A female with central anticholinergic syndrome responsive to neostigmine

Central anticholinergic syndrome is a rarely observed condition in children . The occurrence of this syndrome after ingestion of Solanum pseudocapsicum is infrequent because findings tend to be milder and localized to the gast rointestinal system, without central nervous system involvement. Most patie nts do not present with diagnostic problems because their relatives can usu ally report any ingestion of poisonous agents; however, when drug poisoning or plant ingestion is uncertain, a differential diagnosis with encephaliti s must he considered, Physostigmine salicylate is the specific antidote bec ause it crosses the blood-brain barrier because of its tertiary ammonium gr oup. Neostigmine methylsulfate has a quaternary ammonium group, which preve nts its penetration through the blood-brain barrier; hence its primary infl uence is believed to be due to its action on the peripheral nervous system, We describe a female with central anticholinergic syndrome caused by inges tion of Solanum pseudocapsicum. A slow intravenous infusion of neostigmine methylsulfate (0.03 mg/kg) immediately resolved the clinical picture. To ou r knowledge, this case is the first reported of central anticholinergic syn drome occurring after ingestion of Solanum pseudocapsicum in a child and th e first report of a complete and rapid remission after intravenous neostigm ine methylsulfate administration. (C) 2000 by Elsevier Science Inc, All rig hts reserved.