-ACE inhibitors -beta-blockers -ca-channel blockers -iron -phenothiazines -sedative hypnotics -theophyline -tricyclic antidepressants -vasodilators

Toxic Conditions

Agitated delirium

-alcohol toxicity/withdrawal -anticholinergics -hallucinogens -phencyclidine -sympathomimetics (e.g. cocaine)

Anion-gap acidosis ("MUDPILE CATS")

-Methanol -Uremia -Diabetic Ketoacidosis, starvation ketoacidosis, alcoholic ketoacidosis -Paraldehyde, phenformin, metformin -Iron, isoniazid -Lactic acidosis -Ethylene glycol -Cyanide -Acetylsalicyclic acid -Toluene -Solvents Note: the most common causes are ketoacidosis, lactic acidosis and salicylates. If these have been excluded, toxic alcohol poisoning (methanol, ethylene glycol) should be considered

Bradycardia

-beta blockers -calcium channel blockers -digoxin -alpha agonists (e.g. phenylpropanolamine) -alpha-2 antagonists (e.g. clonidine) -cholinergic agents -opiates -cyclic antidepressants Note: The "big three" causes are beta blockers, calcium channel blockers and digoxin

Coma/obtundation

-alcohols -anticholinergic -anticonvulsants (e.g., barbiturates, carbamazepine, phenytoin, valproate) -barbiturates -cholinergics -neuroleptics (e.g, phenothiazines, chloral hydrate, meprobamate) -opiates -oral hypoglicemics -tricyclic antidepressanst Note: Any toxin that causes seizures or hypotension will also cause obtundation or coma

Elevated Osmolal gap

-Ethylene glycol -Isopropyl alcohol -Mannitol -Methanol -Propylene glycol -Ethanol Note: the most important causes are methanol & ethylen glycol. Also consider shock, trauma, organ failure or non-alcoholic ketoacidosis as causes of an elevated osmolal gap

Hypotension

Radio-opaque compounds

-chloral hydrat -heavy metals -iron -phenothiazines -sustain-release (enteric coated) compounds -toxin in containers (e.g., body packers)

Seizures

-alcohol withdrawal                     -oral hypoglycemics -sedative hypnotic withdrawal      -propranolol -amphetamines                          -propoxyphene -anticholinergics                         -sodium channel blockers -caffeine                                    -theophyline -camphor                                   -tricyclic antidepressants -cocaine -isoniazid Note: any toxin that causes hypotension or hypoglycemia could also cause seizures. Intractable seizures not responsive to the usual management may be caused by isoniazid

Sodium channel blockade

-antihistamines (large overdoses) -carbamazepine -class Ia and Ic antiarrhythmics -cocaine -mesoridazine -propranolol -propoxyphene -thioridazine -tricyclic antidepressants Note: drugs with membrane stabilizing effect, or the ability to inhibit fast sodium channels, cause a significant number of fatalities. Toxicity is characterized by coma, seizures, hypotension, arrhytmias and a widened QRS on the electrocardiogram

Tachycardia

-amphetamines -ACE inhibitors -anticholinergics -cocaine -iron -phenothiazines -sedative hypnotics -theophyline -vasodilators (e.g., nitroglicerin) -tricyclic antidepressants