A Case of Acute Respiratory Failure with a Decrease of Serum Cholinesterase Caused by Distigmine Bromide

Background: Cholinergic crisis caused by cholinesterase inhibitors is rare but life-threatening. Clinical manifestations are thought to be similar to those caused by organophosphates. Case presentation: A 77-year-old woman on a standard dose of distigmine presented with impaired consciousness, blood pressure (BP) of 69/40 mmHg, a pulse rate (PR) of 60 beats/min, miosis, bronchorrhea, and serum cholinesterase (ChE) of 8 IU/L. After discontinuation of distigmine, altered mental status and pupil miosis were gradually resolved in 5 days with a concomitant increase of serum ChE. A 91-year-old woman presented with a headache, BP of 202/86 mmHg, PR of 83 beats/min, miosis, 9 rivastigmine patches on her knees, and ChE of 22 IU/L. The day after close observation without rivastigmine use, her symptoms were almost resolved with a concomitant increase of serum ChE. Conclusion: Our cases and a literature review suggested that, in contrast to distigmine, rivastigmine-induced cholinergic crisis caused hypertension and tachycardia.

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Opposite changes in blood pressure and pulse rate in two patients with distigmine and rivastigmine intoxication

Sedogawa

Matsuo

2020

JA Clin Rep

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A Case of Acute Respiratory Failure with a Decrease of Serum Cholinesterase Caused by Distigmine Bromide

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Opposite changes in blood pressure and pulse rate in two patients with distigmine and rivastigmine intoxication

Opposite changes in blood pressure and pulse rate in two patients with distigmine and rivastigmine intoxication

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