Toxidrome Overview
Quinton Taylor
Toxidrome |
Agent |
Symptoms |
Antidote |
|---|---|---|---|
| Cholinergic |
Insecticides (e.g. organophosphates) physostigmine, neostigmine, pyridostigmine, pilocarpine, nerve agents (e.g. Sarin) |
Muscarinic: Defecation, Urination, Miosis, Bradycardia, Bronchorrhea, Emesis, Lacrimation, Salivation, Sweating (DUMBBELS) Nicotinic: Mydriasis, Tachycardia, Weakness, Hypertension, Fasciculations (MTWtHF) |
Atropine (with pralidoxime if organophosphate poisoning) |
|
Anticholinergic (antimuscarinic) |
Antihistamines, antipsychotics, antidepressants (TCAs), anti-parkinsons, atropine, scopolamine |
Hyperthermia, dry skin, mydriasis, delirium, hallucinations, tachycardia, urinary retention, seizures ("Hot as a hare, red as a beet, dry as a bone, blind as a bat, mad as a hatter") |
Supportive care, consider physostigmine with toxicology |
| Sympathomimetic | Cocaine, amphetamines, bath salts, synthetic cannabinoids, sedative/hypnotic withdrawal, pseudoephedrine, caffeine | Hyperthermia, sweating, mydriasis, diaphoresis, tachycardia, arrhythmias, hypertension, seizures |
None, supportive care; benzodiazepine as needed* |
| Opioid | Morphine, heroin, hydromorphone, fentanyl | Miosis, hypoventilation, somnolence, comatose, bradycardia, hypotension | Naloxone |
| Sedative-hypnotic | Benzos, barbiturates, alcohol, zolpidem | CNS depression, confusion, stupor, coma | None, supportive care only |
| Hallucinogenic | Phencyclidine, LSD, MDMA "Ecstasy" | Hallucinations, depersonalization, agitation, mydriasis (usually), tachycardia, hypertension, nystagmus | None, supportive care only |
| Serotonin syndrome | SSRIs, SNRIs, MAOIs | Hyperreflexia, myoclonus, diaphoresis, flushing, diarrhea, hyperthermia, tachycardia, confusion, agitation, coma |
Supportive care; benzodiazepines as needed*; contact toxicology prior to using cyproheptadine |
| *for treatment of seizures, tachycardia, hypertension, agitation, and hyperthermia | |||
Workup
- ABCs, evaluate vital signs, mental status, pupil size, skin temperature and moisture
- Pulse ox, continuous cardiac monitoring, EKG, blood glucose
- Beta blocker (hypo or normoglycemia) and CCB (hyperglycemia) toxicity
- UDS, acetaminophen/salicylate level, ethanol levels UA, BMP, LFT, blood gas (often venous suffices)
Management
- Decontamination for topical exposures
- Antidotes if known ingestions/fits appropriate toxidrome
- Supportive care
- Discuss with Toxicology for possible ways to enhance elimination of the toxin (e.g. diuresis, alkalinization, dialysis, etc.)