{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:35:59Z","timestamp":1780583759720,"version":"3.54.1"},"reference-count":10,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:00:00Z","timestamp":1716508800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Neurohospitalist"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>Anticholinergic toxicity and neuroleptic malignant syndrome (NMS) are common toxidromes in medical emergencies. However, their co-occurrence, resulting in a dual toxidrome, is rare and presents significant diagnostic and therapeutic challenges. We present the case of a 23-year-old young male with polysubstance dependence, admitted following combined trihexyphenidyl and risperidone toxicity. He was diagnosed with a dual toxidrome of anticholinergic storm and NMS. Treatment of NMS included lorazepam and bromocriptine. Due to the unavailability of physostigmine, the preferred antidote for anticholinergic syndrome, intrathecal neostigmine was administered. The patient subsequently recovered and was discharged. This case highlights the complexity of managing dual toxidromes and the need for alternative therapeutic strategies in resource-limited settings.<\/jats:p>","DOI":"10.1177\/19418744241254580","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T18:29:30Z","timestamp":1716575370000},"page":"428-431","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Dual Toxidrome of Anti-cholinergic Storm and Neuroleptic Malignant Syndrome: A Therapeutic Challenge Overcome by Intrathecal Neostigmine"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7238-1058","authenticated-orcid":false,"given":"Nikhil","family":"Vojjala","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikant Kashinath","family":"Malegaonkar","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajal","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inderpaul Singh","family":"Sehgal","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4476-3478","authenticated-orcid":false,"given":"Ashok Kumar","family":"Pannu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"key":"bibr1-19418744241254580","volume-title":"Increase in Fatal Drug Overdoses across the United States Driven by Synthetic Opioids before and during the COVID-19 Pandemic","author":"Centers for Disease Control and Prevention","year":"2020"},{"key":"bibr2-19418744241254580","doi-asserted-by":"publisher","DOI":"10.4103\/2452-2473.357627"},{"key":"bibr3-19418744241254580","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2016.1245421"},{"key":"bibr4-19418744241254580","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2021.03.013"},{"key":"bibr5-19418744241254580","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2022.01.009"},{"key":"bibr6-19418744241254580","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S118438"},{"key":"bibr7-19418744241254580","doi-asserted-by":"publisher","DOI":"10.3109\/10401239409149014"},{"key":"bibr8-19418744241254580","unstructured":"Kearney TE. In: Olson KR, Anderson IB, Benowitz NL et al., eds. Physostigmine and Neostigmine in Poisoning & Drug Overdose. New York: McGraw-Hill Education; 2018:609."},{"key":"bibr9-19418744241254580","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2020.1854281"},{"key":"bibr10-19418744241254580","doi-asserted-by":"publisher","DOI":"10.4103\/aer.AER_184_17"}],"container-title":["The Neurohospitalist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19418744241254580","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19418744241254580","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19418744241254580","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:57:19Z","timestamp":1777589839000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19418744241254580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,24]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1177\/19418744241254580"],"URL":"https:\/\/doi.org\/10.1177\/19418744241254580","relation":{},"ISSN":["1941-8744","1941-8752"],"issn-type":[{"value":"1941-8744","type":"print"},{"value":"1941-8752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,24]]}}}