Unexpected cholinergic crisis caused by distigmine bromide: A case report

Area of Science:

• Pharmacology
• Critical Care Medicine
• Toxicology

Background:

• Distigmine bromide is a cholinesterase inhibitor prescribed for hypotonic bladder dysfunction.
• Cholinergic crisis is a rare but serious adverse effect of cholinesterase inhibitors.

Observation:

• A patient on distigmine bromide developed severe cholinergic crisis with rapid deterioration.
• Symptoms included hypothermia, respiratory and circulatory failure, bradycardia, and excessive salivation.
• Constipation was noted as a significant pre-existing condition.

Findings:

• Diagnosis of cholinergic crisis was confirmed by clinical presentation and history of distigmine bromide use.
• Treatment involved mechanical ventilation, vasopressors, and continuous intravenous atropine sulfate.
• Serum cholinesterase levels and pre-existing symptoms were not reliable indicators for early crisis detection.

Implications:

• Constipation should be recognized as a critical risk factor for distigmine bromide-induced cholinergic crisis.
• Enhanced vigilance and communication regarding constipation are crucial for preventing adverse events.
• Early recognition and prompt management are vital for improving patient outcomes in cholinergic crisis.