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Accidental acute clidinium toxicity
1Emergency Department, John Radcliffe Hospital, Headley Way, Oxford, UK. serichardson@doctors.org.uk
Emergency Medicine Journal : EMJ
|May 26, 2009
Summary
Clidinium bromide overdose can cause anticholinergic effects like dilated pupils and rapid heart rate. Emergency physicians should consider this toxicity in patients using illicit chlordiazepoxide.
Area of Science:
- Pharmacology
- Toxicology
- Emergency Medicine
Background:
- Clidinium bromide is an antimuscarinic agent.
- It is commonly prescribed with chlordiazepoxide for irritable bowel syndrome.
- Illicit use of chlordiazepoxide is a concern.
Observation:
- A case of accidental staggered overdose of clidinium bromide (50 mg) is presented.
- The patient was also using illicit chlordiazepoxide.
- Presenting symptoms included mild pupillary dilation and sinus tachycardia.
Findings:
- Antimuscarinic toxicity was observed.
- Symptoms persisted for 11 hours.
- The combination of clidinium bromide and illicit chlordiazepoxide likely contributed to the toxicity.
Implications:
- Emergency physicians must recognize antimuscarinic toxicity in patients presenting with symptoms after illicit chlordiazepoxide use.
- This case highlights the potential dangers of combining prescription drugs with illicit substances.
- Awareness of clidinium bromide's anticholinergic properties is crucial for prompt diagnosis and management.
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