Chapter 78 General Toxicology and Toxidromes
2 What are the common toxidromes?
Toxidromes are syndromes associated with particular classes of toxins. They may be useful in making the diagnosis of poisoning and initiating treatment as patients are often too ill to wait for the results of laboratory or other testing (Table 78-1).
| Toxidrome | Clinical findings | Example agents |
|---|---|---|
| Cholinergic | Diarrhea, fecal incontinence, enuresis, miosis, tachycardia followed by bradycardia, lacrimation, sialorrhea, sweating, muscle fasciculations followed by weakness and/or paralysis, altered mental status | Organophosphate and carbamate insecticides Amanita muscaria Nicotine |
| Anticholinergic | Agitated delirium, flushing, decreased sweating, tachycardia, mydriasis, urinary retention, decreased peristalsis, hyperthermia | Atropine Benztropine Scopolamine Diphenhydramine |
| Sympathomimetic | Mydriasis, hyperthermia, seizures, hyperactivity, hypertension, tachycardia, diaphoresis, delusions, piloerection | Cocaine Methamphetamine MDMA |
| Sympatholytic | Miosis, hypotension, bradycardia or reflex tachycardia, CNS depression | Clonidine Methyldopa Oxymetazoline |
| Opioid | Miosis, CNS depression, respiratory depression or apnea, may have hypotension | Heroin Morphine Fentanyl Oxycodone |
| Serotonin syndrome | Mental status changes, autonomic hyperactivity, neuromuscular abnormalities, akathisia, tremor, clonus, muscle hypertonicity, hyperthermia | Sertraline Fluoxetine Citalopram Linezolid Trazodone Meperidine Tramadol |
| Neuroleptic malignant syndrome | Fever, “lead pipe” muscular rigidity, altered mental status, autonomic dysfunction (in setting of recent treatment with neuroleptics) | Haloperidol Chlorpromazine Promethazine Prochlorperazine Ziprasidone Quetiapine |
CNS, Central nervous system; MDMA, methylenedioxymethamphetamine.
