title: A 45-year-old woman with an anticholinergic toxidrome.
abstract: Intentional or accidental intoxications are common in the emergency department, but are not always sufficiently recognised. When intoxication is suspected, the causative agent or combination of agents often remain unclear, making these patients a diagnostic challenge. We present here a 45-year-old woman who was admitted due to altered consciousness. The clinical presentation fitted the anticholinergic toxidrome and an intoxication with venlafaxine (her known prescribed medication) was suspected. Plasma venlafaxine concentrations, however, were very low. After 24 hours the patient recovered completely. Further testing after discharge revealed high concentrations of promethazine, confirming the suspected diagnosis. This case illustrates the importance of knowledge of toxidromes and good collaboration with the hospital pharmacist. Because of the thorough testing the patient could receive proper treatment.
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: N A F
authors.initials: NA
authors.lastname: Verheijden
authors.forename: B C
authors.initials: BC
authors.lastname: Koch
authors.forename: Z
authors.initials: Z
authors.lastname: Brkic
authors.forename: J
authors.initials: J
authors.lastname: Alsma
authors.forename: S C E
authors.initials: SC
authors.lastname: Klein Nagelvoort-Schuit
mesh_terms: D064807:Anticholinergic Syndrome / Q000175:diagnosis* / Q000209:etiology; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008875:Middle Aged
chemical_list: D018680:Cholinergic Antagonists