Copyright (c) 2020 R SiddaRama
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
A Case Report on Atropine Induced CNS Side Effects and Tachycardia
Corresponding Author(s) : R SiddaRama
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 3 No. 2 (2015): 2015 Volume 3- Issue -2
Abstract
Atropine is an anti-cholinergic, prototype of drug obtained from Atropa Belladonna. It mainly blocks the muscarinic receptors which place a major role in performance of the brain for learning, memory and orientation. In the therapeutic dose, atropine has a mild CNS stimulant effect but large doses can produce excitement, restlessness, agitation , hallucinations, coma and death. In therapeutic dose of atropine produces tachycardia through the blockage of M2 receptors of the heart. The uses of atropine includes brad arrhythmias, Severe bradycardia, organophosphate poisoning , 1st degree A-V block, salivary and bronchial secretion reduction. the extreme doses of atropine can causes the tachycardia, delirium, coma, flushed and hot skin, blurred vision, excitement, restlessness, hallucinations and ataxia. Here in this case report, a 30 years old female patient was developed excitement, hallucinations, restlessness, blurring of vision, photophobia, tachycardia, palpitation medullary paralysis and ECG abnormalities due to the atropine administration.
Keywords
Atropine
anti-cholinergic drug
ECG abnormalities
excitement
hallucinations
restlessness
palpitations
References
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[1] Donovan JW (2005) Anticholinergic plants: Critical care toxicology: diagnosis and management of the critically poisoned patient. (1st edtn) Elsevier Mosby-Year Book, Philadelphia.
[2] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa Belladonna intoxication: a case report. Pan Afr Med J 11: 72.
[3] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa belladonna intoxication: a case report. Pan Afr Med J 11: 72.
[4] Joshi P, Wicks AC, Munshi SK (2003) Recurrent autumnal psychosis. Postgrad Med J 79: 239-240.
[5] Mirakhur RK, Dundee JW (1979) Cardiovascular changes during induction of anaesthesia. Influence of three anticholinergic premedicants. Ann R Coll Surg Engl 61: 463-469.
[6] Diaz DM, Diaz SF, Marx GF (1980) Cardiovascular effects of glycopyrrolate and belladonna derivatives in obstetric patients. Bull N Y Acad Med 56: 245-248.
[7] http://www.public.health.wa.gov.au/cproot/2548/2/atropine%20sulfate%20injection.pdf
[8] http://www.dhss.delaware.gov/dph/ems/files/pharmacology08.pdf
[9] http://www.icuadelaide.com.au/files/primary/pharmacology/autonomic.pdf
[10] Galichet LY, Moffat AC, Osselton MD, et al, eds. Clarke’s Analysis of Drugs and Poisons. 3rd ed. London, UK: Pharmaceutical Press; 2004: 658.
[11] Bishop AG, Tallon JM. Anticholinergic visual hallucination from atropine eye drops. CJEM. 1999;1:115–116.
[12] Baker JP, Farley JD. Toxic psychosis following atropine eyedrops. BMJ. 1958:1390–1392.
[13] Glatstein M, Alabdulrazzaq F, Scolnik D (2013) Belladonna alkoloid intoxication: The 10-year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther 20 [Epub ahead of print]
[14] Jakabová S, Vincze L, Farkas A, Kilár F, Boros B, et al. (2012) Determination of tropane alkaloids atropine and scopolamine by liquid chromatography-mass spectrometry in plant organs of Datura species. J Chromatogr A 1232: 295–301.
[15] Robenshtok E, Luria S, Tashma Z, Hourvitz A (2002) Adverse reaction to atropine and the treatment of organophosphate intoxication. Isr Med Assoc J 4: 535-539.
[16] Al-Shaikh AM, Sablay ZM (2005) Hallucinogenic plant poisoning in children. Saudi Med J 26: 118-121.
[17] Spina SP, Taddei A (2007) Teenagers with Jimson weed (Datura stromonium) poisoning. CJEM 9: 1634-1639.
[18] American Academy of Clinical Toxicology, Europan Association of Poisons Centres and Clinical Toxicologists (1997) Position statement: single-dose activated charcoal. J Toxicol Clin Toxicol 35: 721-741.
[19] Green R, Grierson R, Sitar DS, Tenenbein M (2001) How long after drug ingestion is charcoal still effective? J Toxicol Clin Toxicol 39: 601-605.
[20] Green R, Sitar DS, Tenenbein M (2004) Effect of Anticholinergic Drugs on the Efficacy of Activated Charcoal. J Toxicol Clin Toxicol 42: 267-272.
[21] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa Belladonna intoxication case report. Pan Afr Med J 11: 72.
[22] Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE (2000) A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 35: 374-381.
[23] Glatstein M, Alabdulrazzaq F, Scolnik D (2013) Belladonna alkoloid intoxication: The 10-year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther 20 [Epub ahead of print]
[24] Caksen H, Odaba? D, Akbayram S, Cesur Y, Arslan S, et al. (2003) Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol 22: 665–668.
References
[1] Donovan JW (2005) Anticholinergic plants: Critical care toxicology: diagnosis and management of the critically poisoned patient. (1st edtn) Elsevier Mosby-Year Book, Philadelphia.
[2] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa Belladonna intoxication: a case report. Pan Afr Med J 11: 72.
[3] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa belladonna intoxication: a case report. Pan Afr Med J 11: 72.
[4] Joshi P, Wicks AC, Munshi SK (2003) Recurrent autumnal psychosis. Postgrad Med J 79: 239-240.
[5] Mirakhur RK, Dundee JW (1979) Cardiovascular changes during induction of anaesthesia. Influence of three anticholinergic premedicants. Ann R Coll Surg Engl 61: 463-469.
[6] Diaz DM, Diaz SF, Marx GF (1980) Cardiovascular effects of glycopyrrolate and belladonna derivatives in obstetric patients. Bull N Y Acad Med 56: 245-248.
[7] http://www.public.health.wa.gov.au/cproot/2548/2/atropine%20sulfate%20injection.pdf
[8] http://www.dhss.delaware.gov/dph/ems/files/pharmacology08.pdf
[9] http://www.icuadelaide.com.au/files/primary/pharmacology/autonomic.pdf
[10] Galichet LY, Moffat AC, Osselton MD, et al, eds. Clarke’s Analysis of Drugs and Poisons. 3rd ed. London, UK: Pharmaceutical Press; 2004: 658.
[11] Bishop AG, Tallon JM. Anticholinergic visual hallucination from atropine eye drops. CJEM. 1999;1:115–116.
[12] Baker JP, Farley JD. Toxic psychosis following atropine eyedrops. BMJ. 1958:1390–1392.
[13] Glatstein M, Alabdulrazzaq F, Scolnik D (2013) Belladonna alkoloid intoxication: The 10-year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther 20 [Epub ahead of print]
[14] Jakabová S, Vincze L, Farkas A, Kilár F, Boros B, et al. (2012) Determination of tropane alkaloids atropine and scopolamine by liquid chromatography-mass spectrometry in plant organs of Datura species. J Chromatogr A 1232: 295–301.
[15] Robenshtok E, Luria S, Tashma Z, Hourvitz A (2002) Adverse reaction to atropine and the treatment of organophosphate intoxication. Isr Med Assoc J 4: 535-539.
[16] Al-Shaikh AM, Sablay ZM (2005) Hallucinogenic plant poisoning in children. Saudi Med J 26: 118-121.
[17] Spina SP, Taddei A (2007) Teenagers with Jimson weed (Datura stromonium) poisoning. CJEM 9: 1634-1639.
[18] American Academy of Clinical Toxicology, Europan Association of Poisons Centres and Clinical Toxicologists (1997) Position statement: single-dose activated charcoal. J Toxicol Clin Toxicol 35: 721-741.
[19] Green R, Grierson R, Sitar DS, Tenenbein M (2001) How long after drug ingestion is charcoal still effective? J Toxicol Clin Toxicol 39: 601-605.
[20] Green R, Sitar DS, Tenenbein M (2004) Effect of Anticholinergic Drugs on the Efficacy of Activated Charcoal. J Toxicol Clin Toxicol 42: 267-272.
[21] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa Belladonna intoxication case report. Pan Afr Med J 11: 72.
[22] Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE (2000) A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 35: 374-381.
[23] Glatstein M, Alabdulrazzaq F, Scolnik D (2013) Belladonna alkoloid intoxication: The 10-year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther 20 [Epub ahead of print]
[24] Caksen H, Odaba? D, Akbayram S, Cesur Y, Arslan S, et al. (2003) Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol 22: 665–668.
[2] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa Belladonna intoxication: a case report. Pan Afr Med J 11: 72.
[3] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa belladonna intoxication: a case report. Pan Afr Med J 11: 72.
[4] Joshi P, Wicks AC, Munshi SK (2003) Recurrent autumnal psychosis. Postgrad Med J 79: 239-240.
[5] Mirakhur RK, Dundee JW (1979) Cardiovascular changes during induction of anaesthesia. Influence of three anticholinergic premedicants. Ann R Coll Surg Engl 61: 463-469.
[6] Diaz DM, Diaz SF, Marx GF (1980) Cardiovascular effects of glycopyrrolate and belladonna derivatives in obstetric patients. Bull N Y Acad Med 56: 245-248.
[7] http://www.public.health.wa.gov.au/cproot/2548/2/atropine%20sulfate%20injection.pdf
[8] http://www.dhss.delaware.gov/dph/ems/files/pharmacology08.pdf
[9] http://www.icuadelaide.com.au/files/primary/pharmacology/autonomic.pdf
[10] Galichet LY, Moffat AC, Osselton MD, et al, eds. Clarke’s Analysis of Drugs and Poisons. 3rd ed. London, UK: Pharmaceutical Press; 2004: 658.
[11] Bishop AG, Tallon JM. Anticholinergic visual hallucination from atropine eye drops. CJEM. 1999;1:115–116.
[12] Baker JP, Farley JD. Toxic psychosis following atropine eyedrops. BMJ. 1958:1390–1392.
[13] Glatstein M, Alabdulrazzaq F, Scolnik D (2013) Belladonna alkoloid intoxication: The 10-year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther 20 [Epub ahead of print]
[14] Jakabová S, Vincze L, Farkas A, Kilár F, Boros B, et al. (2012) Determination of tropane alkaloids atropine and scopolamine by liquid chromatography-mass spectrometry in plant organs of Datura species. J Chromatogr A 1232: 295–301.
[15] Robenshtok E, Luria S, Tashma Z, Hourvitz A (2002) Adverse reaction to atropine and the treatment of organophosphate intoxication. Isr Med Assoc J 4: 535-539.
[16] Al-Shaikh AM, Sablay ZM (2005) Hallucinogenic plant poisoning in children. Saudi Med J 26: 118-121.
[17] Spina SP, Taddei A (2007) Teenagers with Jimson weed (Datura stromonium) poisoning. CJEM 9: 1634-1639.
[18] American Academy of Clinical Toxicology, Europan Association of Poisons Centres and Clinical Toxicologists (1997) Position statement: single-dose activated charcoal. J Toxicol Clin Toxicol 35: 721-741.
[19] Green R, Grierson R, Sitar DS, Tenenbein M (2001) How long after drug ingestion is charcoal still effective? J Toxicol Clin Toxicol 39: 601-605.
[20] Green R, Sitar DS, Tenenbein M (2004) Effect of Anticholinergic Drugs on the Efficacy of Activated Charcoal. J Toxicol Clin Toxicol 42: 267-272.
[21] Berdai MA, Labib S, Chetouani K, Harandou M (2012) Atropa Belladonna intoxication case report. Pan Afr Med J 11: 72.
[22] Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE (2000) A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 35: 374-381.
[23] Glatstein M, Alabdulrazzaq F, Scolnik D (2013) Belladonna alkoloid intoxication: The 10-year Experience of a Large Tertiary Care Pediatric Hospital. Am J Ther 20 [Epub ahead of print]
[24] Caksen H, Odaba? D, Akbayram S, Cesur Y, Arslan S, et al. (2003) Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol 22: 665–668.