Introduction
Toxicologists refer to certain poisons’ effects as toxidromes (a contraction of the phrases toxic and syndrome). Toxidromes are collections of symptoms and signs that occur in conjunction with a certain form of poisoning.
As an illustration, the herb known as Jimson weed, which is consumed or smoked for its hallucinogenic effects, causes the anticholinergic toxidrome: Large pupils, dry skin that is heated to the touch, urine retention, mental confusion, hallucinations, and coma are among further symptoms.
The majority of toxins either have no linked toxidrome or only contain some of the typical toxidrome characteristics.
Types of Toxidromes
The most commonly encountered toxidromes are the:
(a) anticholinergic,
(b) cholinergic,
(c) opioid,
(d) sedative-hypnotic, and
(e) sympathomimetic (also known as the adrenergic or stimulant) toxidromes.
Common Toxidromes
| Toxidrome | Mental status | Pupils | Other findings | Examples | Antidote |
| Anticholinergic | Delirium Hallucinations Agitation | Dilated | Dry, flushed skin Urinary retention | Sedating antihistamines (eg promethazine, doxylamine, cyproheptadine, pheniramine, alimemazine)Tricyclic antidepressants Atropine Hyoscine Antispasmodics Atypical antipsychotics (eg risperidone, quetiapine) Plants (eg Angels trumpet) | Physostigmine Sodium bicarbonate (tricyclic antidepressants) |
| Hallucinogen | HallucinationsSynaesthesiaAgitation | Dilated | Nystagmus | LSD Mescaline Psilocybe mushrooms | |
| Neuroleptic Malignant syndrome | Confusion | Dilated | Muscle rigidityDiaphoreticMetabolic acidosis Liver failure Renal failureHyperkalaemia RhabdomyolysisBlood clots (veins and arteries) | Antipsychotics (eg risperidone, quetiapine) Antiemetic agents (eg domperidone, droperidol, metoclopramide, promethazine) | Dantrolene (decreases muscle rigidity) |
| Sympatho-mimetic | Agitation Hypervigilance Paranoia | Dilated | DiaphoreticTremors HyperreflexiaSeizures | Cocaine, amphetamine, pseudoephedrine, nicotine, caffeine, cold and flu medications beta agonist (eg phenylephrine) | |
| Serotonin Toxicity | Confusion Agitation Coma | Dilated | TremorMyoclonusDiaphoreticHyperreflexiaTrismus Rigidity | Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Tramadol Tapentadol MDMA/ecstasy Amphetamines Lamotrigine | Cyproheptadine |
| Withdrawal from ethanol /sedatives-hypnotics | Agitated Confusion | Dilated | DiaphoreticDiarrhoea Tremor Seizure | Alcohol BenzodiazepinesBarbiturates (eg Phenobarbitone |
| Opioid | CNS depression Coma | Constricted | Hyporeflexia Pulmonary oedema | Opioids (heroin, morphine, methadone, fentanyl, oxycodone) Cough syrups with codeine derivates (dihydrocodeine, pholcodine) | Naloxone |
| Sedative-hypnotic Ethanol | CNS depression Confusion Coma | Constricted | Hyporeflexia | Alcohol BenzodiazepinesBarbiturates (eg Phenobarbitone) GHB | Flumazenil (benzodiazepines) |
| Cholinergic | Confusion Coma | Constricted | Salivation Lacrimation UrinationDiarrhoea Vomiting | Organophosphates Nerve agentsPhysostigmine | Atropine |
