title: Transient cardiac effects in a child with acute cholinergic syndrome due to rivastigmine poisoning.
abstract: BACKGROUND
  We report a case of rivastigmine poisoning resulting in a full cholinergic syndrome with nicotinic, muscarinic, and central effects requiring supportive or intensive care in a pediatric patient.
  
  
  METHODS
  A 3-year-old girl was admitted to the Emergency Department suspected of having ingested one or two pills of rivastigmine. The child was hyporeactive, with symptoms of altered mental status, sialorrhea, sweating, and diarrhea. Subsequently, she started showing signs of respiratory failure, severe tracheobronchial involvement, and gastric and abdominal distension. An electrocardiogram recorded frequent monomorphic ventricular ectopic beats with bigeminy and trigeminy. Long-term follow-up showed a transient dysrhythmia.
  
  
  CONCLUSIONS
  Poisoning with rivastigmine can be a life-threatening condition. Timely identification and appropriate management of the toxic effects of this drug are essential and often life-saving. This is particularly true in cases of cholinergic syndrome subsequent to drug poisoning. Patients with cholinergic syndrome should also be assessed for possible cardiac complications such as dysrhythmias. The main factors predisposing to the development of such complications are autonomic disorder, hypoxemia, acidosis, and electrolyte imbalance.
authors: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors: Umberto
authors: U
authors: Raucci
authors: National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Rome, Italy.
authors: Nicola
authors: N
authors: Vanacore
authors: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors: Corrado
authors: C
authors: Cecchetti
authors: Paediatric Arrhythmology Unit and Syncope Unit, Paediatric Cardiology and Heart-Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors: Mario Salvatore
authors: MS
authors: Russo
authors: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors: Rossella
authors: R
authors: Rossi
authors: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors: Nicola
authors: N
authors: Pirozzi
mesh_terms: D017109:Akathisia, Drug-Induced / Q000209:etiology*; D002675:Child, Preschool; D002800:Cholinesterase Inhibitors / Q000506:poisoning*; D002802:Cholinesterases / Q000097:blood; D003221:Confusion / Q000139:chemically induced; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D006801:Humans; D048448:Phenylcarbamates / Q000506:poisoning*; D011041:Poisoning / Q000628:therapy; D000068836:Rivastigmine; D012798:Sialorrhea / Q000139:chemically induced; D013546:Sweating / Q000187:drug effects; D013577:Syndrome; D013610:Tachycardia / Q000139:chemically induced*
chemical_list: D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D002802:Cholinesterases; D000068836:Rivastigmine
keywords: cardiac effect; cholinergic syndrome; poisoning; rivastigmine; toxicity