Toxidromes – some neurological poisoning scenarios and some treatments

Toxidrome

Features

Drugs Antihistamines

Drug Treatment Physostigmine (do not use in cyclic antidepressant overdose because of potential worsening of conduction disturbances) Sodium bicarbonate in cyclic antidepressant overdose

Anticholinergic Mydriasis ("Hot as a hare, dry as a bone, red as a beet, mad as a hatter") Blurred vision

Atropine

Fever Dry skin Flushing Ileus Urinary retention Tachycardia Hypertension Psychosis Coma Seizures Myoclonus Cholinergic ("SLUDGE") Salivation Lacrimation Urination Diarrhea GI cramps Emesis Wheezing Diaphoresis Bronchorrhea Bradycardia Miosis Tachycardia -Adrenergic Hypotension Tremor

Baclofen Benztropine Cyclic antidepressants Phenothiazines Propantheline Scopalamine

Carbamate Organophosphates Physostigmine Pilocarpine

Atropine Pralidoxime for organophosphates

Albuterol -Blockade (caution in asthmatics) Caffeine Terbutaline

not with -blockers alone -Adrenergic Bradycardia Mydriasis Hypertension Both .and -adrenergic Tachycardia Mydriasis Diaphoresis Dry mucous membranes Sedative-hypnotic Stupor and coma Confusion Phenylpropanolamin e Amphetamines Benzodiazepines Cocaine Ephedrine Phencyclidine Pseudoephedrine Anticonvulsants Antipsychotics Naloxone for opioids Flumazenil for benzodiazepines Urinary alkalinization for phenobarbital Slurred speech Barbiturates Apnea Benzodiazepines Ethanol Meprobamate Opiates Hallucinogenic Hallucinations Amphetamines Psychosis Panic Fever Mydriasis Cannabinoids Cocaine Lysergic acid diethylamide (LSD) Phencyclidine (PCP) (may present with miosis) Benzodiazepines Haloperidol Hyperthermia Extrapyramidal Rigidity/tremor Haloperidol Opisthotonos Trismus Hyperreflexia Choreoathetos is Phenothiazines Diphenhydramine Benztropine .Toxidrome Features Hypertension Drugs Theophylline Phenylephrine Drug Treatment R Treat hypertension with phentolamine or nitroprusside.

Toxidrome Narcotic Features Drugs Drug Treatment Naloxone Altered mental Dextromethorphan status Slow respirations Miosis Bradycardia Hypotension Hypothermia Decreased bowel sounds Opioids Pentazocine Propoxyphene Serotonin Irritability Hyperreflexia Flushing Diarrhea Diaphoresis Fever Trismus Tremor Myoclonus Fluoxetine Meperidine Paroxetine Sertraline Trazodone Benzodiazepine .