The symptoms of a sympathomimetic toxidrome include anxiety, delusions, diaphoresis, hyperreflexia, mydriasis, paranoia, piloerection, and seizures. While most sedative-hypnotics are anticonvulsant, some such as GHB and methaqualone instead lower the seizure threshold, and so can cause paradoxical seizures in overdose. Substances that may cause this toxidrome include anticonvulsants, barbiturates, benzodiazepines, gamma-Hydroxybutyric acid, Methaqualone, and ethanol. The symptoms of sedative/hypnotic toxidrome include ataxia, blurred vision, coma, confusion, delirium, deterioration of central nervous system functions, diplopia, dysesthesias, hallucinations, nystagmus, paresthesias, sedation, slurred speech, and stupor. Substances that may cause this toxidrome are opioids. Complications include bradycardia, hypotension, and hypothermia. The symptoms of an opiate toxidrome include the classic triad of coma, pinpoint pupils, and respiratory depression as well as altered mental states, shock, pulmonary edema and unresponsiveness. Substances that may cause this toxidrome include amphetamines, cocaine, and phencyclidine. Complications include hypertension, tachycardia, and tachypnea. The symptoms of a hallucinogenic toxidrome include disorientation, hallucinations, hyperactive bowel sounds, panic, and seizures. Īn alternative mnemonic is DUMBELLS - Diarrhea, Urination, Miosis, Bradycardia, Emesis, Lacrimation, Lethargy and Salivation Substances that may cause this toxidrome include carbamates, mushrooms, and organophosphates.Ĭommon mnemonics for organophosphate poisoning include the "killer B's" of bronchorrhea and bronchospasm because they are the leading cause of death, and SLUDGE - Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal distress, and Emesis. Complications include bradycardia, hypothermia, and tachypnea. The symptoms of a cholinergic toxidrome include bronchorrhea, confusion, defecation, diaphoresis, diarrhea, emesis, lacrimation, miosis, muscle fasciculations, salivation, seizures, urination, and weakness. Substances that may cause this toxidrome include the four "anti"s of antihistamines, antipsychotics, antidepressants, and antiparkinsonian drugs as well as atropine, benztropine, datura, and scopolamine.ĭue to the characteristic appearance and behavior of patients with this toxidrome, they are colloquially described as "Blind as a bat, mad as a hatter, red as a beet, hot as hell, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.". Complications include hypertension, hyperthermia, and tachycardia. The symptoms of an anticholinergic toxidrome include blurred vision, coma, decreased bowel sounds, delirium, dry skin, fever, flushing, hallucinations, ileus, memory loss, mydriasis (dilated pupils), myoclonus, psychosis, seizures, and urinary retention. "Classic" toxidromes are presented below, but they are often variable or obscured by the co-ingestion of multiple drugs. Aside from poisoning, a systemic infection may also lead to a toxidrome. A toxidrome may indicate a medical emergency requiring treatment at a poison control center. Common symptoms include dizziness, disorientation, nausea, vomiting, and oscillopsia. It is often the consequence of a drug overdose. The term was coined in 1970 by Mofenson and Greensher. Pralidoxime (reactivates acetylcholinesterase that had been deactivated by phosphorylation)Īnticholinergic toxicity Muscarinic cholinergic antagonists (c.f.Toxidrome ( portmanteau of toxic and syndrome) is a syndrome caused by a dangerous level of toxins in the body.Antidote is atropine to counteract the bradycardia plus pralidoxime, which regenerates AchE by removing the organophosphate. Organophosphates found in insecticides.Physostigmine (treats glaucoma enters CNS treats atropine overdose).Edrophonium (diagnosis of myasthenia gravis extremely short acting).Pyridostigmine (treats myasthenia gravis does not enter CNS).Neostigmine (postop and neurogenic ileus and urinary retention treats myasthenia gravis post-op reversal of NMJ blockage).Indirect cholinergic agonists (acetylcholinesterase inhibitors) Pilocarpine (activates sweat, tears, saliva).Carbachol (treats glaucoma contracts pupils decreases IOP).Bethanechol (activates bowel and bladder). ![]()
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