Atropine toxicity in acute cervical spinal injury

A patient with a C.3/C.4 fracture dislocation resulting in an incomplete tetraplegia was treated with Cimetidine 400 mg bd to prevent gastrointestinal bleeding and 0.6 mg of atropine 6 hourly. He developed symptoms of atropine poisoning in the form of hallucinations, confusion and dilated pupils when the total dosage of atropine was 2.8 mg. This is far below the toxic levels normally considered necessary to produce atropine poisoning. The patient recovered. In view of the fact that this combination of drugs may be used in spinal units to prevent gastrointestinal bleeding and bradycardia, this experience is reported.