EET 10/03 TOXIDROMES

Key Points: 1. Remember the ABCs followed by decontamination-consult Poison Control for assistance. 2. Dont forget thiamine, glucose, narcan in an unconscious patient. 3. Use the vitals, pupils, physical exam, and mental status to help identify the toxidrome and to guide treatment.

Toxidrome: clinical syndrome that suggests a specific class of poisoning. The most important toxidromes to recognize include:
1. 2. 3. 4. 5. sympathomimetic sedative/hypnotic opiate anticholinergic cholinergic

TOXIN e.g.

SYMPATHOMIMETIC Cocaine, amphetamines

SED/HYPNOTIC Benzos, barbiturates

OPIATES Heroin, morphine, clonidine Sedation, confusion, coma

Mental status

Restless, insomnia, paranoia, hallucinations, mania Mydriasis Tachycardia, hypertension, hyperthermia Tremor, warm skin, diaphoresis, hypoactive bowel sounds

Sedation, confusion, delirium, ataxia, coma

Pupils Vitals

Blurred vision (miosis or mydriasis) Hypothermia, hypotension, bradypnea Similar to opiates, nystagmus

Miosis Shallow respirations, hypotension, bradycardia, hypothermia Decreased bowel sounds, hyporeflexia

ANTICHOL Benadryl, TCAs Atropine, antipsychotics, antihistamines Mad as a hatter: psychosis, delirium, chorea, szs, coma mydriasis Tachycardia, fever, hypertension Dry as a bone, red as a beet, hot as a hare Urinary retention Decontaminate Tx sxs: fever, hypertension, benzos, etc.

CHOLINERGIC Organophosphates, pilocarpine, muscarinic mushrooms Altered mental status, weakness, confusion, drowsiness, coma, miosis Bradycardia, hypothermia, tachypnea Salivation Lacrimation Urination Defecation Emesis Decontaminate 2-PAM Atropine

Physical exam

Treatment

Decontamination Supportive care- benzos, mixed alpha/ beta blockade, tx of MI, CVA, rhabdo

Decontamination, Supportive care, Tincture of time Rarely flumazenil induces seizures

Decontaminate Narcandepending on t1/2 of drug, may need gtt

Other tidbits: Salicylate toxicity: hyperventilation, gap metabolic acidosis, fever, hypoglycemia, hypokalemia, seizures, coma, tinnitus, nausea, vomiting. Tx with IV NS, alkalinization of urine, and hemodialysis if severe (toxic dose is 150-300 mg/kg) TCA overdose: arrhythmias, anticholinergic side effects, seizures, vomiting, hypotension. Watch for QT prolongation, QRS widening, Torsades, etc. Alkalinize blood, mag sulfate, lidocaine for arrhythmias, tx seizures with BZD. Digoxin toxicity: cardiac arrhythmias of any flavor, worse with hypokalemia, anorexia, nausea, vomiting, confusion, altered color perception (yellow in a minority). Tx electrolytes, tx arrhythmias according to ACLS, Digibind