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

Toxidrome

Features Hypertension

Drugs Theophylline Phenylephrine

Drug Treatment R Treat hypertension with phentolamine or nitroprusside; 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 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