The most common toxidromes are classified as: Aside from poisoning, a systemic infection may also lead to a toxidrome. A toxidrome may indicate a medical emergency requiring treatment at a poison control center. Common symptoms include dizziness, disorientation, nausea, vomiting, and oscillopsia. Risk calculators and risk factors for ToxidromeĪ toxidrome (portmanteau of toxic and syndrome) is a syndrome caused by a dangerous level of toxins in the body. US National Guidelines Clearinghouse on Toxidromeĭirections to Hospitals Treating Toxidrome Īrticles on Toxidrome in N Eng J Med, Lancet, BMJ My thanks to Blair Bigham for the use of his “Drugs for CERTs” presentation, and the kids from the Toronto rave scene I treated this weekend for the inspiration to write these articles.Editor-In-Chief: C. Be sure to check out Part 2 of this article next month where Opioid, Sedative/Hypnotic and Hallucinogens will be discussed. Some common sympathomimetics are salbutamol, amphetamines, cocaine, methamphetamines and ephedrine. More serious complications include tremors, agitation, hypertension, tachycardia/dysrhythmias, tachypnea, altered LOA, seizure, coma, death. Increased heart rate, respiratory rate, blood pressure, temperature, pupil size and diaphoresis. Signs and symptoms of this toxidrome are similar to the “fight or flight” response. epinephrine and norepinephrine) in the body. These substances either mimic or increase the levels of circulating catecholamines (eg.
Substances causing an increase in sympathetic nervous system activity are classified as Sympathomimetics (hence the name of this toxidrome). Organophosphates (most commonly found in pesticides) and nerve agents (in chemical weapons / accidents) are the most “common” cause of this toxidrome. The substances that cause a Cholinergic toxidrome are much less common than other discussed in this article. Signs and symptoms of this toxidrome can be remembered using the pneumonic “SLUDGE”, which stands for Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal distress, and Emesis.
The signs and symptoms caused by substances in this toxidrome are due to an overly active parasympathetic response (due to the flooding of the CNS with acetylcholine). A helpful rhyme to remember the signs and symptoms of this toxidrome is: “Blind as a bat, mad as a hatter, red as a beet, hot as hell, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.” This toxidrome generally causes an increased heart rate, increased temperature, and increased pupil size.Ĭommon substances that may cause the Anticholinergic toxidrome are Tricyclic antidepressants, anti-nausea medications, cough medications, sleeping medications, anti-histamines, and muscle relaxants.Īs the name would suggest, the Cholinergic toxidrome is the opposite of the Anticholinergic discussed above. Colloquially, patients in this toxidrome “dry up”. The signs and symptoms of this toxidrome are caused by the anticholinergic substance blocking the neurotransmitter acetylcholine in the central and peripheral nervous systems. This 2-part article will discuss the common causes, signs and symptoms and general treatment for the 6 major Toxidromes Anticholinergic, Cholinergic, Sympathomimetic, Opiate, Sedative/Hypnotic, Hallucinogenic. Not all overdoes are fatal, and they can happen to anyone first time or veteran drug users, purposefully or accidental, adult or child. With that in mind, understanding the common causes, basic pathophysiology and the signs and symptoms for the major TOXIDROMES is of huge benefit all levels of healthcare providersĪ drug overdose is the ingestion or application of a substance that is above and beyond the recommended or generally used amount. Given vast number of possible drugs, not to mention the exponential number of possible combinations/interactions, pre-hospital care providers need a way of organizing common signs and symptoms so they can be quickly recognized and the most appropriate care can be provided.
Many of these emergencies are drug related, either due to misuse of prescription medication, or recreational drug use. As first responders and paramedics, we run into a seemingly endless variety of toxicological emergencies in the field.
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