Clues to the Poison (1): Clinical and Biochemical Features
| Feature | Poisons to consider |
|---|---|
| Coma | Barbiturates, benzodiazepines, ethanol, opioids, trichloroethanol, tricyclics |
| Fits | Amphetamines, cocaine, dextropropoxyphene, insulin, oral hypoglycaemics, phenothiazines, theophylline, tricyclics, lead |
| Constricted pupils | Opioids, organophosphates, trichloroethanol |
| Dilated pupils | Amphetamines, cocaine, phenothiazines, quinine, sympathomimetics, tricyclics |
| Arrhythmias | Anti-arrhythmics, anticholinergics, phenothiazines, quinine, sympathomimetics, tricyclics |
| Hypertension | Amphetamines, cocaine |
| Pulmonary oedema | Carbon monoxide, ethylene glycol, irritant gases, opioids, organophosphates, paraquat, salicylates, tricyclics |
| Ketones on breath | Ethanol, isopropyl alcohol, alcoholic or starvation ketoacidosis |
| Hypothermia | Barbiturates, ethanol, opioids, tricyclics |
| Hyperthermia | Amphetamines and MDMA, anticholinergics, cocaine, monoamine oxidase inhibitors |
| Hypoglycaemia | Insulin, oral hypoglycaemics, ethanol, salicylates |
| Hyperglycaemia | Theophylline, organophosphates, salbutamol |
| Acute kidney injury | Amanita phalloides, ethylene glycol, paracetamol, salicylates, prolonged hypotension, rhabdomyolysis (Appendix 25.1) |
| Hypokalaemia | Salbutamol, salicylates, theophylline |
| Metabolic acidosis | Carbon monoxide, ethanol, ethylene glycol, methanol, paracetamol, salicylates, tricyclics |
| Raised plasma osmolality | Ethanol, ethylene glycol, isopropyl alcohol, methanol |
| Rhabdomyolysis | Carbon monoxide, ethanol, opioids, solvents |
MDMA, 3,4-methylenedioxy-methamphetamine (‘ecstasy’).