toxidrome (toxic syndrome)

Introduction

A group of signs & symptoms that consistently result from particular drugs, toxins, intoxicants.

Toxidromes include:

• sympathomimetic (Sym)
• antimuscarinic (AM)
• cholinergic (Chol)
• sedative/hypnotic (S/H)
• opioid

Clinical manifestations

Table

sign	opioid	AM	Chol	Sym	S/H
pulse	d	i	d	i	d
blood pressure	d	i	v	i	d
respirations	d	v	v	i	d
temperature	d	i	d	i	d
bowel sounds	d	d	i	-	-

d = decreased, i = increased, v = variable, - = no change

sign	opioid	AM	Chol	Sym	S/H
skin	sweaty	dry,red,hot	sweaty	sweaty	normal .
mental status	depressed	ADS	depressed	ADS	depressed
pupils	miosis	mydriasis	miosis	mydriasis	miosis/normal

* ADS: agitated, delirum, seizures

• sympathomimetics:
  • tachycardia, hypertension, diaphoresis, agitation, seizures, mydriasis
• cholinergics:
  • Salivation, lacrimation, Urination, Defecation, GI distress, Emesis (SLUDGE)
  • confusion, bronchorrhea, bradycardia, miosis
• antimuscarinics
  • hyperthermia, dry skin & mucous membranes, agitation, delirium
  • tachypnea, tachycardia, hypertension, mydriasis
• opioids
  • respiratory depression, lethargy, confusion, hypothermia, bradycardia
  • hypotension, miosis

Other:

• Opiates: track marks
• antimuscarinic: urinary retention
• cholinergic: fasciculations, weakness, bronchospasm, bronchorrhea
• sympathomimetic: rhabdomyolysis

sign	opioid	AM	Chol	Sym	S/H
skin	sweaty	dry,red,hot	sweaty	sweaty	normal .
mental status	depressed	ADS	depressed	ADS	depressed
pupils	miosis	mydriasis	miosis	mydriasis	miosis/normal

* ADS: agitated, delirum, seizures

• sympathomimetics:
  • tachycardia, hypertension, diaphoresis, agitation, seizures, mydriasis
• cholinergics:
  • Salivation, lacrimation, Urination, Defecation, GI distress, Emesis (SLUDGE)
  • confusion, bronchorrhea, bradycardia, miosis
• antimuscarinics
  • hyperthermia, dry skin & mucous membranes, agitation, delirium
  • tachypnea, tachycardia, hypertension, mydriasis
• opioids
  • respiratory depression, lethargy, confusion, hypothermia, bradycardia
  • hypotension, miosis

Other:

• Opiates: track marks
• antimuscarinic: urinary retention
• cholinergic: fasciculations, weakness, bronchospasm, bronchorrhea
• sympathomimetic: rhabdomyolysis

Management

• sympathomimetics:
  • benzodiazepines for agitation
  • avoid beta-blockers for hypertension
• cholinergics:
  • organophosphate poisoning requires external decontamination
  • atropine, add pralidoxime for CNS toxicity
• antimuscarinic: physostigmine, benzodiazepines for agitation
• opioids: naloxone
• activated charcoal should not be administered if patient is at risk for pulmonary aspiration or > 2 hours has elapsed since ingestion

More general terms

• toxicity; poisoning; overdose