Common Toxidromes and Causes |
Alcohol withdrawal |
-delirium -tachycardia -hypertension -hyperthermia -tremors beginning in firrst 5 to 10 minutes -seizures aregenerelized and are typicalyisolated or occur in a brief flurry beginning at 6 to 48 hours after reduced intake. Focal or protracted seizures are atypical and waarant investigation -delirium tremens (DT) in some patients after several days Note: Sedative Hypnotic withdrawal has similar manifestations but with a different time course that varies with the half life of the agent involved |
Anticholinergic toxidrome |
-altered mental status (hallucinations, agitation, coma) -tachycardia -large pupils -dry skin -decreased bowel sounds -urinary retention |
-antihistamines (Benadryl- Diphenhydramine, Gravol - Dimenhydrinate) -anticholinergic plants (e.g., Jimson weed, Atropa beladona) -cyclic antidepressants -atropin -antiparkinsonian agents -antiemetics -antispasmodics -antipruritics |
Benzodiazepine/sedative hypnotic toxidrome |
-depressed mental status -relatively small pupils -vital signs usually normal -significant respiratory depression is rare with pure benzodiazepine overdose -hypotension in large ingestions |
-overdose of benzodiazepines -some sedative hypnotics |
Cholinergic toxidrome |
-lacrimation, salivation -bradycardia -respiratory secretions -hypoxia -diaphoresis -increased bowel sounds -vomiting -diarrhea and urinary incontinence -fasciculations may accur and muscle weakness can result in respiratory failure |
-organophosphate and acrbamate insectides |
Opiate toxidrome |
-respiratory depression -depressed mental status -small pupils -slight bradycardia (unless hypoxic or hypovolemic) -prompt response to naloxone hydrochloride |
-overdose of heroin & other opiates |
Phenothiazine toxidrome |
-depressed mental status -small pupils -do not respond to naloxone hydrochloride |
-overdose of phenthiazines |
Sympathomimetic toxidrome |
-elevated vital signs -tachycardia -hypertension -hyperthermia -agitated delirium is common -large pupils -diaphoresis (unless severely dehydrated) -bowel sounds present *Note: This toxidrome is usually differentiated from the anticholinergic toxidrome by the presence of marked diaphoresis (instead of dry skin). Also bowel sounds are not decreased. |
-overdose of cocaine or amphetaminea -alcohol or sedative hypnotic withdrawal results in simialr findings |
Serotonin syndrome |
-confusion -hypomania -restlessness -myoclonus -hyperreflexia -diaphoresis -shivering -tremor -rigidity -incordination -hyperthermia Notes: 1. shivering, rigidity, myoclonus and hyperreflexia usually differentiated this syndrome from the sympathomimetic toxidrome (+ history of the drugs that were ingested). 2. DD: Amphetamines overdose (e.g. MDMA,PMA), Cocaine overdose, Malignant hyperthermia, |
-Serotonin Reuptake Inhibitors (SSRIs), Meperidin (Demerol), Fluexitin (Prozac), or other serotonin-enhancing drug ----- especially when a patient taking an MAO inhibitors ingests SSRI |
Selected drugs in which minimal ingested dose may cause severe intoxication in a child |
Calcium blockers, Beta blockers, Clonidine, Tricyclic antidepressants, Oral hypoglicemic drugs, Methanol/Ethylen glycol, |
