Anticholinergic toxicity with wide-complex tachycardia

What it is

The anticholinergic toxidrome comes from low potency antipsychotics, oxybutynin, ACh receptor antagonists such as Ipratropium, Atropine and Scopolamine, TCA and antihistamines.

How it presents

The picture is hot as a desert for the hyperthermia, blind as a bat for the dilated pupils of mydriasis, mad as a hatter for the confusion, dry as a bone for the dry mouth and urinary retention, and red as a beet for the flushed skin. Tachycardia, absent bowel sounds, shaking and grabbing at invisible objects go with them.

Not every case opens with that list. A 23 years old woman brought to the emergency department because she was vague and confused, with a past medical history of depression and medications prescribed 2 months ago that she was not using regularly, may show only an HR of 114 that is regular, a T of 37, a BP of 102/65, a Sat of 99% on RA and an RR of 18. The tachycardia and the confusion carry the case, and the drug history is the rest of it.