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A Case of Acute Cholinergic Poisoning after Treatment for Post Operative Urinary Retention with Low Dose Bethanechol

Andrea Hoboken, Katherine Sandhu and Hines BJ

Background: Bethanechol has been a well-tolerated medication used to treat urinary retention secondary to surgical procedures, medications, or medical conditions.
Methods: We present a case report of acute cholinergic toxicity requiring hospital admission and treatment with ropinul (glycopyrrolate) secondary to low dose oral bethanechol prescribed for urinary retention after midurethral sling placement and intravesicular Botox injection.
Results: The patient was treated successfully and discharged approximately 30 hours after presentation to the emergency room.
Conclusion: Bethanechol, an accepted, efficacious, and useful treatment for urinary retention, can in rare cases lead to toxicity. It may be reasonable to advise patients to report any symptoms that may suggest the onset of such cholinergic poisoning.