A fatal case of cholinergic crisis induced by chronic low dose distigmine bromide intoxication

Mori Hitoshi, Yoshimura Yuya, Tokura Tomohisa, Nodagashira Tatsuya, Konn Akihide

doi:10.57388/jjct.37.1_29

Bibliographic Information

Other Title

ジスチグミン5 mgの長期投与で発症した致死的コリン作動性クリーゼの1例

Abstract

<p>Distigmine bromide is widely used to treat neurogenic bladder. It may cause cholinergic crisis, a serious side effect. We report the case of an 86-year-old woman with neurogenic bladder who had been taking 5 mg of distigmine bromide orally daily for over a year. She presented to our emergency room unconscious with hypotension and bradycardia. She was intubated, high-dose catecholamine was administered, and a temporary pacemaker was placed. She remained hypotensive. Based on her physical findings, particularly excessive sweating, myosis, and increased salivation, along with low serum cholinesterase, cholinergic crisis due to distigmine bromide was diagnosed. We attempted to resuscitate her with intravenous atropine；however, she died from intestinal necrosis. This case suggests that even a low dose of distigmine bromide can induce a cholinergic crisis. Differential diagnosis is difficult in the early phase of the disease. When examining a patient who is taking distigmine bromide, always considering the possibility of the toxidrome of cholinesterase inhibiters is essential.</p>

Journal

Japanese Journal of Clinical Toxicology

Japanese Journal of Clinical Toxicology 37 (1), 29-35, 2024-03-10

Japanese Society for Clinical Toxicology

Keywords

Details 詳細情報について

CRID: 1390581148793329664

DOI: 10.57388/jjct.37.1_29

ISSN: 27582140; 09143777

Text Lang: ja

Data Source

JaLC

Abstract License Flag: Allowed

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