{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T15:24:22Z","timestamp":1761578662521,"version":"build-2065373602"},"reference-count":57,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","theclinics.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Neurologic Clinics"],"published-print":{"date-parts":[[2020,11]]},"DOI":"10.1016\/j.ncl.2020.07.005","type":"journal-article","created":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T18:12:54Z","timestamp":1602180774000},"page":"781-798","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":11,"title":["Toxin-Induced Acute Delirium"],"prefix":"10.1016","volume":"38","author":[{"given":"Alice","family":"Cai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuemei","family":"Cai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"issue":"12","key":"10.1016\/j.ncl.2020.07.005_bib1","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method. A new method for detection of delirium","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann Intern Med"},{"issue":"5","key":"10.1016\/j.ncl.2020.07.005_bib2","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1111\/j.1365-2125.2010.03633.x","article-title":"Anticholinergics, antimuscarinics or atropinics? About the words in pharmacology: Letter to the Editors","volume":"69","author":"Montastruc","year":"2010","journal-title":"Br J Clin Pharmacol"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib3","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1046\/j.1365-2125.1999.00026.x","article-title":"Acetylcholinesterase inhibitors in Alzheimer\u2019s disease","volume":"48","author":"McGleenon","year":"1999","journal-title":"Br J Clin Pharmacol"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.pharmthera.2007.09.009","article-title":"Muscarinic acetylcholine receptors as CNS drug targets","volume":"117","author":"Langmead","year":"2008","journal-title":"Pharmacol Ther"},{"issue":"5","key":"10.1016\/j.ncl.2020.07.005_bib5","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1038\/sj.bjp.0706780","article-title":"Muscarinic receptors: their distribution and function in body systems, and the implications for treating overactive bladder","volume":"148","author":"Abrams","year":"2006","journal-title":"Br J Pharmacol"},{"issue":"7","key":"10.1016\/j.ncl.2020.07.005_bib6","doi-asserted-by":"crossref","first-page":"855","DOI":"10.5811\/westjem.2014.8.23407","article-title":"Diphenhydramine overdose with intraventricular conduction delay treated with hypertonic sodium bicarbonate and i.v. lipid emulsion","volume":"15","author":"Abdi","year":"2014","journal-title":"West J Emerg Med"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib7","doi-asserted-by":"crossref","first-page":"297","DOI":"10.5847\/wjem.j.1920-8642.2017.04.009","article-title":"Anticholinergic syndrome induced by toxic plants","volume":"8","author":"Soulaidopoulos","year":"2017","journal-title":"World J Emerg Med"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib8","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/S0196-0644(00)70057-6","article-title":"A\u00a0comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning","volume":"35","author":"Burns","year":"2000","journal-title":"Ann Emerg Med"},{"issue":"11","key":"10.1016\/j.ncl.2020.07.005_bib9","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/S0196-0644(80)80232-0","article-title":"Asystole complicating physostigmine treatment of tricyclic antidepressant overdose","volume":"9","author":"Pentel","year":"1980","journal-title":"Ann Emerg Med"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib10","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1007\/s13181-010-0077-7","article-title":"Timing and Frequency of Physostigmine Redosing for Antimuscarinic Toxicity","volume":"6","author":"Rosenbaum","year":"2010","journal-title":"J\u00a0Med Toxicol"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib11","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s13181-013-0330-y","article-title":"Use of a Physostigmine Continuous Infusion for the Treatment of Severe and Recurrent Antimuscarinic Toxicity in a Mixed Drug Overdose","volume":"10","author":"Phillips","year":"2014","journal-title":"J\u00a0Med Toxicol"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib12","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1080\/10550490490436055","article-title":"Psychiatric Symptoms in Methamphetamine Users","volume":"13","author":"Zweben","year":"2004","journal-title":"Am J Addict"},{"key":"10.1016\/j.ncl.2020.07.005_bib13","doi-asserted-by":"crossref","DOI":"10.3389\/fnsyn.2016.00025","article-title":"Locus Ceruleus Norepinephrine Release: A Central Regulator of CNS Spatio-Temporal Activation?","volume":"8","author":"Atzori","year":"2016","journal-title":"Front Synaptic Neurosci"},{"issue":"7","key":"10.1016\/j.ncl.2020.07.005_bib14","doi-asserted-by":"crossref","first-page":"336","DOI":"10.5694\/j.1326-5377.2007.tb00932.x","article-title":"Amphetamine-related presentations to an inner-city tertiary emergency department: a prospective evaluation","volume":"186","author":"Gray","year":"2007","journal-title":"Med J Aust"},{"issue":"7","key":"10.1016\/j.ncl.2020.07.005_bib15","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/0278-6915(88)90236-0","article-title":"Methylxanthines: Toxicity to humans. 2. Caffeine","volume":"26","author":"Stavric","year":"1988","journal-title":"Food Chem Toxicol"},{"issue":"9","key":"10.1016\/j.ncl.2020.07.005_bib16","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1309\/WVX1-6FPV-E2LC-B6YG","article-title":"Evaluating Sympathomimetic Intoxication in an Emergency Setting","volume":"31","author":"Williams","year":"2000","journal-title":"Lab Med"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib17","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3109\/15563659409000444","article-title":"Fatal and nonfatal methamphetamine intoxication in the intensive care unit","volume":"32","author":"Chan","year":"1994","journal-title":"J\u00a0Toxicol Clin Toxicol"},{"issue":"3","key":"10.1016\/j.ncl.2020.07.005_bib18","doi-asserted-by":"crossref","first-page":"519.e1-4","DOI":"10.1016\/j.ajem.2016.09.040","article-title":"Dual cocaine and methamphetamine cardiovascular toxicity: rapid resolution with labetalol","volume":"35","author":"Richards","year":"2017","journal-title":"Am J Emerg Med"},{"issue":"3738","key":"10.1016\/j.ncl.2020.07.005_bib19","doi-asserted-by":"crossref","DOI":"10.4414\/smw.2017.14499","article-title":"Emergency department management of body packers and body stuffers","volume":"147","author":"Maier","year":"2017","journal-title":"Swiss Med Wkly"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib20","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.jchemneu.2003.10.002","article-title":"The human raphe nuclei and the serotonergic system","volume":"26","author":"Hornung","year":"2003","journal-title":"J\u00a0Chem Neuroanat"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib21","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/00005792-200007000-00001","article-title":"Serotonin syndrome. Presentation of 2 cases and review of the literature","volume":"79","author":"Mason","year":"2000","journal-title":"Medicine (Baltimore)"},{"issue":"9","key":"10.1016\/j.ncl.2020.07.005_bib22","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1093\/qjmed\/hcg109","article-title":"The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity","volume":"96","author":"Dunkley","year":"2003","journal-title":"QJM"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib23","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.bpa.2003.09.012","article-title":"Malignant hyperthermia - ScienceDirect","volume":"17","author":"Ali","year":"2003","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"10.1016\/j.ncl.2020.07.005_bib24","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1056\/NEJM198507183130306","article-title":"Neuroleptic Malignant Syndrome","volume":"313","author":"Guze","year":"1985","journal-title":"N\u00a0Engl J Med"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/106002809703100208","article-title":"Possible serotonin syndrome associated with tramadol and sertraline coadministration","volume":"31","author":"Mason","year":"1997","journal-title":"Ann Pharmacol"},{"key":"10.1016\/j.ncl.2020.07.005_bib26","doi-asserted-by":"crossref","unstructured":"Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyprohepatdine. The Journal of Emergency Medicine 1998;16(4):615-619. https:\/\/doi.org\/10.1016\/S0736-4679(98)00057-2.","DOI":"10.1016\/S0736-4679(98)00057-2"},{"issue":"3","key":"10.1016\/j.ncl.2020.07.005_bib27","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.neuropharm.2011.01.017","article-title":"Multiple receptors contribute to the behavioral effects of indoleamine hallucinogens","volume":"61","author":"Halberstadt","year":"2011","journal-title":"Neuropharmacology"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib28","doi-asserted-by":"crossref","first-page":"265","DOI":"10.31887\/DCNS.2001.3.4\/fxvollenweider","article-title":"Brain mechanisms of hallucinogens and entactogens","volume":"3","author":"Vollenweider","year":"2001","journal-title":"Dialogues Clin Neurosci"},{"issue":"7","key":"10.1016\/j.ncl.2020.07.005_bib29","first-page":"917","article-title":"The pharmacology and toxicology of \u201cecstasy\u201d (MDMA) and related drugs","volume":"165","author":"Kalant","year":"2001","journal-title":"Can Med Assoc J"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib30","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.pharmthera.2003.11.002","article-title":"Hallucinogens","volume":"101","author":"Nichols","year":"2004","journal-title":"Pharmacol Ther"},{"issue":"5","key":"10.1016\/j.ncl.2020.07.005_bib31","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1093\/jat\/30.5.342","article-title":"Psilocin identified in a DUID investigation","volume":"30","author":"Tiscione","year":"2006","journal-title":"J\u00a0Anal Toxicol"},{"year":"2014","series-title":"DSM-5 handbook of differential diagnosis","author":"First","key":"10.1016\/j.ncl.2020.07.005_bib32"},{"issue":"7","key":"10.1016\/j.ncl.2020.07.005_bib33","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1309\/V3J8-3KW2-BPT1-FU15","article-title":"Evaluating Hallucinogenic or Psychedelic Drug Intoxication in an Emergency Setting","volume":"31","author":"Williams","year":"2000","journal-title":"Lab Med"},{"issue":"1","key":"10.1016\/j.ncl.2020.07.005_bib34","first-page":"9","article-title":"Phencyclidine Intoxication and Adverse Effects: A Clinical and Pharmacological Review of an Illicit Drug","volume":"8","author":"Bey","year":"2007","journal-title":"Calif J Emerg Med"},{"issue":"18","key":"10.1016\/j.ncl.2020.07.005_bib35","doi-asserted-by":"crossref","first-page":"11934","DOI":"10.1073\/pnas.182234399","article-title":"Salvinorin A: A potent naturally occurring nonnitrogenous opioid selective agonist","volume":"99","author":"Roth","year":"2002","journal-title":"Proc Natl Acad Sci U\u00a0S\u00a0A"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib36","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1001\/archinte.1980.00330160128046","article-title":"Rhabdomyolysis and Acute Renal Failure Associated With Phencyclidine Intoxication","volume":"140","author":"Barton","year":"1980","journal-title":"Arch Intern Med"},{"year":"1999","series-title":"Basic neurochemistry","author":"Siegel","key":"10.1016\/j.ncl.2020.07.005_bib37"},{"issue":"1","key":"10.1016\/j.ncl.2020.07.005_bib38","first-page":"9","article-title":"Kindling in Alcohol Withdrawal","volume":"22","author":"Becker","year":"1998","journal-title":"Alcohol Health Res World"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib39","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1139\/jpn.0333","article-title":"The role of GABAA receptors in mediating the effects of alcohol in the central nervous system","volume":"28","author":"Davies","year":"2003","journal-title":"J\u00a0Psychiatry Neurosci"},{"issue":"1","key":"10.1016\/j.ncl.2020.07.005_bib40","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/1941874416637404","article-title":"Oral baclofen withdrawal resulting in progressive weakness and sedation requiring intensive care admission","volume":"7","author":"Alvis","year":"2017","journal-title":"Neurohospitalist"},{"issue":"22","key":"10.1016\/j.ncl.2020.07.005_bib41","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1056\/NEJMra1407298","article-title":"Recognition and Management of Withdrawal Delirium (Delirium Tremens)","volume":"371","author":"Schuckit","year":"2014","journal-title":"N\u00a0Engl J Med"},{"issue":"11","key":"10.1016\/j.ncl.2020.07.005_bib42","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1016\/j.apmr.2007.07.021","article-title":"Prolonged, Severe Intrathecal Baclofen Withdrawal Syndrome: A Case Report - Archives of Physical Medicine and Rehabilitation","volume":"88","author":"Hansen","year":"2007","journal-title":"Am Acad Phys Med Rehabil"},{"issue":"7","key":"10.1016\/j.ncl.2020.07.005_bib43","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1001\/jama.1994.03520070039035","article-title":"Individualized Treatment for Alcohol Withdrawal: A Randomized Double-blind Controlled Trial","volume":"272","author":"Saitz","year":"1994","journal-title":"J\u00a0Am Med Assoc"},{"issue":"3","key":"10.1016\/j.ncl.2020.07.005_bib44","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD005194.pub2","article-title":"Pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings","author":"Denis","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"10.1016\/j.ncl.2020.07.005_bib45","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.psym.2019.02.002","article-title":"Use of phenobarbital in alcohol withdrawal management - a retrospective comparison study of phenobarbital and benzodiazepines for acute alcohol wit","volume":"60","author":"Nisavic","year":"2019","journal-title":"Psychosomatics"},{"issue":"6","key":"10.1016\/j.ncl.2020.07.005_bib46","doi-asserted-by":"crossref","first-page":"454","DOI":"10.4037\/ajcc2018745","article-title":"Treatment of Alcohol Withdrawal Syndrome: Phenobarbital vs CIWA-Ar Protocol","volume":"27","author":"Tidwell","year":"2018","journal-title":"Am J Crit Care"},{"key":"10.1016\/j.ncl.2020.07.005_bib47","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/13556219971470","article-title":"Alcohol-thiamine interactions: an update on the pathogenesis of Wernicke encephalopathy","volume":"4","author":"Todd","year":"1999","journal-title":"Addict Biol"},{"issue":"17","key":"10.1016\/j.ncl.2020.07.005_bib48","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1056\/NEJM196604282741705","article-title":"Occurrence of Acute Wernicke\u2019s Encephalopathy during Prolonged Starvation for the Treatment of Obesity","volume":"274","author":"Drenick","year":"1966","journal-title":"N\u00a0Engl J Med"},{"issue":"3","key":"10.1016\/j.ncl.2020.07.005_bib49","first-page":"297","article-title":"Thiamine requirement in the adult human as measured by urinary excretion of thiamine metabolites","volume":"85","author":"Ziporin","year":"1965","journal-title":"J\u00a0Nutr"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib50","first-page":"26","article-title":"Thiamine Deficiency and Delirium","volume":"10","author":"Osiezagha","year":"2013","journal-title":"Innov Clin Neurosci"},{"issue":"5","key":"10.1016\/j.ncl.2020.07.005_bib51","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/S1474-4422(07)70104-7","article-title":"Wernicke\u2019s encephalopathy: new clinical settings and recent advances in diagnosis and management","volume":"6","author":"Sechi","year":"2007","journal-title":"Lancet Neurol"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib52","doi-asserted-by":"crossref","first-page":"501","DOI":"10.2214\/AJR.07.3959","article-title":"Neuroimaging Findings in Acute Wernicke\u2019s Encephalopathy: Review of the Literature","volume":"192","author":"Zuccoli","year":"2009","journal-title":"Am J Roentgenol"},{"issue":"4","key":"10.1016\/j.ncl.2020.07.005_bib53","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.2214\/ajr.171.4.9763009","article-title":"Usefulness of CT and MR imaging in the diagnosis of acute Wernicke\u2019s encephalopathy","volume":"171","author":"Antunez","year":"1998","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"10.1016\/j.ncl.2020.07.005_bib54","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.annemergmed.2007.02.007","article-title":"Myths and Misconceptions of Wernicke\u2019s Encephalopathy: What Every Emergency Physician Should Know","volume":"50","author":"Donnino","year":"2007","journal-title":"Ann Emerg Med"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib55","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1111\/j.1749-6632.1969.tb13005.x","article-title":"Influence of magnesium deficiency on the utilization of thiamine","volume":"162","author":"Zieve","year":"1969","journal-title":"Ann N Y Acad Sci"},{"issue":"1","key":"10.1016\/j.ncl.2020.07.005_bib56","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/j.0954-6820.1985.tb08836.x","article-title":"Aggravation of thiamine deficiency by magnesium depletion. A case report","volume":"218","author":"Dyckner","year":"1985","journal-title":"Acta Med Scand"},{"issue":"2","key":"10.1016\/j.ncl.2020.07.005_bib57","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1093\/alcalc\/agn118","article-title":"The Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment","volume":"44","author":"Kopelman","year":"2009","journal-title":"Alcohol Alcohol"}],"container-title":["Neurologic Clinics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0733861920300578?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0733861920300578?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T10:17:14Z","timestamp":1760005034000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0733861920300578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":57,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,11]]}},"alternative-id":["S0733861920300578"],"URL":"https:\/\/doi.org\/10.1016\/j.ncl.2020.07.005","relation":{},"ISSN":["0733-8619"],"issn-type":[{"type":"print","value":"0733-8619"}],"subject":[],"published":{"date-parts":[[2020,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Toxin-Induced Acute Delirium","name":"articletitle","label":"Article Title"},{"value":"Neurologic Clinics","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ncl.2020.07.005","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}