Toxidromes

What is a toxidrome

       It is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others.

The cholinergic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Cholinergic SLUDGE	•      Salivation •      Lacrimation •      Urination •      Diarrhoea •      GI cramps •      Emesis •      Wheezing •      Diaporesis •      Bronchorrhoea •      Bradycardia •      Miosis	•      Carbamate •      Organophosphates •      Physostigmine •      Pilocarpine	•      Atropine •      Pralidoxime for organophosphates

The anticholinergic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Anticholinergic Hot as a hare Dry as a bone Red as a beet Mad as a hatter Blind as a bat	•      Mydriasis •      Blurred vision •      Fever •      Dry skin •      Flushing •      Ileus •      Urinary retention •      Tachycardia •      Hypertension •      Psychosis •      Coma •      Seizures •      Myoclonus	•      Antihistamines •      Atropine •      Baclofen •      Benztropine •      Tricyclic         antidepressants •      Phenothiazines •      Propantheline •      Scopolamine	• Physostigmine  (do not use in cyclic antidepressant overdose as will worsen conduction disturbances)

Hallucinogenic Sympathomimetic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Hallucinogenic	•      Disorientation •      Hallucinations •      Hyperactive Bowel •      Panic •      Seizure •      Tachycardia •      Hypertension •      Tachypnoea	•      Amphetamine •      Cocaine •      Pseudoephedrine •      Phencyclidine •      Ephedrine	•      Benzodiazepines

Sedative/hypnotic toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Sedative / hypnotic	•      Stupor & coma •      Confusion •      Slurred speech •      Apnoea	•      Anticonvulsants •      Antipsychotics •      Barbiturates •      Benzodiazepines •      Ethanol •      Meprobamate •      Opiates	•      Naloxone •      Flumazenil •      Urinary alkanisation for Phenobarbital

Opiate toxidrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Narcotic	•      Altered mental status •      Slow shallow breaths •      Meiosis •      Bradycardia •      Hypotension •      Hypothermia •      Decreased bowel sounds	•   Dextromethorphan •   Opiates •   Pentazocine •   Propoxyphene	•      Nalaoxone

Serotonergic syndrome

Syndrome	Signs &Symptoms	Poisons	Antidote
Serotonergic	•   Irritability •   Hyperreflexia •   Flushing •   Diarrhoea •   Diaphoresis •   Fever •   Trismus •   Tremor •   Myoclonus	•      Fluoxetine •      Meperidine •      Paroxetine •      Trazodone •      Clomipramine	•      Benzodiazepine