Document Detail

Physostigmine: is there a role for this antidote in pediatric poisonings?
MedLine Citation:
PMID:  17496766     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Ingestion of anticholinergic medications is common in pediatrics. Toxicity may result in symptoms such as severe agitation requiring physical restraint. Physostigmine, an antidote for anticholinergic poisoning, could be useful in this situation. Many physicians are hesitant to use physostigmine after case series suggested its use in tricyclic antidepressant overdose was associated with asystole. This paper reviews the anticholinergic toxidrome and pathophysiology, recent literature on the efficacy and toxicity of physostigmine, and its dosing, indications, and contraindications. RECENT FINDINGS: Recent articles suggest that toxicity associated with physostigmine consists mostly of seizures and cardiac arrhythmia, and occurs when used in the absence of anticholinergic symptoms. Despite potential complications, physostigmine has been shown to be useful in cases of confirmed anticholinergic poisoning by controlling agitation and reversing delirium, and appears to be safer and more effective than benzodiazepines in this situation. SUMMARY: In the proper clinical situation such as pure anticholinergic overdose with severe symptoms, physostigmine can be beneficial. The potential for side effects is not insignificant, and the antidote should be used with caution in any patient with unknown ingestions or those with cardiac conduction defects. More research is needed, especially involving children, before we will fully understand the indications and toxicities associated with physostigmine.
Nan Frascogna
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in pediatrics     Volume:  19     ISSN:  1040-8703     ISO Abbreviation:  Curr. Opin. Pediatr.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-05-14     Completed Date:  2007-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9000850     Medline TA:  Curr Opin Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  201-5     Citation Subset:  IM    
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35233, USA.
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MeSH Terms
Antidotes / adverse effects,  therapeutic use*
Cholinergic Antagonists / adverse effects,  therapeutic use*
Cholinesterase Inhibitors / poisoning*
Physostigmine / adverse effects,  therapeutic use*
Poisoning / drug therapy
Reg. No./Substance:
0/Antidotes; 0/Cholinergic Antagonists; 0/Cholinesterase Inhibitors; 57-47-6/Physostigmine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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