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Atropine toxicity in identical twins.

Two cases of atropine toxicity in monozygotic twins presented with the usual systemic manifestations: hyperpyrexia, agitation, mydriasis, tachypnea, tachycardia, decreased gastrointestinal motility, anhydrosis, and skin flush. Intravenous physostigmine, the treatment of choice, was used to resolve the toxic crisis. Physostigmine counteracts atropine's anticholinergic effects at the postganglionic nerve synapses of the autonomic nervous system. The chance of atropine toxicity occurring with ophthalmic usage may be lessened by careful parental instruction about dosages and about the warning signs of its systemic toxicity.