Toxidrome

A toxidrome (a portmanteau of toxic and syndrome, coined in 1970 by Mofenson and Greensher^[2]) is a syndrome caused by a dangerous level of toxins in the body. It is often the consequence of a drug overdose. Common symptoms include dizziness, disorientation, nausea, vomiting and oscillopsia. It may indicate a medical emergency requiring treatment at a poison control center. Aside from poisoning, a systemic infection may also lead to one. Classic toxidromes are presented below, which are variable^[1] or obscured by co-ingestion of multiple drugs.^[3]

Toxidrome^[1]

Symptoms	BP	HR	RR	Temp	Pupil size	Bowel sounds	Diaphoresis
anticholinergic	up	up	up	up	up	down	down
cholinergic	~	~	~	~	down	up	up
hallucinogenic	up	up	up	~	up	up	~
sympathomimetic	up	up	up	up	up	up	up
sedative-hypnotic	down	down	down	down	~	down	down

A common tool for assessing for the presence of toxidrome in the United Kingdom is the CRESS tool.^[4]

Toxidrome flowchart diagnosis

Anticholinergic

See also: Anticholinergic toxicity

The symptoms of an anticholinergic toxidrome include blurred vision, coma, decreased bowel sounds, delirium, dry skin, fever, flushing, hallucinations, ileus, memory loss, mydriasis (dilated pupils), myoclonus, psychosis, seizures and urinary retention. Complications include hypertension, hyperthermia and tachycardia. Substances that may cause this toxidrome include antihistamines, antipsychotics, antidepressants, antiparkinsonian drugs, atropine, benztropine, datura, diphenhydramine and scopolamine.^[3]

Cholinergic

See also: Cholinergic toxicity

The symptoms of a cholinergic toxidrome include bronchorrhea, confusion, defecation, diaphoresis, diarrhea, emesis, lacrimation, miosis, muscle fasciculations, salivation, seizures, urination and weakness. Complications include bradycardia, hypothermia and tachypnea. Substances that may cause this toxidrome include carbamates, mushrooms and organophosphates.

Hallucinogenic

The symptoms of a hallucinogenic toxidrome include disorientation, hallucinations, hyperactive bowel sounds, panic and seizures. Complications include hypertension, tachycardia and tachypnea. Substances that may cause this toxidrome include substituted amphetamines, cocaine and phencyclidine.

Opiate

See also: Opioid overdose

The symptoms of an opiate toxidrome include the classic triad of coma, pinpoint pupils and respiratory depression^[3] 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, hallucinations, nystagmus, paresthesias, sedation, slurred speech and stupor. Apnea is a potential complication. Substances that may cause it include anticonvulsants, barbiturates, benzodiazepines, 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, delusions, diaphoresis, hyperreflexia, mydriasis, paranoia, piloerection and seizures. 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.^[3]

References

1. Goldfrank, Flomenbaum, Lewin, Weisman, Howland, Hoffman (1998). Goldfrank's Toxicologic Emergencies (6th ed.). Stamford, Connecticut: Appleton & Lange. ISBN 0-8385-3148-2.{{cite book}}: CS1 maint: multiple names: authors list (link)
2. Mofenson HC, Greensher J (1970). "The nontoxic ingestion". Pediatric Clinics of North America. 17 (3): 583–90. doi:10.1016/s0031-3955(16)32453-1. PMID 5491430.
3. Stead, LG; Stead, SM; Kaufman, MS (2006). First Aid for the Emergency Medicine Clerkship (2nd ed.). McGraw-Hill. pp. 395–6. ISBN 0-07-144873-X.
4. "CRESS tool". JESIP Website. Retrieved 2024-06-06.

Further reading

Nelson, Lewis H.; Flomenbaum, Neal; Goldfrank, Lewis R.; Hoffman, Robert Louis; Howland, Mary Deems; Neal A. Lewin (2006). Goldfrank's toxicologic emergencies. New York: McGraw-Hill, Medical Pub. Division. ISBN 0-07-143763-0.