Journal of the Japanese Society of Intensive Care Medicine
Online ISSN : 1882-966X
Print ISSN : 1340-7988
ISSN-L : 1340-7988
A case of cholinergic crisis induced by chronic distigmine bromide intoxication
Shinshu KatayamaJunji KumasawaKyoji OeNaoki TazawaHayoung LeeChikao ItoMiyuki KasuyaNoritsugu Irabu
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2011 Volume 18 Issue 2 Pages 227-231


A fetal case of chronic distigmine bromide intoxication in a 72 year old woman is presented. She had had a history of chronic renal dysfunction and liver cirrhosis for approximately 20 years. She initially presented with dysuria, and was place placed on 10 mg/day of oral distigmine bromide. After 9 months, she developed intractable diarrhea, vomiting, and finally cardiopulmonary arrest. She was resuscitated, but was finally pronounced dead despite the treatment. Her serum concentration of distigmine bromide found to be 69.9 ng/dl. Her serum cholinesterase was low. Bases on the aforementioned data, a diagnosis of distigmine bromide intoxication were confirmed. She had a background of chronic renal failure and liver cirrhosis as well as a chronically low level of cholinesterase, and it therefore took a long time to reach a diagnosis of distigmine bromide intoxication. When the residual ratio of serum cholinesterase was calculated, it had been at an abnormally low level since approximately 7 months before, and based on this and the time at which the intractable digestive symptoms began to occur, we therefore diagnosed chronic intoxication. When elderly patients on distigmine bromide developed intractable digestive symptoms, intoxication caused by this drug must be included in one of the differential diagnosis and should be candidate for intensive care.

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© 2011 The Japanese Society of Intensive Care Medicine
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