TOXIDROMES


Primary Considerations for Presenting Chief Complaint in the Poisoned Patient
CHIEF COMPLAINT COMMON CAUSES
Coma Alcohols
Antipsychotics
Antiseizure medications
Carbon monoxide
Muscle relaxants
Opiates
Sedative/hypnotics
Delirium Anticholinergics/cholinergics
Muscle relaxants
Sympathomimetics
Withdrawal syndromes
Seizure Isonaizid
Anticholinergics/cholinergics
Antidepressants
Mushrooms (Gyrometra sp.)
Sympathomimetics
Toxic alcohols
Withdrawal syndromes
Hepatic injury Acetaminophen
Carbon tetrachloride
Ethanol
Mushrooms (Amanita phalloides)
Renal Injury Ethylene glycol
Heavy metal salts (mercury)
Mushrooms (Cortinarius orellanus)
Rhabdomyolysis (cocaine, amphetamines)

Common Toxidromes
Toxidrome Representative Agent(s) Most Common Findings Additional Signs & Symptoms Potential Interventions
Opioid Heroin
Morphine
Oxycodone
Central nervous system depression, miosis, respiratory depression Hypothermia, bradycardia

Death may result from respiratory arrest, acute lung injury

Ventilation or naloxone
Sympathomimetic Cocaine
Amphetamine
Psychomotor agitation, mydriasis, diaphoresis, tachycardia, hypertension, hyperthermia Seizures, rhabdomyolysis, myocardial infarction
Death may result from seizures, cardiac arrest, hyperthermia
Cooling, sedation with benzodiazepines, hydration
Cholinergic -Organophosphate insecticides
- Carbamate insecticides
Muscarinic effects (salivation, lacrimation, diaphoresis, nausea, vomiting, urination, defecation, bronchorrhea)

Nicotinic effects (muscle fasciculations and weakness)

Bradycardia, miosis/mydriasis, seizures, respiratory failure, paralysis

Death may result from respiratory arrest from paralysis, bronchorrhea, or seizures

Airway protection and ventilation, atropine, pralidoxime
Anticholinergic Scopolamine
Atropine
Altered mental status, mydriasis, dry flushed skin, urinary retention, decreased bowel sounds, hyperthermia, dry mucous membranes Seizures, dysrhythmias, rhabdomyolysis

Death may result from hyperthermia and dysrhythmias

Physostigmine (if appropriate), sedation with benzodiazepines, cooling, supportive management
Salicylates Aspirin
Oil of wintergreen
Altered mental status, respiratory alkalosis, metabolic acidosis, tinnitus, hyperpnea, tachycardia, diaphoresis, nausea, vomiting Low-grade fever, ketonuria

Death may result from acute lung injury or cerebral edema

Multidose activated charcoal, alkalinization of urine with potassium repletion, hemodialysis
Sedative-hypnotic Barbiturates
Benzodiazepines
Depressed level of consciousness, slurred speech, ataxia Stupor to coma, depressed respirations, apnea, bradycardia Ventilatory support
Hypoglycemic Sulfonylureas
Insulin
Altered mental status, diaphoresis, tachycardia, hypertension Paralysis, slurring of speech, bizarre behavior, seizures
Death may result from seizures, altered behavior
Glucose-containing solution IV and oral feedings if possible, frequent glucose measurement, octreotide
Hallucinogenic Phencyclidine
Lysergic acid diethylamide

Psilocybin
Mescaline

Hallucinations, dysphoria, anxiety Hyperthermia, mydriasis, nausea, sympathomimetic symptoms Generally supportive
Serotonin SSRIs
Meperidine
A variety of drug interactions with dextromethorphan, monoamine oxidase inhibitors, tricyclic antidepressants, other SSRIs, and amphetamines
Altered mental status, increased muscle tone, hyperreflexia, hyperthermia Intermittent whole-body tremor
Death may result from hyperthermia
Cooling, sedation with benzodiazepines, supportive management, theoretical benefit of cyproheptadine
Extrapyramidal Haloperidol
Phenothiazines
Risperidone
Olanzapine
Dystonia, torticollis, tremor, muscle rigidity Choreoathetosis, hyperreflexia, seizures Diphenhydramine
Benztropine
Benzodiazepines