Treatment of Adolescent Antimuscarinic (Anticholinergic) Toxidrome

Inclusion Criteria: * Age \>=10 and \< 18 years * Present to the Emergency Department or Intensive Care Unit for an antimuscarinic toxidrome from either a pharmaceutical agent such as antihistamine overdose, or natural toxins or products such as Datura stramonium * Antimuscarinic toxidrome will be defined with at least one central nervous system agitation effect (agitation, delirium, visual hallucinations, mumbling incomprehensible speech), and at least 2 peripheral nervous system adverse effect (mydriasis, dry mucus membranes, dry axillae, tachycardia, decreased bowel sounds). * Patients will also be required to have a RASS score of +2 to +4 on initial assessment. Exclusion Criteria: * History of seizures or seizure during acute clinical course * History of asthma or wheezing during clinical course Bradycardia (Heart Rate \<60) * Concomitant use of atropine or choline ester or depolarizing neuromuscular blocker during present illness and hospital course * Diabetes gangrene, known intestinal obstruction or urogenital tract, vagotonic state * QRS interval \> 120 ms on electrocardiogram * Known to be pregnant at the time of enrollment * Known ward of the state