Cholinergic Crisis Caused by Cholinesterase Inhibitors: a Retrospective Nationwide Database Study

In contrast to information on the effects of organophosphate, pesticide, or environmental exposures, data on cholinergic crisis caused by pharmaceutical cholinesterase inhibitors are sparse. The present study aimed to describe the characteristics, demographics, and mortality of patients with cholinergic crisis caused by pharmaceutical cholinesterase inhibitors using a nationwide inpatient database in Japan.

We identified patients diagnosed with cholinergic crisis as a result of taking cholinesterase inhibitor medications in the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016. We examined the patients' characteristics, treatments, and mortality.

A total of 235 patients with cholinergic crisis were identified during the 69-month study period. Forty-eight patients required mechanical ventilation (20.4%), and 15 patients died (6.4%) in hospital. The median lengths of hospital stay and intensive care unit stay were 15 days (interquartile range, 6-42) and 4 days (2-8), respectively. Approximately half of all hospitalized patients required catecholamines, atropine, or mechanical ventilation, while the other half did not require any of these treatments. Patients who required catecholamines, atropine, or mechanical ventilation were more likely to die and had longer hospital stays.

Cholinergic crisis caused by pharmaceutical cholinesterase inhibitors is a rare but potentially life-threatening condition. Patients who require mechanical ventilation and catecholamines or atropine have a poorer prognosis.