While the authors correctly draw distinctions between the clinical appearance of anticholinergic toxidrome
and the sympathomimetic toxidrome
commonly associated with cathinone ingestion we believe there are some additions that we can make; it is mentioned that a D.
Humans eating contaminated fish are susceptible to the toxidrome
caused by the ciguatera toxin, which includes gastrointestinal upset followed by neurologic symptoms including paresthesias and hot-cold reversal (Friedman et al.
This clustering of symptoms and signs is called the opioid toxidrome
, and should serve to guide therapy.
Because advanced laboratory techniques are usually not routinely and rapidly available in most hospitals, the emergency physician maybe left in a diagnostic quandary when a patient with apparent sympathomimetic toxidrome
(agitation with tachycardia, hyperthermia, and/or hyperthermia) fails to display cocaine metabolites or amphetamines in the urine drug screen.
in illicit drug use Toxidrome
Features Drugs implicated Adrenergic Hypertension, tachycardia, Amphetamines, mydriasis, diaphoresis, cocaine, ephedrine, agitation, dry mucus membranes phencyclidine Sedative Stupor and coma, confusion, Barbiturates, slurred speech, apnoea benzodiazepines, ethanol, opiates Hallucinogenic Hallucinations, psychosis, Amphetamines, panic, fever, hyperthermia cannabinoids, cocaine Narcotic Altered mental status, slow Opiates shallow breaths, miosis, bradycardia, hypotension, hypothermia, decreased bowel sounds Epileptogenic Hyperthermia, hyperrreflexia, Cocaine, tremors, seizures phencyclidine Adapted from Devlin and Henry.
The first section, on general patient principles, covers toxidrome
recognition, biodromes, and specific body systems.
Treatment of antihistamine-induced rhabdomyolysis initially requires recognizing the appropriate toxidrome
associated with antihistamines, terminating further exposure, and reducing the further absorption of the medication.
Because treatment ofthe poisoned patient often does not require an antidote and because many drugs that require antidotes are not found in the point-of-care drug screen, treatment should be based on the presenting toxidrome
and not on the drug screen.
Proper identification of a particular toxidrome
could be used to exclude some drug classes as the cause of the symptoms without urine drug testing.
As a result of using Google Glass, consulting toxicologists reported being more confident in diagnosing specific toxidromes
Knowledge of the general classes of agents, including their specific toxidromes
, unusual clinical signs and symptoms, or unusual clusters of patients exhibiting similar signs and symptoms, should serve to alert clinicians to a potential event.
Antidotes are only of potential value in the treatment of plants containing cardiac glycosides and those that present with cholinergic and anticholinergic toxidromes