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Cholinergic Crisis Caused by Cholinesterase Inhibitors: a Retrospective Nationwide Database Study

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Abstract

Introduction

In contrast to information on the effects of organophosphate, pesticide, or environmental exposures, data on cholinergic crisis caused by pharmaceutical cholinesterase inhibitors are sparse. The present study aimed to describe the characteristics, demographics, and mortality of patients with cholinergic crisis caused by pharmaceutical cholinesterase inhibitors using a nationwide inpatient database in Japan.

Methods

We identified patients diagnosed with cholinergic crisis as a result of taking cholinesterase inhibitor medications in the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016. We examined the patients’ characteristics, treatments, and mortality.

Results

A total of 235 patients with cholinergic crisis were identified during the 69-month study period. Forty-eight patients required mechanical ventilation (20.4%), and 15 patients died (6.4%) in hospital. The median lengths of hospital stay and intensive care unit stay were 15 days (interquartile range, 6–42) and 4 days (2–8), respectively. Approximately half of all hospitalized patients required catecholamines, atropine, or mechanical ventilation, while the other half did not require any of these treatments. Patients who required catecholamines, atropine, or mechanical ventilation were more likely to die and had longer hospital stays.

Conclusions

Cholinergic crisis caused by pharmaceutical cholinesterase inhibitors is a rare but potentially life-threatening condition. Patients who require mechanical ventilation and catecholamines or atropine have a poorer prognosis.

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Funding

This work was supported by grants from the Ministry of Health, Labour and Welfare of Japan (H29-Policy-Designated-009 and H29-ICT-Genral-004); the Ministry of Education, Culture, Sports, Science and Technology of Japan (17H04141); and the Japan Agency for Medical Research and Development (AMED).

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Authors and Affiliations

  1. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Hiroyuki Ohbe, Taisuke Jo, Hiroki Matsui & Hideo Yasunaga

  2. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan

    Kiyohide Fushimi

Authors
  1. Hiroyuki Ohbe
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  2. Taisuke Jo
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  3. Hiroki Matsui
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  4. Kiyohide Fushimi
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  5. Hideo Yasunaga
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Correspondence to Hiroyuki Ohbe.

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The authors declare that they have no conflict of interest.

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Ohbe, H., Jo, T., Matsui, H. et al. Cholinergic Crisis Caused by Cholinesterase Inhibitors: a Retrospective Nationwide Database Study. J. Med. Toxicol. 14, 237–241 (2018). https://doi.org/10.1007/s13181-018-0669-1

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  • DOI: https://doi.org/10.1007/s13181-018-0669-1

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