Ahmet Kağan ÖZKAYA, Sinem Sarı GÖKAY, Özlem Tolu KENDİR, Rıza Dinçer YILDIZDAŞ, Hayri Levent YILMAZ

Uncontrolled Agitation and Flushed Face Due to Tropicamide: A Missed Diagnosis

Introduction: Topical ophthalmic drugs that are not used in appropriate doses may lead to overdose symptoms.Case Report: A 2-month-old boy presented to the emergency department with extreme agitation, flushed face, mydriasis, cataract in the left eye, dry oral mucosa, spasticity in all extremities, and wheezing. It was learned that the patient had been receiving eye drops containing tropicamide at repeated doses before ophthalmologic evaluation. Pheniramine maleate and methylprednisolone were given to counter the drug-related side-effects or allergic reactions to the eye drop. At the follow-up, his symptoms and findings had become exacerbated, and he was admitted to the pediatric intensive care unit due to shock and drug-related anticholinergic toxicity.Conclusion: This case illustrates the importance of recognizing toxidromes at differential diagnosis and is the first reported pediatric case with tropicamide-induced anticholinergic syndrome

Keywords:

Anticholinergic syndrome, tropicamide, children,

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Labetoulle M, Frau É, Le Jeunne C. Systemic adverse effects of topical ocular treatments. Presse Med 2005; 34: 589-95. [CrossRef ]
Alpay A, Ermis B, Ugurbas SC, Battal F, Sagdik HM. The local vasocon- striction of infant's skin following instillation of mydriatic eye drops. Eur J Clin Pharmacol 2010; 66: 1161-4. [CrossRef ]
Coco TJ, Liebelt EL. General Approach to Poisoning. In Baren JM, Ro- throck SG, Brennan JA, Brown L, eds. Pediatric Emergency Medicine. Philadelphia: Saunders, Elsevier PA; 2008. p.106-14. [CrossRef ]
Reilly KM, Chan L, Mehta NJ, Salluzzo RF. Systemic toxicity from ocular homatropine. Acad Emerg Med 1996; 3: 868-71. [CrossRef ]
Micromedex® 2.0. Truven Health Analytics, Greenwood Village, Colo- rado, USA. Available from: http://www.micromedexsolutions.com/
Brunner GA, Fleck S, Pieber TR, Lueger A, Kaufmann P, Smolle KH, et al. Near fatal anticholinergic intoxication after routine fundoscopy. Inten- sive Care Med 1998; 24: 730-1. [CrossRef ]
Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE. A comparison of physostigmine and benzodiazepines for the treatment of anticholin- ergic poisoning. Ann Emerg Med 2000; 35: 374-81. [CrossRef ]
Lee AC, So KT. Acute anticholinergic poisoning in children. Hong Kong Med J 2005; 11: 520-3.
J Emerg Med Case Rep 2017; 8: 59-61
Özkaya et al. Tropicamide and Anticholinergic Syndrome