Clues to the Poison (2): Toxidromes
| Toxidrome | Example | Heart rate | Blood pressure | Respiratory rate | Conscious level | Pupil size | Sweating | Temperature | Comments |
|---|---|---|---|---|---|---|---|---|---|
| Sympathomimetic | Cocaine, cathinones, amphetamines, some novel psychoactive substances (legal highs) | ↑ | ↑ | ↑ | ↑ | ↑ | ↑ | ↑ | Electrolyte disturbances and muscle breakdown |
| Anticholinergic | Hyoscine, antidepressants, diphenhydramine, antipsychotics | ↑ | (↑) | ↓ | ↓ | ↑ | ↓ | ↑ | Urinary retention |
| Cholinergic | Organophosphorous sarin, VX | No change | No change | (No change) | ↓ | ↑ | (No change) | Emesis, diarrhoea, urinary incontinence, hypersalivation | |
| Opioid | Morphine, fentanyl, codeine, methadone, buprehorphine | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | Classical triad not always present Monitor GCS/AVPU as naloxone only short acting |
| Sedative hypnotic | Benzodiazepines, “Z” hypnotics | ↓ | ↓ | ↓ | ↓ | (↑) | ↓ | ↓ | Monitor GCS/AVPU |
| Serotonin syndrome | SSRI, SNRI | ↑ | ↑ | ↑ | ↑ | ↑ | ↑ | ↑ | Check for myoclonus Short onset and duration of events |
| Neuroleptic malignant syndrome | Antipsychotics | ↑ | (↑) | No change | ↓ | (↑) | ↑ | ↑ | ↑muscle tone and CK Takes five or more days to resolve |
| Alcohol withdrawal | Alcohol | ↑ | No change | (No change) | (↑) | ↑ | ↑ | (↑) | Consider using CIWA-Ar/GMAWS to objectively monitor and respond to withdrawal |
| Opioid withdrawal | Opioids | ↑ | (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.