Cite this post as:
Scott Weingart, MD FCCM. EMCrit RACC Podcast 218 – Physostigmine with Bryan Hayes. EMCrit Blog. Published on February 20, 2018. Accessed on May 29th 2023. Available at [https://emcrit.org/emcrit/physostigmine/ ].
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
Original Release: February 20, 2018
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Recently I had a case of Mandrake poisoning. The root was eaten by a young woman in order to increase fertility. Soon after, she developed signs of anti-cholinergic poisoning, mainly dryness, urinary retention and sinus tachycardia. In addition, she became severely agitated, with restlessness and visual hallucinations. We gave her Diazepam in order to control the agitation, so she slept for a while but due to renewed signs of delirium, she got 1 mg of Physostigmine and than another one, which worked like magic. She became coherent and cooperative, after the first dose. Later, she was discharged intact from the… Read more »
I’ve used this effectively in severely symptomatic diphenhydramine and scoplamine intoxications. Curious about its being ‘contraindicated in TCA overdoses’… that must be from very old data (or a few case reports?). Keep up the great work!
I wonder if it might be worth giving a dose of the muscle relaxant reversal combination of glycopyrronium and neostigmine as a test dose.. It will last for a few minutes, prevent any Bradycardias and inform you as to whether it will help. Most of our ODs are mixed and it is difficult to decide what to reverse safely!
“Alright… pretend I’m an idiot”. I love it.
Great ‘cast. I was always taught to fear the Physo… no longer. Thanks for the deep dive.