Toxidrome

Question 1

Common toxidromes

Answer 1

1. Sympathomimetic
2. Cholinergic
3. Anti-cholinergic
4. Opioid
5. Sedative-hypnotic
6. Hallucinogenic

Question 2

Cholinergic toxidrome

SLUDGE

Answer 2

Salivation
Lacrimation
Urination
Defecation
GI (nausea, cramp)
Emesis

Examples: Organophosphate, carbamate, mushrooms

Question 3

Cholinergic

- Muscarinic vs Nicotinic

Answer 3

Muscarinic (DUMBELS)

• Diarrhea
• Urination
• Miosis
• Bradycardia / Bronchorrhea / Bronchospasm
• Emesis
• Lacrimation
• Salivation

*Killer Bs

Nicotinic (Mon to Fri)

• Mydriasis
• Tachycardia
• Weakness
• HT
• Fasciculations

Confusion, convulsion, coma

Muscarinic not in skeletal muscles

Question 4

Antidote for cholinergic toxidrome

Answer 4

Atropine 0.6mg, no end point until lung dries

Pralidoxime aka 2-PAM (Oximes)
- reverse binding of ChI with AChE

Question 5

Sympathomimetic syndrome symptoms

MATHS

Answer 5

Mydriasis
Agitation, arrhythmia, angina
Tachycardia
HT, hyperthermia
Seizure, sweating

Question 6

Sympathomimetic syndrome

Tx

Answer 6

Benzodiazepines

Avoid beta blockers due to unopposed alpha agonism

Question 7

Opioid toxidrome symptoms

CPRHHH

Answer 7

Coma
Pinpoint pupils
RS depression
Hypotension
Hypothermia
Hyporeflexia

Question 8

Anti-cholinergic toxidrome symptoms

Answer 8

Hot as a hare
- anhydrosis, hyperthermia

Dry as a bone
- dry skin, dry mucous membranes

Blind as a bat
- mydriasis

Red as a beet
- flushed skin

Mad as a hatter

• altered mental state
• delirium

hallucination / delirium / coma
seizure
tachycardia
HT
hyperthermia
dry skin
dry mouth
mydriasis, with blurring of vision
decrease BS
constipation
urinary retention

Question 9

Anti-cholinergic toxidrome Tx

Answer 9

Sedation for delirium
- BZD

avoid antipsychotic / physical restraints