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Table 36.2

Clues to the Poison (2): Toxidromes

ToxidromeExampleHeart rateBlood pressureRespiratory rateConscious levelPupil sizeSweatingTemperatureComments
Sympathomimetic

Cocaine, cathinones,

amphetamines, some novel psychoactive substances (legal highs)

Electrolyte disturbances and muscle breakdown
AnticholinergicHyoscine, antidepressants, diphenhydramine, antipsychotics()Urinary retention
Cholinergic

Organophosphorous

sarin, VX

No changeNo change(No change)(No change)Emesis, diarrhoea, urinary incontinence, hypersalivation
Opioid

Morphine, fentanyl,

oxycodone,

codeine, methadone, buprehorphine

Classical triad not always present Monitor GCS/AVPU as naloxone only short acting
Sedative hypnoticBenzodiazepines, “Z” hypnotics()Monitor GCS/AVPU
Serotonin syndrome

SSRI, SNRI

lithium

Check for myoclonus

Short onset and duration of events

Neuroleptic malignant syndromeAntipsychotics()No change()

muscle tone and CK

Takes five or more days to resolve

Alcohol withdrawalAlcoholNo change(No change)()()Consider using CIWA-Ar/GMAWS to objectively monitor and respond to withdrawal
Opioid withdrawalOpioids(No change)()()()Consider using COWS to objectively monitor and respond to withdrawal

reduction in effect

() qualified change in effect

increase in effect

Sources: Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM (1989) Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction 84, 1353–1357.

Wesson DR, Ling W (2003) The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs 35, 253–259.