Toxidromes

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

ToxidromeMental statusPupilsOther findingsExamplesAntidote
  AnticholinergicDelirium
Hallucinations
Agitation
DilatedDry, flushed skin
Urinary retention
Sedating antihistamines (eg promethazine, doxylamine, cyproheptadine, pheniramine, alimemazine)Tricyclic antidepressants
Atropine
Hyoscine
Antispasmodics
Atypical antipsychotics (eg risperidonequetiapine)
Plants (eg Angels trumpet)
Physostigmine
Sodium bicarbonate (tricyclic antidepressants)
HallucinogenHallucinationsSynaesthesiaAgitationDilatedNystagmusLSD
Mescaline
Psilocybe mushrooms
 
Neuroleptic Malignant syndromeConfusionDilatedMuscle rigidityDiaphoreticMetabolic acidosis
Liver failure
Renal failureHyperkalaemia
RhabdomyolysisBlood clots (veins and arteries)
Antipsychotics (eg risperidonequetiapine)
Antiemetic agents (eg domperidone, droperidol, metoclopramide, promethazine)
Dantrolene (decreases muscle rigidity)
Sympatho-mimeticAgitation
Hypervigilance Paranoia
DilatedDiaphoreticTremors
HyperreflexiaSeizures
Cocaine, amphetamine, pseudoephedrine, nicotine, caffeine, cold and flu medications beta agonist (eg phenylephrine) 
Serotonin Toxicity   Confusion Agitation
Coma
DilatedTremorMyoclonusDiaphoreticHyperreflexiaTrismus
Rigidity
Monoamine oxidase inhibitors
Selective serotonin reuptake inhibitors
Tramadol
Tapentadol
MDMA/ecstasy
Amphetamines
Lamotrigine
Cyproheptadine    
 Withdrawal from ethanol /sedatives-hypnoticsAgitated ConfusionDilatedDiaphoreticDiarrhoea
Tremor
Seizure
Alcohol
BenzodiazepinesBarbiturates (eg Phenobarbitone
Opioid  CNS depression ComaConstrictedHyporeflexia
Pulmonary oedema
Opioids (heroin, morphine, methadone, fentanyl, oxycodone)                      
Cough syrups with codeine derivates (dihydrocodeine, pholcodine)
Naloxone
 Sedative-hypnotic
Ethanol
CNS depression
Confusion
Coma
ConstrictedHyporeflexiaAlcohol
BenzodiazepinesBarbiturates (eg Phenobarbitone)
GHB
Flumazenil (benzodiazepines)
 CholinergicConfusion
Coma
ConstrictedSalivation
Lacrimation
UrinationDiarrhoea
Vomiting
Organophosphates
Nerve agentsPhysostigmine
Atropine