Distigmine bromide is commonly or occasionally prescribed to treat urinary bladder dyskinesia caused or induced by side effects of psychiatric medication such as antidepressants. We report sudden cardiovascular collapse caused by cholinergic crisis due to distigmine bromide intoxication in a patient with shizophrenia who attempted sucide by antipsychiatric drug overdose. Because the patient did not recognize distigmine bromide as a psychiatric medication, he ingested it with other drugs and was transferred to our department. We did not initially noticed the cholinergic crisis and treated him with the ordinal method against phenothiazine poisoning. He went into sudden cardiac arrest about 90min after admission. After cardiopulmonary resuscitation (CPR), hemodialysis was conducted and atropine sulfate administered. The ingested dose of distigmine bromide was assumed to be 175mg, indicating about 23% LD50 in mice. He fully recovered without complications on hospital day 6. Such a case of unnoticed cholinergic crisis due to distigmine bromide overdose is rare. We include a review of the literature.
