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toxidrome (toxic syndrome)
A group of signs & symptoms that consistently result from particular drugs, toxins, intoxicants.
Toxidromes include:
1) sympathomimetic (Sym)
2) antimuscarinic (AM)
3) cholinergic (Chol)
4) sedative/hypnotic (S/H)
5) opioid
Clinical manifestations:
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 [3]
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
General
toxicity; poisoning; overdose
References
- Daubert GP, Emergency Medicine, University of California, Davis
- Holstege CP, Borek HA.
Toxidromes.
Crit Care Clin. 2012 Oct;28(4):479-98
PMID: 22998986
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015