'Red as a beet and blind as a bat' Anticholinergic delirium in adolescents: lessons for the paediatrician

Anticholinergic syndrome has been widely documented in the literature but is uncommon in paediatric medicine. Teenage boys are most at risk of self-induced anticholinergic syndrome through intentional ingestion of plants. We report on a 14 year old boy who presented to our hospital with clinical signs of anticholinergic toxicity and who was discharged 36 hours after admission with no major residual effects. Classical anticholinergic syndrome should be readily diagnosed by the experienced clinician ('hot as a hare, red as a beet, dry as a bone, blind as a bat and mad as a hatter'). Acute presentations should be treated with benzodiazepines and supportive care. Treatment of the delirium with haloperidol may be harmful. Lack of familiarity with anticholinergic syndrome may also delay the diagnosis or result in potentially harmful treatments. A high index of suspicion is often required in the paediatric setting due to infrequent acute hospital presentation.