Toxidromes
Toxidromes
This page acts as an overview of the various toxidromes one might encounter, with further detail on some of them on the other pages in the poisons section.
Resources
- Toxic syndromes ('toxidromes') are a constellation of clinical features arising due to ingestion of toxic substances, usually either recreational drugs, overdose of therapeutic agents or frank poisoning
- The table is non-exhaustive, and it's worth bearing in mind multiple substance ingestion can lead to a mixed picture
| Toxidrome | Causative agents | Cardio-respiratory features | Mental status | Neurology | Pupils | Other features |
| Opioid | Morphine Fentanyl |
↓RR/respiratory arrest ↓HR Hypotension |
Sedation Coma |
Hypo-reflexia | Miosis (pin-point) | Pulmonary oedema Needle marks Hypothermia |
| Anti-cholinergic | TCA overdose Anti-histamines Phenothiazines |
↑RR ↑HR + ↑BP |
Agitation Delirium Hallucinations Coma |
Mydriasis | Dry, flushed skin Hyperthermia |
|
| Sympathomimetic | Cocaine Amphetamines Theophylline |
↑HR ↑BP |
Agitation Hallucinations Paranoid |
Seizures Hyper-reflexia |
Mydriasis | Sweating Hyperthermia |
| Cholinergic | Nicotine Organophosphate Sarin, Novichok |
↓↓HR Bronchoconstriction Variable RR & BP |
Confusion Coma |
Muscle weakness Seizures |
Miosis | Sialorrhoea Sweating Diarrhoea Vomiting |
| Sedative-hypnotic | Alcohol Benzodiazepine Barbiturates |
↓RR/apnoea ↓HR, ↓BP |
Confusion Stupor Coma |
Hypo-reflexia | Variable (often miosis) | Hypothermia |
| Serotonin syndrome | Multiple SSRI, SNRI, TCA |
↑RR ↑HR ↑BP |
Confusion Agitation Coma |
Tremor Clonus Hyper-reflexia |
Mydriasis | Hyperthermia Sweating |
| Hallucinogenics | LSD PCP Mescaline |
↑HR ↑BP |
Agitation Hallucinations Depersonalisation |
Nystagmus | Mydriasis | Hyperthermia Sweating |