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A
toxidrome (a
portmanteau of
toxic and
syndrome, coined in 1970 by Mofenson and Greensher
) is a syndrome caused by a dangerous level of
in the body. It is often the consequence of a drug
overdose. Common
include
dizziness,
disorientation,
nausea,
vomiting and
oscillopsia. It may indicate a medical emergency requiring treatment at a poison control center. Aside from
, a systemic
infection may also lead to one. Classic toxidromes may be variable
or obscured by co-ingestion of multiple drugs.
A common tool for assessing for the presence of toxidrome in the United Kingdom is the CRESS tool.
Anticholinergic
The symptoms of an
anticholinergic toxidrome include blurred vision,
coma, decreased
bowel sounds,
delirium, dry
skin,
fever, flushing,
,
ileus,
memory loss,
mydriasis (dilated
pupils),
myoclonus,
psychosis,
and urinary retention. Complications include
hypertension,
hyperthermia and
tachycardia. Substances that may cause this toxidrome include
,
,
, antiparkinsonian drugs,
atropine,
benztropine,
datura,
diphenhydramine and scopolamine.
Cholinergic
The symptoms of a cholinergic toxidrome include
bronchorrhea,
confusion,
defecation,
diaphoresis,
diarrhea,
emesis,
lacrimation,
miosis, muscle fasciculations,
salivation,
,
urination and weakness. Complications include
bradycardia,
hypothermia and
tachypnea. Substances that may cause this toxidrome include
,
and
.
Hallucinogenic
The symptoms of a hallucinogenic toxidrome include
disorientation,
, hyperactive bowel sounds,
panic and
. Complications include
hypertension,
tachycardia and
tachypnea. Substances that may cause this toxidrome include substituted amphetamines,
cocaine and
phencyclidine.
Opiate
The symptoms of an opiate toxidrome include the classic triad of
coma,
miosis and
hypoventilation[ as well as altered mental states, shock, pulmonary edema and unresponsiveness. Complications include bradycardia, hypotension and hypothermia. Substances that may cause this toxidrome are opioids.
]
Sedative/hypnotic
The symptoms of sedative/hypnotic toxidrome include ataxia, blurred vision, coma, confusion, delirium, deterioration of central nervous system functions, diplopia, dysesthesias, , nystagmus, paresthesias, sedation, slurred speech and stupor. Apnea is a potential complication. Substances that may cause it include , , , gamma-Hydroxybutyric acid, Methaqualone and ethanol. While most sedative-hypnotics are anticonvulsant, some such as GHB and methaqualone instead lower the seizure threshold, so can cause paradoxical seizures in overdose.
Sympathomimetic
The symptoms of a sympathomimetic toxidrome include anxiety, , diaphoresis, hyperreflexia, mydriasis, paranoia, piloerection and . Complications include hypertension and tachycardia. Substances that may cause this toxidrome include cocaine, amphetamine and compounds based upon amphetamine's structure such as ephedrine (Ma Huang), methamphetamine, phenylpropanolamine and pseudoephedrine. The bronchodilator salbutamol may also cause this toxidrome. It may appear very similar to the anticholinergic toxidrome, but is distinguished by hyperactive bowel sounds and sweating.[
]
Further reading
