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, Bronchosecretions, Emesis, Lacrimation, Salivation, Sweating (DUMBBELLS) Nicotinic: Mydriasis, Tachycardia, Weakness, Hypertension, Fasciculations (MTWtHF) |
Atropine (with pralidoxime if organophosphate poisoning) |
| Anticholinergic | 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/hyponotic withdrawal, pseudoephedrine, caffeine | Hyperthermia, mydrasis, diaphoresis, tachycardia, arrythmias, hypertension, seizures | None, supportive care; benzodiazepines 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, MOAIs | 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 | |||
General Workup
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ABCs, evaluate vital signs, mental status, pupil size, skin temperature and moisture
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Pulse ox, continuous cardiac monitoring, EKG, blood glucose
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UDS, acetaminophen/salicylate levels, ethanol levels, UA, BMP, hepatic function panel, blood gas
General Management
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Decontamination for topical exposures
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Antidotes if known ingestions/fits appropriate toxidrome
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Supportive care
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Discuss with toxicology, may be ways to enhance elimination of the toxin (e.g. diuresis, alkalinization, dialysis, etc.)