Atropine poisoning

Here's a recent news item about a bunch of idiots in Perth, Australia who snorted hyoscine instead of the cocaine they thought it was. Major fail!

They found themselves in the emergency room exhibiting classical features of the atropine toxidrome - mad as Max, hot as a pot, dry as Mars, red as Sonja, and blind as Dare Devil.

Once a diagnosis is made, treatment is quite simple. Apart from respiratory support, overcome the atropine effects by administering physostigmine, an acetylcholinesterase inhibitor.

Here are short videos on :

cholinergic neurotransmission

acetylcholinetserase inhibitors

Over-Atropinization

There was a time in Pharmacology, when acetylcholine was very topical, as were the effects of atropine. We studied the over-atropinization toxidrome by memorizing the idioms found in almost every textbookof Pharmacology : Hot as a hare, mad as a hatter, red as a beet, dry as a bone, blind as a bat..... I must confess these idioms didn't mean much to me as a student in Singapore. I just couldn't identify with them. Hot as a hare?? Mad as a hatter?? But memorize them we did, and made it through the exams.

Here is my contemporay remake of the idioms! Hot as a (hot) pot, Mad as (Mad) Max, Red as (Red) Sonja, Dry as (Mars), Blind as Dare Devil.

We don't see much over-atropinization nowadays, but it's worth remembering the toxidrome.

For completeness sake, the full toxidrome looks something like this:
Delirium
Drowsiness
Dilated pupils
Dry mouth
Dysphagia
Drunken gait
Dry, hot skin
Death