What Are the Signs of an Atropine Overdose?

Atropine poisoning refers to poisoning caused by eating excessive amounts of roots, stems, fruits of atropine-containing plants, or taking their preparations.

Chinese name: Atropine poisoning

Foreign name: atropinism
Main cause: Atropine overdose

Atropine Poisoning I. Introduction to Atropine Poisoning

Atropine alkaloids include atropine, anisodamine, scopolamine, anisodamine, etc., and existing synthetic alternatives to atropine, such as Wei'ankang, quaternary ammonium bromideamine, tertiary ammonium benatiqine, and Huma Tropin, and the selective M receptor subtype blocking drug pirenzepine are equal; and botanicals such as belladonna, daffodil, mandala, coriander, tangut, etc. all contain such alkaloids ^{[1 ]} .

This class of drugs is completely absorbed orally, and can also be absorbed through mucous membranes or damaged skin. 5-10 mg of atropine may show obvious symptoms of poisoning, with a minimum lethal dose of 80 to 130 mg, and individual 50 mg. Oral scopolamine is 5 mg / time, and the lethal dose is about 8 mg. Poisoning can occur in the following situations: Oral or injection overdose, such as rescue of organophosphate poisoning, can be directly converted from organophosphate poisoning coma to atropine poisoning coma, should be identified according to other circumstances; China's folk mandala Orchid flower wine is taken orally to treat joint pain. Too much can be poisoned. Poisoning by eating Datura berry by children; applying transdermal Datura leaf or belladonna cream for transdermal absorption of poisoning ^[1] .

Atropine poisoning II, the poisoning mechanism of atropine drugs

Atropine blocks acetylcholine receptors (an important neurotransmitter) in effector organs dominated by postganglionic cholinergic nerves. When overdose, the symptoms are mainly the symptom after the paracrine nerve action is relieved and the central nervous system (CNS) excitement, but it has no counteracting effect on nicotine-like symptoms.

Atropine poisoning III. Common causes of atropine poisoning

(1) Mistake of atropine drugs or plants containing atropine by mistake.

(2) Atropine poisoning caused by overuse of atropine drugs.

(3) Eye drops containing atropine flow into the nasal cavity. Applying belladonna cream to the skin and mucous membranes can also cause absorption poisoning ^[2] .

Atropine poisoning IV. Key points for diagnosis of atropine poisoning

If you are not sure whether atropine poisoning has occurred, you can refer to the following three main diagnostic points:

(1) Medical history: history of swallowing plant fruits, rhizome disease or do not use a lot of atropine drugs.

(B) symptoms of poisoning: the main clinical manifestations of poisoning are ^[1]

Dry mouth, dry throat, dry skin, increased body temperature in summer, etc., caused by decreased glandular secretion;

Heart rate increases;

pupil dilation, blurred vision, unclear near objects;

abdominal distension, constipation, dysuria may occur in old age; the above four points are caused by blocked acetylcholine receptors ;

Flushing of the face and skin is caused by vasodilatation. Severe poisoning can result in blood pressure drop or shock due to peripheral vasodilation and central paralysis of vascular movement;

Central irritations such as irritability, multilingualism, hallucinations, delirium, and convulsions, and finally appeared critical signs such as coma and respiratory depression, and eventually died of respiratory failure.

Scopolamine poisoning may have no central excitement symptoms, mandala poisoning without fever, skin flushing and so on. Symptoms of poisoning can last for hours to days.

(3) Laboratory auxiliary inspection:

1. Put a little of the suspected poison into the evaporation dish, add a little fuming nitric acid, evaporate to dryness on the water bath, add a few drops of 10% potassium hydroxide alcohol solution after cooling, if it is atropine poison, it will be violet, and soon Turns red.

2. Check for gastric lavage and vomitus for residues of mandala fruit, roots and leaves.

3 Take urine for cat eye dilation test or send urine for qualitative analysis of atropine.

4 It can also be injected subcutaneously from 0.03 to 0.06 mg / kg · times. If no symptoms such as sweating, salivation, tearing, and increased bowel movements occur, atropine poisoning can be diagnosed ^[3] .

Atropine poisoning V. Essentials of treatment of atropine poisoning

(1) Emetic and gastric lavage After taking poison by accident, you can use a tongue depressor to stimulate the throat to induce vomiting, or take 1% copper sulfate solution to induce vomiting. Can also use 1: 5000 potassium permanganate solution, 2% sodium bicarbonate solution or strong tea for gastric lavage. After gastric lavage, sodium sulfate can be used to relieve diarrhea, and those with longer poisoning time can clean the intestines with normal saline.

(2) Application of detoxification and antagonists

1. Neostigmine: 0.05 to 0.08 mg / kg · times of neostigmine, subcutaneously or intramuscularly, once every 3 to 4 hours.

2. Available mung bean 2009, licorice 259, silver flower 1009, forsythia 509, add 1000ml of water, fry to 200mL, take 20ml each time, once every 2 hours.

3 Salicylic acid lentiline: 0.03 0.06mg / kg · times, injected subcutaneously. In severe cases, it can be injected intravenously, once every 15-30 minutes. It has an anti-atropine effect.

4 Eye contact with toxicants can be washed with boric acid.

(3) Promote the excretion of poisons

Give electrolytes. 10% glucose can be infused, and large doses of vitamins C2 to 49 can be added. Intravenous furosemide, 1 to 2mg / kg · times, to promote the excretion of poison.

(D) symptomatic treatment

1. Those who are irritable and convulsed should pay attention to protection and prevent injuries. Appropriate use of drugs such as diazepam or 10% water containing chloral. But avoid morphine and long-acting barbiturates that inhibit the respiratory center.

2. If you have symptoms such as drowsiness, coma, and respiratory depression, you can use respiratory stimulants, such as sodium benzoate caffeine, and use an artificial respirator to maintain breathing if necessary.

3 People with high fever can physically cool down, but also intramuscular injection of Antongding and Chaihu. Those with symptoms of shock should be actively treated with anti-shock.

^[3]

Atropine poisoning

1. Cure: The symptoms and signs of poisoning disappeared without complications. Methacholine and cat eye experiments were normal.

2. Improvement: Symptoms and signs are reduced, but there are dry mouth, reduced glandular secretion, and slightly dilated pupils ^[4] .

Atropine poisoning

1. Cases of overdose are mainly gastric lavage, catharsis and liquid supplementation with potassium permanganate solution.

2. Severe cases of gastric lavage + intramuscular injection of neostigmine, intravenous injection of beauty and sleep, attention to support symptomatic and other comprehensive treatment, the course of treatment is extended accordingly.

3. It is necessary to maintain a good balance of hydroelectric acid and acid and control infection during the treatment process. The elderly and patients with heart disease should be cautious when using neostigmine.

Atropine poisoning

1. Promote the toxicity of belladonna, mandala and coriander, and warn people not to use their berries and rhizomes for food or to treat diseases without authorization.

2. Before using atropine drugs, please check the usage and dosage in detail, and do not increase the dosage without authorization in order to speed up the improvement of the disease. If possible, try to use these drugs under your doctor's supervision.

Atropine poisoning

By studying the poisoning of atropine drugs, we know the impact of such drugs and their devastating effects on the human body, which warns the world to use atropine drugs reasonably. In addition, medical workers should also closely combine the dosage of the drug with the patient's physical condition when treating such drugs for diseases. Do not use the drugs blindly and avoid misuse. Just like who can carry a boat or cover it with water, drugs can save and harm people, so always remember to use a reasonable amount of any drug and use it cautiously ^[5] !