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Transient cardiac effects in a child with acute cholinergic syndrome due to rivastigmine poisoning

Umberto Raucci1, Nicola Vanacore2, Corrado Cecchetti1

  • 1Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

The Journal of Emergency Medicine
|February 13, 2014
PubMed

Insights

Rivastigmine poisoning in a child caused a severe cholinergic syndrome requiring intensive care. Prompt recognition and management of its toxic effects, including cardiac complications, are crucial for survival.

Area of Science:

  • Toxicology
  • Pediatric Emergency Medicine
  • Clinical Pharmacology

Background:

  • Rivastigmine, an acetylcholinesterase inhibitor, is used to treat dementia.
  • Poisoning can lead to a severe cholinergic syndrome with nicotinic, muscarinic, and central nervous system effects.

Observation:

  • A 3-year-old girl ingested rivastigmine, presenting with altered mental status, sialorrhea, sweating, diarrhea, and respiratory failure.
  • She developed significant gastrointestinal distress and frequent ventricular ectopic beats, indicating cardiac involvement.
  • Follow-up revealed a transient cardiac dysrhythmia.

Findings:

  • Cholinergic syndrome from rivastigmine poisoning can be life-threatening in pediatric patients.
  • The case highlights the need for intensive care and supportive management for severe poisoning.
  • Cardiac complications, such as dysrhythmias, can occur and require careful monitoring.

Implications:

  • Early identification and management of rivastigmine toxicity are essential for patient outcomes.
  • Assessment for cardiac complications is critical in patients with cholinergic syndrome due to poisoning.
  • Autonomic dysfunction, hypoxemia, acidosis, and electrolyte imbalances are key factors predisposing to complications.
Abstract

Keywords:
cardiac effectcholinergic syndromepoisoningrivastigminetoxicity

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