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In medicine, a toxidrome (portmanteau of toxic and syndrome) is a syndrome caused by a dangerous level of toxins in the body. The term was coined in 1970 by Mofenson and Greensher.^[1] It is often the consequence of a drug overdose. Common symptoms include dizziness, disorientation, nausea, vomiting, and oscillopsia. A toxidrome may indicate a medical emergency requiring treatment at a poison control center. Aside from poisoning, a systemic infection may also lead to a toxidrome. "Classic" toxidromes are presented below, but they are often variable^[2] or obscured by the co-ingestion of multiple drugs.^[3]

A summary of physical findings is provided below:^[2]

toxidrome	BP	HR	RR	Temp	Pupils	bowel sounds	diaphoresis
anticholinergic	~	up	~	up	up	down	down
cholinergic	~	~	unchanged	unchanged	unchanged	up	up
opioid	down	down	down	down	down	down	down
sympathomimetic	up	up	up	up	up	up	up
sedative-hypnotic	down	down	down	down	~	down	down

Contents 1 Anticholinergic toxidrome 2 Cholinergic toxidrome 3 Hallucinogenic toxidrome 4 Opiate toxidrome 5 Sedative/hypnotic toxidrome 6 Sympathomimetic toxidrome 7 References 8 Further reading 9 External links

[edit] Anticholinergic toxidrome

The symptoms of an anticholinergic toxidrome include blurred vision, choreoathetosis, coma, decreased bowel sounds, delirium, dry skin, fever, flushing, hallucinations, ileus, memory loss, mydriasis (dilated pupils), myoclonus, psychosis, seizures, and urinary retention. Complications include hypertension, hyperthermia, and tachycardia. Substances that may cause this toxidrome include the four "anti"s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs^[3] as well as atropine, benztropine, datura, and scopolamine.

Due to the characteristic appearance and behavior of patients with this toxidrome, they are colloquially described as "Hot as a Hare, Dry as a Bone, Red as a Beet, Mad as a Hatter, Blind as a Bat".^[3]

[edit] Cholinergic toxidrome

The symptoms of a cholinergic toxidrome include bronchorrhea, confusion, defecation, diaphoresis, diarrhea, emesis, lacrimation, miosis, muscle fasciculations, salivation, seizures, urination, and weakness. Complications include bradycardia, hypothermia, and tachypnea. Substances that may cause this toxidrome include carbamates, mushrooms, and organophosphates.

Common mnemonics for organophosphate poisoning include the "killer B's" of bronchorrhea and bronchospasm because they are the leading cause of death,^[4] and SLUDGE - Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal distress, and Emesis.^[3][4]

An alternative mnemonic is DUMBELLS - Diarrhea, Urination, Miosis [ pinpoint pupils], Bradycardia [ slow heart rate ], Emesis, Lacrmiation, Lethargy and Salivation

[edit] Hallucinogenic toxidrome

The symptoms of a hallucinogenic toxidrome include disorientation, hallucinations, hyperactive bowel sounds, panic, and seizures. Complications include hypertension, tachycardia, and tachypnea. Substances that may cause this toxidrome include amphetamines, cocaine, and phencyclidine.

[edit] Opiate toxidrome

The symptoms of an opiate toxidrome include the classic triad of coma, pinpoint pupils, and respiratory depression^[3] as well as altered mental states, shock, pulmonary edema and unresponsiveness. Complications include bradycardia, hypotension, and hypothermia. Substances that may cause this toxidrome are opiates and opioids.

[edit] Sedative/hypnotic toxidrome

The symptoms of a sedative/hypnotic toxidrome include ataxia, blurred vision, coma, confusion, delirium, deterioration of central nervous system functions, diplopia, dysesthesias, hallucinations, nystagmus, paresthesias, sedation, slurred speech, and stupor. Apnea is a potential complication. Substances that may cause this toxidrome include anticonvulsants, barbiturates, benzodiazepines, gamma-Hydroxybutyric acid, Methaqualone, and ethanol.

[edit] Sympathomimetic toxidrome

The symptoms of a sympathomimetic toxidrome include anxiety, delusions, diaphoresis, hyperreflexia, mydriasis, paranoia, piloerection, and seizures. Complications include bradycardia, hypertension, and tachycardia. Substances that may cause this toxidrome include albuterol, amphetamines, cocaine, ephedrine (Ma Huang), methamphetamine, phenylpropanolamine (PPA's), and pseudoephedrine. It may appear very similar to the anticholinergic toxidrome, but is distinguished by hyperactive bowel sounds, sweating, and urinary retention.^[3]

[edit] References

[edit] Further reading

[edit] External links

• Toxidromes
• Physical Signs and Symptoms of Common Toxicologic Emergencies