Atropine poisoning mimicking septicemia

Area of Science:

• Emergency Medicine
• Clinical Toxicology

Background:

• A young female presented to the emergency room with fever, tachycardia, and respiratory distress.
• Initial management included empirical antibiotics and mechanical ventilation due to a provisional diagnosis of septicemia.

Observation:

• Despite initial treatment, the patient's recovery was incomplete, with persistent bilateral mid-dilated fixed pupils.
• Extensive blood investigations and infection screening tests were negative, ruling out sepsis.

Findings:

• A detailed clinical assessment and history led to a strong suspicion of atropine poisoning.
• The constellation of symptoms, including fever, tachycardia, and fixed dilated pupils, were consistent with anticholinergic toxicity.

Implications:

• This case underscores the critical importance of thorough clinical examination and pupillary reflex assessment in the emergency department.
• Recognizing atypical presentations of poisoning is vital for accurate diagnosis and timely management, even when infection is suspected.