Transient cardiac effects in a child with acute cholinergic syndrome due to rivastigmine poisoning

Umberto Raucci, Nicola Vanacore, Corrado Cecchetti, Mario Salvatore Russo, Rossella Rossi, Nicola Pirozzi

Research output: Contribution to journalArticlepeer-review


Background We report a case of rivastigmine poisoning resulting in a full cholinergic syndrome with nicotinic, muscarinic, and central effects requiring supportive or intensive care in a pediatric patient. Case Report A 3-year-old girl was admitted to the Emergency Department suspected of having ingested one or two pills of rivastigmine. The child was hyporeactive, with symptoms of altered mental status, sialorrhea, sweating, and diarrhea. Subsequently, she started showing signs of respiratory failure, severe tracheobronchial involvement, and gastric and abdominal distension. An electrocardiogram recorded frequent monomorphic ventricular ectopic beats with bigeminy and trigeminy. Long-term follow-up showed a transient dysrhythmia. Conclusion Poisoning with rivastigmine can be a life-threatening condition. Timely identification and appropriate management of the toxic effects of this drug are essential and often life-saving. This is particularly true in cases of cholinergic syndrome subsequent to drug poisoning. Patients with cholinergic syndrome should also be assessed for possible cardiac complications such as dysrhythmias. The main factors predisposing to the development of such complications are autonomic disorder, hypoxemia, acidosis, and electrolyte imbalance.

Original languageEnglish
Pages (from-to)21-25
Number of pages5
JournalJournal of Emergency Medicine
Issue number1
Publication statusPublished - 2014


  • cardiac effect
  • cholinergic syndrome
  • poisoning
  • rivastigmine
  • toxicity

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)


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