What is the recommended treatment for anticholinergic toxicity?

Anticholinergic toxicity occurs due to excessive blockade of acetylcholine receptors, often resulting from overdose of medications with anticholinergic properties. Symptoms can include confusion, agitation, hallucinations, dilated pupils, flushed skin, and in severe cases, seizures and respiratory failure.

The recommended treatment for anticholinergic toxicity is physostigmine, which is a reversible inhibitor of the enzyme acetylcholinesterase. By inhibiting this enzyme, physostigmine increases the levels of acetylcholine in the synaptic cleft, thereby counteracting the effects of anticholinergic agents. It can help to reverse symptoms such as delirium and other CNS effects by promoting cholinergic activity, addressing the underlying mechanism of toxicity.

While other treatments like activated charcoal can manage the ingestion of toxins if administered promptly, they do not specifically counteract the anticholinergic effects. Atropine is used for treating bradycardia and certain types of poisoning but is also an anticholinergic itself, which would not be appropriate in this context. Flumazenil is a benzodiazepine antagonist and is not effective for anticholinergic toxicity, as it targets a different class of drugs entirely. Therefore, the most effective