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24 hours) and resolution once offending agent has been withdrawn |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 |
*Many of these toxidromes occur on a spectrum with only some signs or symptoms present depending on dose of ingestion, coingestions, tolerance, etc.
Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005 Mar 17;352(11):1112-20.
Boyer EW. Management of opioid analgesic overdose. N Engl J Med. 2012 Jul 12;367(2):146-55