The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome

Background. We report two pediatric cases of anticholinergic toxidrome, including the youngest reported to date, in which standard therapeutic strategies were either contraindicated or ineffective, while treatment with dexmedetomidine was rapidly efficacious with no adverse effects. Moreover, with t...

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Main Authors: Mitchell Zekhtser, Erin Carroll, Molly Boyd, Shashikanth Ambati
Format: Article
Language:English
Published: Wiley 2021-01-01
Series:Case Reports in Critical Care
Online Access:http://dx.doi.org/10.1155/2021/7590960
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author Mitchell Zekhtser
Erin Carroll
Molly Boyd
Shashikanth Ambati
author_facet Mitchell Zekhtser
Erin Carroll
Molly Boyd
Shashikanth Ambati
author_sort Mitchell Zekhtser
collection DOAJ
description Background. We report two pediatric cases of anticholinergic toxidrome, including the youngest reported to date, in which standard therapeutic strategies were either contraindicated or ineffective, while treatment with dexmedetomidine was rapidly efficacious with no adverse effects. Moreover, with the recent shortage of physostigmine, we highlight an alternative treatment in this clinical setting. Case Summaries. In case 1, a two-year-old had an overdose presenting with an anticholinergic toxidrome. However, his hypopnea precluded the use of benzodiazepines due to the high likelihood of intubation. In case 2, a 14-year-old had a polypharmacy overdose inducing agitated delirium that was refractory to high-dose benzodiazepines. Due to the unknown ingestion, physostigmine was avoided. In both cases, dexmedetomidine helped the patient remain calm and metabolize the ingestions. Conclusion. Our experience suggests that dexmedetomidine may be a useful adjunct in anticholinergic presentations in the setting of polypharmacy, when standard therapy is proven ineffective, contraindicated, or unavailable.
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spelling doaj-art-8bd80c2fdc884d25a64f30e5e5a274c72025-02-03T01:26:59ZengWileyCase Reports in Critical Care2090-64202090-64392021-01-01202110.1155/2021/75909607590960The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic ToxidromeMitchell Zekhtser0Erin Carroll1Molly Boyd2Shashikanth Ambati3Department of Emergency Medicine, Albany Medical Center, Albany, New York, USADepartment of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USADepartment of Emergency Medicine, Albany Medical Center, Albany, New York, USADivision of Pediatric Critical Care Medicine and Department of Pediatrics, Albany Medical Center, Albany, New York, USABackground. We report two pediatric cases of anticholinergic toxidrome, including the youngest reported to date, in which standard therapeutic strategies were either contraindicated or ineffective, while treatment with dexmedetomidine was rapidly efficacious with no adverse effects. Moreover, with the recent shortage of physostigmine, we highlight an alternative treatment in this clinical setting. Case Summaries. In case 1, a two-year-old had an overdose presenting with an anticholinergic toxidrome. However, his hypopnea precluded the use of benzodiazepines due to the high likelihood of intubation. In case 2, a 14-year-old had a polypharmacy overdose inducing agitated delirium that was refractory to high-dose benzodiazepines. Due to the unknown ingestion, physostigmine was avoided. In both cases, dexmedetomidine helped the patient remain calm and metabolize the ingestions. Conclusion. Our experience suggests that dexmedetomidine may be a useful adjunct in anticholinergic presentations in the setting of polypharmacy, when standard therapy is proven ineffective, contraindicated, or unavailable.http://dx.doi.org/10.1155/2021/7590960
spellingShingle Mitchell Zekhtser
Erin Carroll
Molly Boyd
Shashikanth Ambati
The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome
Case Reports in Critical Care
title The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome
title_full The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome
title_fullStr The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome
title_full_unstemmed The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome
title_short The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome
title_sort role of dexmedetomidine in pediatric patients presenting with an anticholinergic toxidrome
url http://dx.doi.org/10.1155/2021/7590960
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