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Anticholinergic toxicity — ABEM Board MCQ

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ModerateToxicologyAnticholinergic toxicityABEM Board

A 17-year-old boy arrives confused after ingesting diphenhydramine. Triage acuity is ESI 2; T 101.4 F, HR 138/min, BP 146/82 mm Hg. Skin is hot and dry, pupils are dilated, bowel sounds are decreased, and QRS is 92 ms. He is hallucinating but protecting the airway. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Provide supportive care with benzodiazepines and active cooling

Most anticholinergic toxicity is managed supportively with benzodiazepines, cooling, and monitoring; physostigmine is reserved for selected cases.

Reference: ACMT anticholinergic toxicity guidance