Transcript TOXIDROMES
Toxidromes
and
Drug Ingestions
Toxidromes
What is a Toxidrome?
A constellation of clinical signs that may
suggest a particular type of ingestion
Toxidromes may indicate what type of drugs a
patient has taken if they are unable or
unwilling to tell you
Toxidromes
The most common toxidromes seen are:
Anticholingeric
Cholinergic
Sympathomimetic
Sedative
Hallucinogenic
Serotonergic
Anticholinergic
Toxidromes
Anticholinergic Toxidrome
Due to drugs that block muscarinic and
nicotine acetylcholine receptor
Antihistamines (1st generation)
Tricyclic antidepressants
Antitussives (cough mixtures)
Antipsychotics
Anticonvulsants
Antimuscularinic drugs
Atropine
Scopolamine
Ipatroprium bromide
Plants
Mushrooms
Datura
Anticholinergic Toxidrome
The anticholinergic toxidrome consists of:
Delirium + peripheral antimuscarinic effects
Mad as a hatter
Red as a beet
Mydriasis
Hot as a hare
Flushed skin
Blind as a bat
Confusion/hallucinations/seizure/coma
Hyperthermia
Dry as a bone
Dry skin, urinary retention, ileus
Cholinergic
Toxidromes
Cholinergic Toxidrome
Due to drugs that activate acetylcholine
receptor
ie the opposite of anticholinegric toxidromes
Cholinergic Toxidrome
Caused by:
Organophosphate insecticides
Carbamate insecticides
Chemical warfare agents eg Ricin, Tabun, Soman, VX
Alzheimer's medication eg donepezil
Agents used for myasthenia gravis
Neostigmin
Edrophonium
Pilocarpine
Phyostigmine
Cholinergic Toxidrome
The cholinergic toxidrome =“DUMBELS”:
D
U
M
B
Miosis (or mydriasis)
Emesis
Lacrimation
Salivation
urination
Bronchospasm
Bronchorrhoea
Bradycardia
Diaphoresis
Diarrhoea (and abdo cramps)
E
L
S
Sympathomimetic
Toxidromes
Sympathomimetic Toxidrome
Act via stimulation of sympathetic nervous
system
Toxidrome – everything stimulated
Hypertension
Tachycardia
Tachypnoea
Hyperthermia
Agitation
Dilated pupils (usually)
Diaphoresis/flushing
c.f: anticholinergic – dry
Sympathomimetic Toxidrome
In New Zealand the most commonly seen sympathomimetic
ingestion is methamphetamine
Can also be seen with
Alpha receptor agonists
Beta receptor agonist
Phenylephrine eg OTC cold preparations eg - coldrex
Salbutamol
Theophylline
Caffeine
Alpha and beta agonists
Amphetamine
Cocaine
Pseudo/ephedrine
MDMA (ecstasy)
Sedative or Hypnotic
Toxidromes
Sedative or Hypnotic Toxidrome
Caused by any medication that causes
CNS depression, such as:
Benzodiazepines
Barbiturates
Alcohols
Opioids
Anticonvulsants
Antipsychotics
Sedative or Hypnotic Toxidrome
Toxidrome
Decreased Level of consciousness
Hypoventilation
Hypotension
Bradycardia
Opioids + barbiturates also cause
Miosis
Hypothermia
Hallucinogenic
Toxidromes
Hallucinogenic Toxidrome
As it sounds, this is caused by drugs and
agents that cause hallucinations
Amphetamine
Cannaboids
Cocaine
LSD
PCP
Magic mushrooms (Psilocybin spp.)
Hallucinogenic Toxidrome
Primarily presents with hallucination
Also can present with:
Frank psychosis
Panic attacks and anxiety
Sympathomimetic symptoms esp. tachycardia,
hypertension and fever
Serotonergic
Toxidromes
Serotonergic Toxidrome
A collection of signs and symptoms
produced by excess serotonin in the
central, peripheral and autonomic nervous
systems
Serotonergic Toxidrome
Multiple medications can cause
serotonergic toxidrome (or serotonin
syndrome)
Most commonly occurs when ≥ 2 medications
which affect either serotonin reuptake or
metabolism are given, but can also occur with
a single agent
Serotonergic Toxidrome
Associated with:
Selective serotonin reuptake inhibitors (SSRI -antidepressants)
Serotonin noradrenalin reuptake inhibitors (SNRI –antidressants)
Eg metoclopramide, ondansteron
Anticonvulsants
Eg pethidine, tramadol, fentanyl
Antiemetics
Eg moclobmide
Analgesic
Eg venlafaxine, citaloprma
Tricyclic antidepressants
Monoamine oxidase iunhibitors (Block serotonin break down –used as
antidepressants)
Eg paroxtetine, fluoxetine
Eg valproaic acid
Dietary supplements
Eg St johns wort, ginseng
Serotonergic Toxidrome
Produces wide variety of signs and
symptoms due to CNS, peripheral and
autonomic dysfunction
Most commonly produces
Tremor
Hyperreflexia and muscle rigidity esp in the legs
Clonus
Fever
Tachycardia and hypertension