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