Mad as a Hatter

Blind as a bat,
Red as a beet,
Dry as a bone,
Hot as a hare,
Mat as a hatter.

I loved CSI the very first time I saw it, because in the episode, Grissom recited this poem while his accomplices gazed at him in awe. As a medical student, it just seemed like a funny poem to remember, and difficult, because it doesn’t even rhyme. And I could never remember if it was a cholinergic syndrome or an anticholinergic syndrome.

My patient came in pacing, agitated, picking things out of the air. As I interviewed her, she kept turning to the side, looking up, speaking to the air. I asked her if someone was in the room with us. Yes, she said. It was her son’s best friend. I asked if he had been in the room before. She said he kept coming in and out of the room. She had called 911 because of teenagers breaking into her house, but when the police arrived, it was just her.

In reviewing her med list, I discovered that she was taking a huge dose of a prescription antihistamine…a likely cause of an anticholinergic syndrome like the delerious character in the CSI episode…(except he was drinking Jimson Weed tea).

A single dose of IV physostigmine (brand name Antilirium) rapidly calmed her down, and she lay down and slept for hourse while we rehydrated her. She was admitted to medicine service for 24 hours of observation and hydration.

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