Toxidrome

Symptoms/Signs

Agents

Sympathomimetic

Tachycardia, tachypnea, HTN, dilated pupils, sweaty, agitation/paranoia; seizures, hyperthermia, rhabdomyolysis

Cocaine, amphetamines, ephedrine, thyroid hormone, MDMA, PCP, LSD, newer designer drugs such as synthetic cannabinoids: “Spice” or “K2”

Anticholinergic

(“hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter”)

Tachycardia, tachypnea, dilated pupils, hyperthermia, delirium, agitation/paranoia; seizures, dry/flushed skin, dry mouth, urinary retention

Tricyclic antidepressants, atropine, antihistamines, phenothiazines, anti-Parkinson’s medications, scopolamine, dicyclomine and other GI and urinary antispasmodics

Cholinergic

(DUMBBBELS)- note the Killer B’s

Diarrhea/Diaphoresis, Urination, Miosis, Bradycardia (muscarinic), Bronchorrhea, Bronchospasm, Emesis, Lacrimation, Salivation/Seizures. Syndrome may first appear as an adrenergic toxidrome that progresses to cholinergic

Nerve agents, Organophosphate and carbamate pesticides, nicotine, pilocarpine, bethanechol

Sympatholytic

Bradycardia, hypotension, CNS depression

Alpha-blockers, beta-blockers, clonidine, brimonidine, tizanidine, Visine, dexmedetomidine

Opioid/sedatives

Miosis, hypopnea, obtundation, hypotension, bradycardia, hyporeflexia

Heroin, opioids/opiates, benzodiazepines, barbiturates, ETOH, GHB, muscle relaxants, baclofen

Serotonin syndrome

Dilated pupils, fever, agitation, tachycardia, hyperreflexia, clonus, flushing, diarrhea. Rapid onset (<24 hours) and resolution once offending agent has been withdrawn

SSRIs, MAOIs, meperidine, lithium

Neuroleptic malignant syndrome

Fever, labile BP, lead pipe rigidity, AMS, dyskinesia, rhabdomyolysis, dysrhythmias. Gradual onset (>24 hours) and resolution

Haloperidol and other antipsychotics