A Case of Acute Respiratory Failure with a Decrease of Serum Cholinesterase Caused by Distigmine Bromide

Abstract

We presented a case of acute respiratory failure with decreased serum cholinesterase caused by an anticholinesterase agent (distigmine bromide).A 70-year-old man had been taking distigmine bromide for prostatic hypertrophy. He underwent coronary artery bypass grafting for unstable angina. Dyspnea, diarrhea and bradycardia were noticed on the 5th postoperative day. Blood gas analysis showed marked respiratory acidosis (facemask; O2 5l·min-1, pH7.186, PaCO2 86.4mmHg, PaO2 97.6mmHg and BE 12.6mml·l-1). The clinical features were similar to acute organophosphate poisoning. We diagnosed these symptoms as a cholinergic crisis from distigmine bromide poisoning as serum cholinesterase decreased to 91 (normal range: 3000-6500) IU·l-1. The clinical symptoms improved after stopping the administration of distigmine bromide.This case shows us that we should be aware of the possibility of acute respiratory failure due to cholinergic crisis in patients taking distigmine bromide.