{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:43:23Z","timestamp":1789965803335,"version":"4.0.1"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2006,6,1]],"date-time":"2006-06-01T00:00:00Z","timestamp":1149120000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2006,6,1]],"date-time":"2006-06-01T00:00:00Z","timestamp":1149120000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"Abstract<\/jats:title>\n Introduction<\/jats:title>\n Intoxications with carbachol, a muscarinic cholinergic receptor agonist are rare. We report an interesting case investigating a (near) fatal poisoning.<\/jats:p>\n <\/jats:sec>\n Methods<\/jats:title>\n The son of an 84-year-old male discovered a newspaper report stating clinical success with plant extracts in Alzheimer's disease. The mode of action was said to be comparable to that of the synthetic compound 'carbamylcholin'; that is, carbachol. He bought 25 g of carbachol as pure substance in a pharmacy, and the father was administered 400 to 500 mg. Carbachol concentrations in serum and urine on day 1 and 2 of hospital admission were analysed by HPLC-mass spectrometry.<\/jats:p>\n <\/jats:sec>\n Results<\/jats:title>\n Minutes after oral administration, the patient developed nausea, sweating and hypotension, and finally collapsed. Bradycardia, cholinergic symptoms and asystole occurred. Initial cardiopulmonary resuscitation and immediate treatment with adrenaline (epinephrine), atropine and furosemide was successful. On hospital admission, blood pressure of the intubated, bradyarrhythmic patient was 100\/65 mmHg. Further signs were hyperhidrosis, hypersalivation, bronchorrhoea, and severe miosis; the electrocardiographic finding was atrio-ventricular dissociation. High doses of atropine (up to 50 mg per 24 hours), adrenaline and dopamine were necessary. The patient was extubated 1 week later. However, increased dyspnoea and bronchospasm necessitated reintubation. Respiratory insufficiency was further worsened by Proteus mirabilis<\/jats:italic> infection and severe bronchoconstriction. One week later, the patient was again extubated and 3 days later was transferred to a peripheral ward. On the next day he died, probably as a result of heart failure. Serum samples from the first and second days contained 3.6 and 1.9 mg\/l carbachol, respectively. The corresponding urine concentrations amounted to 374 and 554 mg\/l.<\/jats:p>\n <\/jats:sec>\n Conclusion<\/jats:title>\n This case started with a media report in a popular newspaper, initiated by published, peer-reviewed research on herbals, and involved human failure in a case history, medical examination and clinical treatment. For the first time, an analytical method for the determination of carbachol in plasma and urine has been developed. The analysed carbachol concentration exceeded the supposed serum level resulting from a therapeutic dose by a factor of 130 to 260. Especially in old patients, intensivists should consider intoxications (with cholinergics) as a cause of acute cardiovascular failure.<\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/cc4937","type":"journal-article","created":{"date-parts":[[2006,6,1]],"date-time":"2006-06-01T21:49:48Z","timestamp":1149198588000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Case report: Acute unintentional carbachol intoxication"],"prefix":"10.1186","volume":"10","author":[{"given":"Martin","family":"Schulz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Graefe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Stuby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilke","family":"Andresen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Kupfermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achim","family":"Schmoldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2006,6,1]]},"reference":[{"key":"4460_CR1","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1007\/BF01860236","volume":"164","author":"H Kreitmair","year":"1932","unstructured":"Kreitmair H: Eine neue Klasse Cholinester.\n Arch Exp Pathol Pharmakol 1932, 164: 346-356. 10.1007\/BF01860236","journal-title":"Arch Exp Pathol Pharmakol"},{"key":"4460_CR2","first-page":"183","volume-title":"Goodman & Gilman's The Pharmacological Basis of Therapeutics","author":"JH Brown","year":"2006","unstructured":"Brown JH, Taylor P: Muscarinic receptor agonists and antagonists. In Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11th edition. Edited by: Brunton LL. New York: McGraw-Hill; 2006:183-200.","edition":"11"},{"key":"4460_CR3","first-page":"609","volume":"ii","author":"NN","year":"1944","unstructured":"NN: Overdose of carbachol.\n Lancet 1944, ii: 609.","journal-title":"Lancet"},{"key":"4460_CR4","first-page":"27","volume":"22","author":"B Sangster","year":"1979","unstructured":"Sangster B, Savelkoul TJF, Nieuwenhuis MG, van der Sluys Veer J: Two cases of carbachol intoxication.\n Neth J Med 1979, 22: 27-28.","journal-title":"Neth J Med"},{"key":"4460_CR5","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1136\/bmj.1.5851.463","volume":"i","author":"O Cochrane","year":"1973","unstructured":"Cochrane O: Spontaneous oesophageal rupture after carbachol therapy.\n BMJ 1973, i: 463-464.","journal-title":"BMJ"},{"key":"4460_CR6","first-page":"176","volume":"123","author":"BA Lowden","year":"1980","unstructured":"Lowden BA: Error in glaucoma therapy.\n Can Med Assoc J 1980, 123: 176.","journal-title":"Can Med Assoc J"},{"key":"4460_CR7","first-page":"1860","volume":"114","author":"H M\u00f6nig","year":"1989","unstructured":"M\u00f6nig H, Bruhn HD, Meissner A, Hausmann B: Kreislaufkollaps durch Carbachol-haltige Augentropfen.\n Dtsch Med Wochenschr 1989, 114: 1860.","journal-title":"Dtsch Med Wochenschr"},{"key":"4460_CR8","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1211\/0022357001774598","volume":"52","author":"NSL Perry","year":"2000","unstructured":"Perry NSL, Houghton PJ, Theobald A, Jenner P, Perry EK: In-vitro inhibition of human erythrocyte acetylcholinesterase by\n Salvia lavandulaefolia\n essential oil and constituent terpenes.\n J Pharm Pharmacol 2000, 52: 895-902. 10.1211\/0022357001774598","journal-title":"J Pharm Pharmacol"},{"key":"4460_CR9","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1211\/0022357991772808","volume":"51","author":"EK Perry","year":"1999","unstructured":"Perry EK, Pickering AT, Wang WW, Houghton PJ, Perry NSL: Medicinal plants and Alzheimer's disease: from ethnobotany to phytotherapy.\n J Pharm Pharmacol 1999, 51: 527-534. 10.1211\/0022357991772808","journal-title":"J Pharm Pharmacol"},{"key":"4460_CR10","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/S0378-8741(99)00113-0","volume":"69","author":"G Wake","year":"2000","unstructured":"Wake G, Court J, Pickering A, Lewis R, Wilkins R, Perry E: CNS acetylcholine receptor activity in European medicinal plants traditionally used to improve failing memory.\n J Ethnopharmacol 2000, 69: 105-114. 10.1016\/S0378-8741(99)00113-0","journal-title":"J Ethnopharmacol"},{"key":"4460_CR11","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1211\/0022357011777846","volume":"53","author":"NSL Perry","year":"2001","unstructured":"Perry NSL, Houghton PJ, Sampson J, Theobald AE, Hart S, Lis-Balchin M, Hoult JRS, Evans P, Jenner P, Milligan S, et al.: In-vitro activity of\n S. lavandulaefolia\n (Spanish sage) relevant to treatment of Alzheimer's disease.\n J Pharm Pharmacol 2001, 53: 1347-1356. 10.1211\/0022357011777846","journal-title":"J Pharm Pharmacol"},{"key":"4460_CR12","unstructured":"Journal of Ethnopharmacology[http:\/\/www.ncl.ac.uk\/medplant\/about_mprc\/Abstract_Fulltext\/Wake_nicotinic.htm]"}],"container-title":["Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/cc4937.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/cc4937\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/cc4937.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T12:51:13Z","timestamp":1728305473000},"score":1,"resource":{"primary":{"URL":"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/cc4937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,6,1]]},"references-count":12,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2006,6]]}},"alternative-id":["4460"],"URL":"https:\/\/doi.org\/10.1186\/cc4937","relation":{},"ISSN":["1364-8535"],"issn-type":[{"value":"1364-8535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,6,1]]},"assertion":[{"value":"1 March 2006","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2006","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 June 2006","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"R84"}}