[Acute respiratory failure associated with cholinergic crisis: report of five cases and review of the literature].

Abstract

Distigmine bromide is a cholinesterase inhibitor widely used for the treatment of hypotonic neurogenic bladder. However, this drug is also known to cause cholinergic crisis, a rare but serious adverse reaction. Cholinergic crisis is an excessive amount of acetylcholine due to the systemic inhibition of cholinesterase activity, characterized by parasympathetic symptoms such as sweating, salivation, miosis, bradycardia, diarrhea and circulatory and respiratory failure. The incidence of cholinergic crisis has been estimated at approximately 0.2%, and the majority of the patients are elderly with underlying conditions such as cerebrovascular disease. Since 2004, we have encountered 5 cases of acute respiratory failure associated with cholinergic crisis induced by the administration of a normal oral dose of distigmine. We present these cases here and review an additional 23 cases from the literature in Japan. In these 28 cases, mechanical ventilation was required for 57%, with a mean duration of 5.1 days and a mortality rate of 11%. Pneumonia was observed in half of the cases in the acute phase, and relapse due to the readministration of distigmine was reported in 20% of cases. It is important to remember that cholinergic crisis in the elderly is often misdiagnosed and is occasionally treated as simple aspiration pneumonia.

• Authors: Mikoto Takahashi, Satoshi Ubukata, Eizaburo Sato, Makoto Shoji, Naoto Morikawa, Hiroshi Watanabe, Hiroshi Takahashi
• Journal: Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society (Nihon Kokyuki Gakkai Zasshi) Vol. 49 Issue 12 Pg. 877-84 (Dec 2011) ISSN: 1343-3490 [Print] Japan
• PMID: 22352046 (Publication Type: Case Reports, English Abstract, Journal Article, Review)

Chemical References

• Cholinesterase Inhibitors
• Pyridinium Compounds
• distigmine

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Autonomic Nervous System Diseases (chemically induced)
• Cholinesterase Inhibitors (adverse effects)
• Female
• Humans
• Male
• Pyridinium Compounds (adverse effects)
• Respiratory Insufficiency (chemically induced)