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Anticholinergic toxidrome from amitriptyline — SCE Acute Medicine MCQ

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HardToxicology and OverdoseAnticholinergic toxidrome from amitriptylineSCE Acute Medicine

A 29-year-old man is brought to hospital by police because he is shouting that neighbours implanted cameras in his walls. He is febrile at 38.6 C, HR 128, pupils are dilated, skin is dry and bowel sounds are reduced. He takes amitriptyline for neuropathic pain. What is the most likely diagnosis?

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Correct answer: E — Anticholinergic toxidrome

Agitation, hallucinations, fever, mydriasis, dry skin and reduced bowel sounds in a patient taking amitriptyline suggest anticholinergic toxicity. Primary psychosis should not be diagnosed without addressing abnormal vital signs and toxidrome features. Opioid intoxication causes miosis and respiratory depression. The acute medicine rule is that new psychosis with abnormal observations is medical until proven otherwise.

Reference: TOXBASE anticholinergic poisoning, BNF