delirium accompanied by cholinergic deficiency and organ failure in a 73-year-old critically ill patient: physostigmine as a therapeutic option

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ID: 214140
2015
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Abstract
Delirium is a common problem in ICU patients, resulting in prolonged ICU stay and increased mortality. A cholinergic deficiency in the central nervous system is supposed to be a relevant pathophysiologic process in delirium. Acetylcholine is a major transmitter of the parasympathetic nervous system influencing several organs (e.g., heart and kidneys) and the inflammatory response too. This perception might explain that delirium is not an individual symptom, but rather a part of a symptom complex with various disorders of the whole organism. The cholinergic deficiency could not be quantified up to now. Using the possibility of bedside determination of the acetylcholinesterase activity (AChE activity), we assumed to objectify the cholinergic homeostasis within minutes. As reported here, the postoperative delirium was accompanied by a massive hemodynamic and renal deterioration of unclear genesis. We identified the altered AChE activity as a plausible pathophysiological mechanism. The pharmacological intervention with the indirect parasympathomimetic physostigmine led to a quick and lasting improvement of the patient’s cognitive, hemodynamic, and renal status. In summary, severe delirium is not always an attendant phenomenon of critical illness. It might be causal for multiple organ deterioration if it is based on cholinergic deficiency and has to be treated at his pathophysiological roots whenever possible.
Reference Key
zujalovic2015casedelirium Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Benedikt Zujalovic;Eberhard Barth
Journal trendy ekonomiky a managementu
Year 2015
DOI
10.1155/2015/793015
URL
http://dx.doi.org/10.1155/2015/793015
Keywords
critical care first aid intensive care medical emergencies

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