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Hot, blind, and mad: avoidable geriatric anticholinergic delirium
Kristen L Ochs1, Michele Zell-Kanter, Mark B Mycyk
1Southern Illinois University, Edwardsville, IL 62026, USA.
The American Journal of Emergency Medicine
|April 5, 2011
Summary
Elderly patients are sensitive to delirium-inducing drugs. A 93-year-old developed anticholinergic delirium after receiving diphenhydramine, highlighting risks in older adults.
Area of Science:
- Geriatrics
- Emergency Medicine
- Pharmacology
Background:
- The elderly are susceptible to medications causing delirium.
- Anticholinergic medications pose a risk for adverse effects in older adults.
Observation:
- A 93-year-old woman received subcutaneous diphenhydramine as a local anesthetic in the emergency department due to a reported allergy to "caine" anesthetics.
- Within 20 minutes, the patient exhibited symptoms of anticholinergic toxidrome: agitation, tachycardia, mydriasis (dilated pupils), and dry skin.
Findings:
- Subcutaneous diphenhydramine administration led to anticholinergic delirium in an elderly patient.
- Diphenhydramine is frequently associated with anticholinergic adverse effects, particularly in the geriatric population.
Implications:
- Clinicians must exercise caution when prescribing diphenhydramine to elderly patients.
- Consideration of alternative anesthetic agents may be necessary for elderly patients with "caine" allergies.
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