The importance of physical examination findings and the use of physostigmine.

I read with interest the case report by Özkaya et al.1 in the first issue of the The Turkish Journal of Pediatrics 2015 publications regarding Datura stramonium poisoning. I thank the authors for this case report but I want to express some aspects of this case concerning the diagnosis and treatment. Although the patient history is very important in the diagnosis and treatment of the case, the patients medical history may be insufficient because of some of the following reasons: babies or children are not able to fully express themselves, the patient maybe elderly or the relatives of patients maybe indifferent and careless or it could be a physician-induced cause. In this respect, both the patient history and the treatment are expected to be detailed in light of the findings of the physical examination. Upon presentation to the emergency department, the patient was found to be tachycardic and confused with dilated pupils and dry, flushed, hot skin. The physical examination findings described in this case appear to primarily occur after exposure to anticholinergic agents. Therefore, the findings of anticholinergic toxidrome should be well known. The sudden onset hallucinative consciousness changes (GCS:12), fever, dry skin, tachycardiac, mydriasis, vision abnormalities, slurred speech and ataxia may not only show that there is a serious anticholinergic poisoning in the 5-year-old previously completely healthy child but also may indicate the use of physostigmine to narrow the differential diagnosis or to provide diagnosis and treatment. The use of physostigmine can help in both the diagnosis and management of patients intoxicated with these substances2-4. REFERENCES