1/8/2016

Poisoning syndromes ­ toxidromes

Official reprint from UpToDate®  
www.uptodate.com ©2016 UpToDate®

Poisoning syndromes (toxidromes)
Toxidrome
Sympathomimetic

Mental
status
Hyperalert,
agitation,
hallucinations,
paranoia

Pupils

Vital signs

Mydriasis

Hyperthermia,
tachycardia,
hypertension,
widened pulse
pressure,
tachypnea,

Other
manifestations
Diaphoresis,
tremors,
hyperreflexia,
seizures

hyperpnea
Anticholinergic

Hypervigilance,

Mydriasis

agitation,
hallucinations,
delirium with
mumbling
speech, coma

Hallucinogenic

Hallucinations,
perceptual
distortions,
depersonalization,

Mydriasis
(usually)

Examples of
toxic agents
Cocaine,
amphetamines,
cathinones,
ephedrine,
pseudoephedrine,
phenylpropanolamine,
theophylline, caffeine

Hyperthermia,

Dry flushed skin, dry

Antihistamines,

tachycardia,
hypertension,
tachypnea

mucous membranes,
decreased bowel
sounds, urinary
retention,
myoclonus,
choreoathetosis,
picking behavior,
seizures (rare)

tricyclic
antidepressants,
cyclobenzaprine,
orphenadrine,
antiparkinson agents,
antispasmodics,
phenothiazines,
atropine,
scopolamine,
belladonna alkaloids
(eg, Jimson Weed)

Hyperthermia,
tachycardia,
hypertension,
tachypnea

Nystagmus

Phencyclidine, LSD,
mescaline, psilocybin,
designer
amphetamines (eg,

synesthesia,
agitation

MDMA ["Ecstasy"],
MDEA)

Opioid

CNS depression,
coma

Miosis

Hypothermia,
bradycardia,
hypotension,
apnea,
bradypnea

Hyporeflexia,
pulmonary edema,
needle marks

Opioids (eg, heroin,
morphine,
methadone,
oxycodone,
hydromorphone),
diphenoxylate

Sedative­hypnotic

CNS depression,
confusion, stupor,
coma

Variable

Hypothermia,
bradycardia,
hypotension,
apnea,
bradypnea

Hyporeflexia

Benzodiazepines,
barbiturates,
carisoprodol,
meprobamate,
glutethimide,
alcohols, zolpidem

Cholinergic

Confusion, coma

Miosis

Bradycardia,
hypertension

Salivation, urinary
and fecal

Organophosphate and
carbamate

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