The treatment of maternal and fetal anticholinergic toxicity with physostigmine

A 20-year-old female at 36 weeks gestation ingested an unknown amount of diphenhydramine in a suicide attempt. She had a witnessed tonic-clonic seizure at home. Upon arrival to the emergency department, she was tachycardic with a pulse of 166, and confused. Fetal heart rate was 200–210 with poor variability. After being lavaged and given activated charcoal, the patient was given a small dose of intravenous physostigmine. Her pulse rapidly decreased from 134 to 121 beats/min and her mental status improved. The fetal pulse decreased from 192 to 182 b/m within 10 min. This case suggests that physostigmine can be used safely and effectively in pregnant women to treat signs and symptoms of severe anticholinergic poisoning in both the patient and fetus.