A case of cholinergic crisis induced by distig-mine bromide successfully treated with non-invasive positive pressure ventilation

We report the case of a 75-year-old man with dementia complaining of dyspnea and showing con-sciousness drowsiness. On his admission, bradycardia, diaphoresis and miosis were noted. Computed tomography icans of the chest revealed infiltrates in his right lung field. Blood gas analysis showed respiratory failure accompanied with carbon dioxide acidosis and he was treated with non-invasive positive pressure ventilation (NPPV), resulting in the improvement of his resp ratory conditions. The serum level of cholin- esterase was declined at 4IU/l on admission and then increased spontaneously. In addition, he took distig- mine brpmide at a dose of 10 mg per day, which is above the standard dose in Japan. Therefore, we consider that his respiratory failure was caused by cholinergic crisis induced by distigmine bromide. Although many cases showing cholinergic crisis induced by distigmine bromide have been previously reported, there is no report of a case treated with NPPV As a cause of respiratory failure, we should pay attention to cholinomimetic crisis by cholinesterase inhibitos, and NPPV seems to be one of the useful methods for such cases.