Anticholinergic poisoning

• Hot as a hare: increased body temperature
• Blind as a bat: mydriasis (dilated pupils)
• Dry as a bone: dry mouth, dry eyes, decreased sweat
• Red as a beet: flushed face
• Mad as a hatter: delirium

Examples

• Diphenhydramine
• Benztropine
• Dimenhydrinate
• Scopolamine
• Jimson weed overdose

Treatment

• Supportive management
• benzodiazepines for agitation
• avoid antipsychotics
  
• Physostigmine (contraindicated in TCA overdose)
  
• Adult - 1-2 mg via slow IV Push (0.2-0.3 mg every 5 minutes)
• Pediatric - 20 mcg/kg to maximum of 0.5 mg
• Half life may result in need to re-dose medication
• Keep atropine nearby in cholinergic effects occur (bronchospasm, bronchorrhea, bradycardia)
• Caution with QRS > 100 ms (get a screening EKG first)