Clinical MCQ 6

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


Correct Answer: D


♦ 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.

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