Why do anticholinergics cause delirium

For 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26 Background Anticholinergic syndrome results from competitive antagonism of acetylcholine at central and peripheral muscarinic receptors. Some cough medications may also contain paracetamol - so a concentration should be considered in these accidental ingestions as well.

Consider salicylate concentrations if differential includes salicylate toxicity. Consider concentrations for specific agents if available - eg carbamazepine Consider UEC and CK Management Stop any causative agents Active resuscitation is infrequently required. Attention should be paid to the maintenance of airway, breathing and circulation. Treat seizures with benzodiazepines Treat hypoglycaemia Treat hyperthermia with cooling measures.

Antipyretics are unhelpful. These children often benefit from 1-to-1 nursing. Avoid haloperidol and droperidol, which may worsen anticholinergic effects. Urinary retention may contribute to the agitation. Bladder scan will reveal the need for a urinary catheter. There exists some controversy over the use of physostigmine - a cholinesterase inhibitor - which has been used to reduce delirium in anticholinergic syndrome.

The use of physostigmine may be indicated following discussion with the toxicology service. Discharge requirements Asymptomatic children at risk of anticholinergic syndrome - with deliberate self-poisoning or significant accidental ingestion should be observed for 6 hours.

Prior to discharge, all children require: Normal GCS Normal ECG Ensure provision for safe discharge are in place In cases of deliberate ingestion, a risk assessment should indicate that the child or young person is at low risk of further self harm in the discharge setting.

Discharge information and follow-up: Accidental ingestion: Parent information sheet from Victorian Poisons Information centre on the prevention of poisoning Intentional self-harm: Referral to local mental health services e.

Diphenhydramine, Doxylamine, Promethazine, Chlorpheniramine, Cyproheptadine. Severe Anticholinergic Toxicity. Lee et al. Examples given were atypical and typical antipsychotic medications, cholinesterase inhibitors, antidepressants, benzodiazepines, and gabapentin.

Caution must be used when prescribing typical antipsychotic, such as haloperidol for delirium symptoms due to its association with extrapyramidal symptoms. Researchers explored alternative atypical antipsychotics, such as olanzapine, quetiapine and risperidone have shown to be as effective when treating delirium.

The researchers found no significant differences when comparing typical and atypical antipsychotics. The data collected were inconclusive in determining the effectiveness of atypical antipsychotics when treating the elderly. They reported the study results showed the use of antipsychotics to treat delirium in the geriatric population were inconclusive.

Anticholinergic side effects cited included confusion, cognitive and functional deficits. The anticholinergic side effects also can contribute to sedation, hypotension, dizziness, falls, and urinary incontinence with increased risk of urinary infections. The clinical presentation of these potential side effects will make it necessary to have further studies to clarify benefits on the use of antipsychotic medications when treating the geriatric population.

Marcum et al. Etiological factors are intrinsic and extrinsic. Medication classifications with central nervous system side effects can be precipitating risks for falls and fractures. Anticholinergic effects can cause dizziness, sedation, cognitive impairment, as well as blurred vision. Any one of these factors could preclude an adverse event. The study included postmenopausal women where the participants self-reported falls and current prescription use.

Associations increased dependent on length of use and polypharmacy of anticholinergic products. Anticholinergic effects not only include cognitive decline, but memory impairment, constipation and urinary retention. Researchers suggested that health care providers need to be cognizant of the adverse effects when prescribing and look into alternative methods of treatment. There also needs to be an increased awareness of the fall risk in anticholinergics available over the counter medications, such as diphenhydramine.

Research demonstrated the role of acetylcholine and cholinergic burden that occurs in anticholinergics can result in cognitive decline and dementia and should be avoided in those persons over the age of 65 years which aligned with the recommendations by the World Health Organization. Mintzer and Burns reviewed the anticholinergic side effects and the prevalence of anticholinergic administration for a variety of comorbidities.

Mintzer and Burns discussed the clinical manifestations of side effects of anticholinergic properties often seen in over the counter drug stores, such as Cimetidine Tagamet. Recommendations included finding alternatives to combinations of anticholinergic medications. Study results showed associations between falls and anticholinergics were increased dependent upon the length of use of anticholinergics and polypharmacy of anticholinergic products.

It was noted that health care providers need to be cautious when prescribing haloperidol due to its extrapyramidal side effects. The researchers reported inconclusive evidence that atypical or typical antipsychotics were more beneficial than the other. As a health care provider, one needs to be cognizant of current research literature. The above literature review depicts a glimpse of anticholinergics, its burden and side effects. As shown in the research, cognitive decline or delirium does not stand alone in the pocket of side effects.

Anticholinergics also go beyond the prescription pad; they are in the grocery and drug stores. Citation: Zanetos J Anticholinergic and Delirium. J Dement 1: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Select your language of interest to view the total content in your interested language.

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