1. List down and explain the different diagnostic tests used in determining poisons in the human body.

According to the video “Poisoning and Toxidromes: Definitions, Types & Diagnosis – Emergency
Medicine” presented by Lecturio Medical, the application of differential diagnosis (drug-to-drug
approach) is impossible on poisoning circumstances in real life settings. Since the pharmacology,
pharmacokinetics, and clinical manifestations of drugs can be overlapping and obviously it is time
consuming. Hence, the term “toxidromes” (specific group of autonomic-related signs and symptoms
that were caused by certain groups of medications or chemicals) are created to successfully narrow
down toxicologic differential. Five traditional or most commonly encountered toxidromes (relying on
observable findings in the eyes, skin, secretions, and vital signs) were mentioned in the video:

TYPES SYMPTOMS MANAGEMENT and ANTIDOTE

Sympathomimetic/Adrenergic - excess  Tachycardia, Mydriasis, Hypertension,  Gastric decontamination
stimulation on alpha-adrenergic, beta- Diaphoresis, Hyperthermia  ANTIDOTE: BZD
adrenergic, dopamine, and serotonin
receptors

-CAUSE: Stimulants
Anti-cholinergic - under  Unopposed sympathetic tone:  IV fluids
stimulation/inhibition of cholinergic Tachycardia, Mydriasis , Hypertension,  For HIGH TOXICITY
neurotransmission in the muscarinic Hyperthermia (very common) INGESTION: GI
receptor sites  Loss of cholinergic innervation on the decontamination
mucosa and skin (ANHYDROSIS and  ANTIDOTE: Physostigmine
-COMMON CAUSE/S: Overdosing of OTC DEHYDRATED)
anti-cholinergic medications (anti-  Mnemonics: mad as a hatter, blind as a
histamines, TCAs, antiemetics, etc.) bat, red as a beet, hot as a hare, and dry
as a bone
Cholinergic - over-stimulation at a  Diarrhea/Diaphoresis, Urination, Miosis,  Decontaminate, intubate
neuromuscular junction due to an Bronchorrhea, Bradycardia, Emesis, early, and high oxygen flow
excess of acetylcholine (ACh) Lacrimation, Salivation  ANTIDOTE: Atropine

-Can be CAUSED by
ORGANOPHOSPHATES (pesticides)
Sedative-Hypnotic  Somnolence  IV access, provide oxygen,
 Apnea and perform aggressive
 POTENTIAL respiratory depression supportive care
 ANTIDOTE: Flumenazil
Opioid – drug overdosing for  MIOSIS (pin-point)  Support respiration, and
recreational/suicides  FATAL respiratory depression oxygenation
 CNS depression  ANTIDOTE: Naloxone
 Apnea