ([[mydriasis]]) - urinary retention elevated body temperature (due to decreased sweating), increased HR; dry mouth; dry, flushed skin; cycloplegia; constipation; disorientation Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants. # Treatment - supportive care - benzodiazepines - cooling if needed - foley for urinary retention # mnemonic * Blind as a bat: mydriasis, dilated pupils and the inability to accomodate * Mad as a hatter: delirium * Dry as a bone: inability to form sweat * Red as a beet: skin flushing * Hot as a hare: fever * Fast as a fiddle: tachycardia * Full as a flask: urinary retention, ileus Jimson weed (Datura) = "gardener’s pupil" (mydriasis due to plant alkaloids) **"The ANTIs** anti-parkinson's - benztropine antihistamines - promethazine antitussives - dextromethorphan antidepressants - TCA anti psychotics - droperidol, chlorpromaze, olanzapine anticovulsants - carbamazepine antispasmodics - oxybutynin, hyoscine