A 62 year old man come to emergency with a complain of Severe Agitation. He has a h/o Ingestion of diphenhydramine. O/E – blood pressure is 160/85 mmHg, the pulse is 160/min, and the temperature is 38.4 C(101.1F). Physical exam reveals dry mucous membranes and flushed dry skin. Decreased bowel sounds and a distended bladder. EKG reveals a wide complex tachycardia with.
What is the Right Treatment?
A. Labetalol
B. Diltiazem
C. Adenosine
D. Sodium bicarbonate
Answer
Correct Answer: D
Explanation
♦ The patient’s signs and symptoms are most consistent with anticholinergic toxicity.
♦ Sodium bicarbonate is used to treat the wide complex tachycardia that can occur from the sodium channel blockade seen in significant anticholinergic toxicity.
♦ Diphenhydramine is a frequently used antihistamine. It is the most common overdose that presents in anticholinergic toxicity and is particularly known to cause a wide complex tachycardia.
♦ Class IA antiarrhythmics should not be given in cases of suspected anticholinergic toxicity. Their mechanism of action is to block sodium channels, and therefore, could exacerbate the anticholinergic effects.
