Toxidromes

 

Atropinics & Anticholinergics

 

(Atropine, Tricyclic, Antidepressants, Phenothiazines, Antihistamines)

 

  • VS: fever, tachycardia, hypertension, cardiac arrhythmias
  • CNS: delirium, psychosis, coma, convulsions
  • Eye: mydriasis, dilated pupils

 

Amphetamines & Sympathomimetics

 

(OTC cold preps & diet pills)

 

  • VS: fever, tachycardia, hypertension
  • CNS: hyperactive, delirious,tremulous, myoclonus, psychosis, convulsions
  • Eye: mydriasis, dilated pupils
  • Skin: flushing, severe sweating

 

Barbiturates & Sedatives / Hypnotics

 

  • VS: hypothermia, hypotension, bradypnea
  • CNS: confusion, coma, ataxia
  • Eye: nystagmus, miosis, mydriasis
  • Skin: vesicles, bullae

 

Opiates

 

  • VS: bradycardia, bradypnea, hypotension, hypothermia
  • CNS: euphoria to coma, hyporeflexia
  • Eye: pinpoint pupils

 

Organophosphate / Cholinergic

 

  • VS: bradycardia or tachycardia, tachypnea
  • CNS: confusion, drowsiness, coma, convulsions, muscle, fasciculations, weakness, paralysis
  • Eye: pinpoint pupils, blurry vision, lacrimation
  • Skin: sweating
  • Odor: garlic
  • Misc: salivation, bronchorrhea, bronchospasm, pulmonary edema, diarrhea, increased urine.

 

Phenothiazines

 

  • VS: postural hypotension, hypothermia, tachycardia, tachypnea
  • CNS: lethargy, coma, tremor, convulsions, ataxia, torticollis, back aching, oculogyric crisis, trismus, tongue protrusion
  • Eye: Miosis

 

Salicylates

 

  • VS: fever, tachypnea
  • CNS: lethargy, coma
  • Odor: oil of wintergreen with methyl salicylate
  • Misc: vomiting, acidosis

 

Theophylline

 

  • VS: tachycardia, arrhythmias
  • CNS: headaches, restlessness, muscle twitching, seizure
  • Misc: vomiting, hematemesis

 

Antidotes

 

acetaminophen

  • [acetylcysteine]

 

anesthetic/vasoconstrictor combos, local dental

  • [phentolamine]

 

anticholinergics

  • [physostigmine]

 

arsenic

  • [dimercaprol OR penicillamine]

 

benzodiazepines

  • [flumazenil]

 

beta blockers

  • [glucagon]

 

calcium channel blockers

  • [calcium chloride]

 

carbamates

  • [atropine OR pralidoxime (2-PAM)]

 

cholinergics

  • [atropine OR pralidoxime (2-PAM)]

 

cholinesterase inhibitors

  • [atropine OR pralidoxime (2-PAM)]
    • Info: may use glycopyrrolate or hyoscyamine to prevent muscarinic effects of cholinesterase inhibitors

 

copper

  • [penicillamine OR trientine]

 

cyanide

  • [hydroxocobalamin OR sodium nitrite AND sodium thiosulfate]
    • Info: may give amyl nitrite before sodium nitrite

 

digitalis/digoxin

  • [digoxin immune Fab]
    • Info: may add colestipol if w/in 1-3h after last oral digoxin ingestion

 

ethylene glycol

  • [ethanol OR fomepizole]

 

folate antagonists

  • [leucovorin]

 

gold

  • [dimercaprol]

 

heavy metals

  • [dimercaprol OR penicillamine]

 

heparin

  • [protamine sulfate]

 

hypoglycemics

  • [glucagon]

 

iron

  • [deferoxamine OR deferasirox]

 

lead

  • [calcium EDTA OR dimercaprol OR penicillamine OR succimer]

 

mercury

  • [dimercaprol OR penicillamine]

 

methanol

  • [ethanol OR fomepizole]

 

methemoglobinemia

  • [methylene blue]

 

methotrexate

  • [leucovorin OR levoleucovorin]

 

neuromuscular blockers, non-depolarizing

  • [edrophonium OR neostigmine OR physostigmine]
    • Info: may use glycopyrrolate or hyoscyamine
    • to prevent muscarinic effects of cholinesterase inhibitors

 

opioids

  • [naloxone OR nalmefene]

 

organophosphates

  • [atropine OR pralidoxime (2-PAM)]

 

scorpion sting

  • [Centruroides immune Fab]

 

snake bite

  • [antivenin (Micrurus fulvius)]
    • Info: for North American Coral snake bite
  • [Crotalidae polyvalent immune Fab]
    • Info: for North American Crotalid snake (rattlesnake) bite

 

spider bite

  • [antivenin (Latrodectus mactans)]
    • Info: for black widow spider bite

 

warfarin

  • [phytonadione]