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Acute atropine poisoning: signs, treatment
Last reviewed: 23.04.2024
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Atropine is widely used in medicine alone in the form of sulphate and is part of many complex drugs - anti-asthma (Solutan, Franol), antispasmodics (Besalol, Spasmoveralgin) and some others. It is used in ophthalmology and psychiatry. Atropine poisoning occurs as a result of accidental or deliberate overdose of the substance. The effect of toxic doses is explained by the ability of this substance to cause atropine delirium - a narcotic-like condition with impaired consciousness (hallucinations and delusions), which can even lead to death due to respiratory paralysis.
Atropine is chemically released from plant materials. Its predecessor, the even more active natural alkaloid hyoscyamine, is found in many poisonous plants of the nightshade family. In our zone it is belladonna, dope, henbane. Directly with an extract of the leaves and roots of these plants, candles, drops, tablets, tinctures are produced. Such drugs are not uncommon, many of them are sold without a prescription, are considered natural and harmless, they can be found in almost any home medicine chest. In fact, drugs with alkaloids are potent agents that require adherence to the dosing regimen and caution during storage.
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Causes of the atropine poisoning
Poisoning with this substance occurs accidentally with improper dosing of drugs, as part of which it is present, eating poisonous plants in food, or intentionally, when it is used as a drug.
The main risk factors of intoxication relate primarily to the carelessness or lack of basic knowledge. So, young children left to themselves can try the fruits of a poisonous plant out of curiosity and desire to try everything “on the teeth”, and they don’t need much for poisoning - 2-3 belladonna berries or 15-20 dope seeds.
Adults, having not studied how to follow the instructions for the preparation, self-medicating or skip past the doctor’s warning about dosing, can poison themselves or, worse, cause harm to their child. You can get poisoned even with an overdose of eye drops, inhaling the evaporation of a bouquet of wild flowers, in which there is a dope, although of course, getting the toxic substance inside is more dangerous.
The reason for the poisoning can be a desire to get a drug rush.
The pathogenesis of intoxication is based on the ability of atropine to bind mainly to muscarinic cholinergic receptors, moreover, although to a much lesser extent, atropine can bind to nicotinic cholinergic receptors, making them insensitive to the neurotransmitter acetylcholine. This leads to an increase in its concentration at the synapse, as a result of which the transmission of nerve impulses is slowed down in different parts of the brain. Violation of acetylcholine metabolism causes a disorder of higher nervous activity, as well as parasympathetic (cholinergic) innervation.
Certain doses of atropine and its predecessor (maximum per day is prescribed for adults no more than 2 mg orally, for children - 0.1-1 mg) through exposure, mainly to the cerebral cortex, cause an acute psychotic reaction, accompanied by motor stimulation. The well-known ancient expression “henbane overeat” is not without reason - a person under the influence of this hallucinogen becomes inadequate.
If the patient fails to help, prolonged overexcitation of cholinergic systems leads to their exhaustion, depression of the reflexes - paralysis of breathing, amnesia, loss of consciousness. Possible coma and death.
Atropine-like alkaloids in contact with the mucous membranes of the eyes and the alimentary canal are quickly absorbed. The speed depends on the dose, fullness of the stomach with food. If the alkaloids of the atropine group got inside on an empty stomach, the first symptoms of intoxication are observed after a few minutes, and the full picture of poisoning develops in an hour or two. Injection forms are even more intense. Poisonous substances are broken down by the liver and excreted in the urine and sweat. During the day, the body is released from half of the dose, but this day still needs to be experienced.
Statistics show that the proportion of poisoning with blockers of muscarinic receptors is about 12-15% of all chemical intoxications. Most of the victims are children who have eaten a poisonous plant or tried atropine containing drugs stored in an accessible place.
Symptoms of the atropine poisoning
The first signs of the presence of atropine in the body are externally manifested by an expansion of the pupils, which cease to respond to changes in light. This is accompanied by an increase in intraocular pressure, the appearance of a veil before the eyes; after an hour or two, accommodation paralysis and photophobia may occur.
At the same time, discomfort appears on the mucous membranes of the mouth and nasopharynx. There is a noticeable dryness up to burning, strong thirst, which is associated with a decrease in the production of saliva, bronchial secretions. It becomes difficult for the patient to swallow, the voice becomes hoarse or disappears completely.
His arms and legs begin to tremble, and painful muscle spasms may appear.
The secretion of gastric and pancreatic juice decreases. Frequent painful false urges to empty the bowel (tenesmus) may occur.
Alkaloids poisoning of the atropine group is manifested by redness and dryness of the skin, scarlet-like rash (most often in children). The patient's pulse quickens (it can reach 160-190 beats / min). Small children may not have tachycardias due to the low tonus of the vagus nerve.
Severe intoxications are accompanied by hyperthermia with pyretic values caused by impaired sweating. The patient has logoreia, motor agitation, incoordination, headache, shortness of breath, hallucinations and secondary delusions, up to a violent state and a complete loss of orientation. There may be convulsions, epileptiform seizures. The patient behaves inadequately, there are signs of psychosis.
The excited state lasts for several hours. It can be replaced by depression of the central nervous system. In this case, mobility is limited and muscle relaxation occurs. The patient may lose consciousness. Dyspnea is periodically replaced by superficial and rare respiratory movements, which accelerate and become frequent and deep, then decrease again (breathing like Cheyne-Stokes), the face becomes pale with a bluish tinge. Pulse in a patient is fast, weak filling, irregular. There is a decrease in blood pressure.
Acute atropine poisoning can be fatal. The patient dies of asphyxiation during paralysis of the respiratory center, however, most cases of acute intoxication end with recovery. It takes two to four days, sometimes mydriasis lasts up to two weeks.
Phases of atropine poisoning: arousal and depression, can be expressed in varying degrees depending on the dose taken, body weight, patient's age and individual response.
Mild poisoning is manifested by mydriasis, cycloplegia, dryness and hyperemia of the mucous membranes and skin, accelerated heartbeat, weakening of intestinal motility, urinary retention, anxiety and speech disorders, tremor in the limbs. Gradually, this state goes into sleep.
In medicine, in the treatment of certain diseases accompanied by severe muscle weakness, drugs are used to enhance the action of acetylcholine by inhibiting the activity of the enzyme catalyzing the reaction of its cleavage, cholinesterase. They have a reversible and irreversible effect on the enzyme. In the first case, upon the termination of their action, the enzymatic activity is restored, in the second - no. Drugs cause intoxication with overdose.
Irreversible anticholinesterase effect is, getting into the human body, organophosphate fertilizers and insecticides. These substances can cause severe poisoning even when they hit the surface of the skin, as they are well absorbed.
Poisoning with irreversible anticholinesterase agents is manifested by the directly opposite atropine effects - hypersalivation, hyperhidrosis, pupil constriction, accommodation spasm. Peristalsis of the gastrointestinal tract increases, as a result of which abdominal pain, vomiting, and frequent urge to defecate. Abnormally active contraction of the bronchial muscles leads to difficulty wheezing, shortness of breath as a result of spasms. Slow pulse, muscular tremor is observed.
Neurological symptoms, however, are similar to atropine poisoning - psychomotor agitation turns into depression of reflexes.
Severe poisoning leads to seizures, hypotension and collapse. The cause of death is respiratory paralysis.
Anticholinesterase drugs and blockers of muscarinic cholinergic receptors produce the opposite actions - they excite or inhibit parasympathetic innervation, therefore they are antidotes for corresponding acute poisonings.
Chronic atropine poisoning occurs with its long-term use and small overdose. Observed: dilated pupils, disorders of accommodation, dry mucous membranes and skin, dizziness, somewhat rapid pulse, trembling in the limbs, delayed emptying of the bladder and constipation.
Complications and consequences
The most terrible outcome of atropine poisoning is death from respiratory paralysis. However, it is comforting that this happens very rarely. Most people have time to help, and he survives.
However, severe poisoning and prolonged coma may be complicated by the development of gross memory and mental retardation, toxic polyneuritis, or inflammation of the meninges. A substance that has entered the body in a toxic dose affects the muscular layer and tissues of all organs, disrupts the glands. Complications of poisoning can be pneumonia, atelectasis of the lungs, diseases of the digestive system, glaucoma, retinal detachment.
Diagnostics of the atropine poisoning
Atropine poisoning is diagnosed by clinical symptoms and information about its use. Analyzes and instrumental diagnostics that can confirm or refute atropine intoxication do not exist. The only test is to drop a drop of the patient's urine into the eye of a rabbit or cat. They must expand the pupils, which will confirm the presence of atropine in the body.
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Treatment of the atropine poisoning
Emergency help with atropine poisoning or poisonous plants (getting it through the mouth) - gastric lavage. The patient is given to drink 2-3 liters of warm water with crushed tablets of activated carbon or the same slightly pink solution of potassium permanganate. Simultaneously, the ambulance crew is called. The unconscious patient is turned on its side to avoid suffocation when sticking the tongue.
The patient is hospitalized. Depending on the condition of the patient, stabilization measures are taken. Gastric lavage through a probe can be carried out, the tip of which must be lubricated with vaseline oil in order not to damage the dried esophagus.
If, as a patient, it is not possible to do a gastric lavage, a subcutaneous injection of apomorphine (an emetic) is done in order to quickly remove toxic residues. In addition, prescribe a siphon enema with a solution of tannin (0.5%).
In cases of impaired respiratory function, artificial lung ventilation or tracheal intubation may be indicated.
For removal of the sucked poison they perform forced diuresis with blood alkalization, detoxification hemosorption.
The patient must be given an antidote for atropine poisoning - as such, reversible anticholinesterase agents with the ability to exert the exact opposite effect are used to eliminate the blockade of cholinergic receptors: to restore the tone of the muscles of the bronchi, the gastrointestinal tract, the musculoskeletal system, glands, reduce intraocular pressure.
For example, prozerin in case of poisoning with atropine is administered subcutaneously or drip, diluted in saline solution. Introduction repeated. First, 3 ml of a 0.05% solution of the drug is administered, then, with insufficient effect, repeat the introduction. Within 20-30 minutes you can enter up to 12 ml of a solution of prozerin. The drug mainly restores parasympathetic innervation, since it poorly overcomes the blood-brain barrier and its central action is weak.
Physostigmine for atropine poisoning is used in patients with convulsions, pyretic temperature values and the development of acute vascular insufficiency. It is administered intravenously. Young children about 0.5 mg, in adolescence - 1 mg. Injections are made every 5–20 minutes until the signs of the anticholinergic effect of atropine disappear.
Antidote preparations are used with caution, monitoring the achievement of a satisfactory ratio between their effects. The dose is chosen empirically, and the introduction of the following doses of the drug is unpredictable. They are usually lower than the original, since some of the drug is excreted from the body. Physostigmine is not recommended for use at low temperature values, not dangerous hallucinations or delusions.
Other medications are prescribed symptomatically. Psychomotor stimulation is stopped by antipsychotics, convulsions by barbiturates, with hyperthermia external cooling is used (ice blisters, wet wraps) and antipyretic agents, the accelerated pulse is normalized with β-adrenergic blockers. Treatment is aimed at restoring and maintaining vital body functions.
After discharge from the hospital during the rehabilitation period, great attention should be paid to the day regimen and the patient's diet. Nutritional foods containing minerals, proteins and vitamins should prevail in the diet. Greens, vegetables, fruits, lean meat and fish, dairy products will restore strength and energy, and also have a beneficial effect on the work of the digestive organs.
Recommended daily walks in the fresh air, the duration of which needs to be increased gradually, physical therapy exercises will be useful.
Acute poisoning with atropine can have very serious consequences, so alternative treatment is not recommended. It is necessary to call the ambulance crew and not to refuse hospitalization. Herbal therapy can be practiced during the recovery period - drink vitamin teas, brew infusions that strengthen the immune system.
Homeopathy also recommends that when poisoning, first of all, remove the poison from the body, that is, flush the stomach and cause vomiting, make an enema. There is no specific antidote in homeopathy, symptomatic treatment. Considering the danger of this poisoning, homeopathy can be applied only in very mild forms or in the recovery period.
Prevention
When treating drugs containing atropine, it is necessary to strictly follow the recommendations of the doctor and dosage. When the first symptoms of overdose (dry mucous membranes, thirst, lethargy, anxiety, drowsiness) appear, you must inform the doctor.
Keep drugs with atropine in places inaccessible to children.
Do not leave young children unattended, examine the appearance of poisonous plants themselves and tell older children about them. In general, to teach them not to eat unfamiliar berries, not to collect bouquets of wild-growing unknown plants and explain why this should not be done.