Dry Mouth, Dilated Pupils, and Tachycardia! - USMLE Forums
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  #1  
Old 11-13-2012
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Poison Dry Mouth, Dilated Pupils, and Tachycardia!

A 30 year old farmer presents to the ER with the history of salivation, lacrimation, urination, diarrhea and muscle fasciculation. you suspect poisoning and give drug that controls his symptoms. after giving the drug you notice dry mouth, dilated pupil, tachycardia. next step in management is..
a) increase atropine dose
b) increase atropine+PAM dose
c) increase PAM dose
d) physostigmine
e) neostigmine
f) give malathion+parathion
g) donepezil/tacrine
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  #2  
Old 11-13-2012
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I think its option C. increase PAM dose
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  #3  
Old 11-13-2012
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C? Increase pralidoxime to revert the anticholinergic symptoms?
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  #4  
Old 11-13-2012
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Judging by the dry mouth and tachy, I think the pt has been given too much atropine. So the answer should be D. Physostigmine to reverse the effects of atropine OD.
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  #5  
Old 11-13-2012
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With atropine overdose we are looking for the three C's of anti-Muscuranics. Cardiotoxicity, Convulsions and Coma. Since the CNS symptoms haven't manifested yet, we should act like the good physicians we are and load our patient with physostigmine. At this point, it is important to ask why Physo and not Neostigmine?

Physostigmine is a tertiary amine and Neostigmine is a quaternary amine. Tertiary amine crosses the CNS barrier whereas quaternary does not.

So according to me, we should give Physostigmine to the patient.
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  #6  
Old 11-13-2012
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Default my answer :)

d)physostigmine - Tx of atropin OD
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  #7  
Old 11-14-2012
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Default D?

The patient has an atropine overdose right? So it's antidote is physostigmine
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  #8  
Old 11-14-2012
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Seems like Anti-cholinergic symptoms. So its a atropine overdose
Will go wit D. Physostigmine
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  #9  
Old 11-14-2012
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Default my answer D

d)physostigmine-->the only one permeable to CNS
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  #10  
Old 11-14-2012
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it sounds like the doctor gave him too much weed.....
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  #11  
Old 11-14-2012
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Quote:
Originally Posted by convalescence View Post
it sounds like the doctor gave him too much weed.....
Well he dosen't look hungry
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Old 11-14-2012
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Correct Answer d

Opp>>>>atropine od>>>treatment by physostigmine
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  #13  
Old 11-15-2012
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Please don't mind everyone here
I just have a doubt
Dry mouth , tachycardia , and mydriasis are seen with pharmacological doses of atropine also as far as I know
So where is the point of overdose from the data in the vignette ??
To the best of my knowledge
Atropine psychosis is a sure finding of overdose
Please clarify
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  #14  
Old 12-12-2012
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dry mouth, dilated pupils and tachycardia are the signs that appear first with atropine overdose and psychosis is the last one ..... mentioned in ANS pharmacology Kaplan
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  #15  
Old 01-01-2013
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Dilated pupils indicate that pt is atropinised. So y to increase atropine. U shd go for physostigmine
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  #16  
Old 01-10-2013
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Quote:
Originally Posted by rupesh View Post
A 30 year old farmer presents to the ER with the history of salivation, lacrimation, urination, diarrhea and muscle fasciculation. you suspect poisoning and give drug that controls his symptoms. after giving the drug you notice dry mouth, dilated pupil, tachycardia. next step in management is..
a) increase atropine dose
b) increase atropine+PAM dose
c) increase PAM dose
d) physostigmine
e) neostigmine
f) give malathion+parathion
g) donepezil/tacrine


The patient came in as Organophosphates. The correct treatment will be Atropine and Pralidoxime. But in this case the Dr. give him Atropine alone and which cause side effects of Atropine. In order to treat Atropine overdose, the Dr. has to give Physostigmine. In this case the answer is D.
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  #17  
Old 12-08-2013
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Quote:
Originally Posted by rupesh View Post
A 30 year old farmer presents to the ER with the history of salivation, lacrimation, urination, diarrhea and muscle fasciculation. you suspect poisoning and give drug that controls his symptoms. after giving the drug you notice dry mouth, dilated pupil, tachycardia. next step in management is..
a) increase atropine dose
b) increase atropine+PAM dose
c) increase PAM dose
d) physostigmine
e) neostigmine
f) give malathion+parathion
g) donepezil/tacrine
Patient was given Atropine, but the end point of this drug is to reduce the bronchial secretion to improve oxygenation of the patient. Dry mouth, tachycardia & non-reactive dilated pupil are not signs of atropinization rather they are the first symptoms of Atropine toxicity, in that case Physostigmine should be started, being a narrow T.I drug as well as short acting, patient requires intensive monitoring, as patient may need subsequent doses.
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Old 12-08-2013
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when do we give PAM? I just want to know so that if they throw up a question like this...is PAM given after atropine to stop the muscular symptoms?
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  #19  
Old 12-09-2013
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PAM should be started as soon as possible, because there is a question of aging, which means OPC have bound irreversibly with AchE, PAM will not be working.
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