ABSTRACT
Cholinergic Toxidrome ◾ Features: Salivation, Lacrimation, Urination, Defecation, Emesis, or SLUDE = Mus-
carinic + miosis, bronchorrhea and bronchospasm = (DUMBBELS), ↓ HR. Nicotinic: weakness, fasciculations, paralysis, sweating. CNS: agitation/ confusion, seizures, coma
◾ Causes: OPs, carbamates, “stigmines” and oximes; pilocarpine eye drops, nerve gases, echothiophate gtts = AchE inhibitors; Clitocybe/Inocybe (glutamic acid, ibotenic acid → muscimol) muscarinic mushrooms
◾ Features: “Fight or flight,” hypertension, tachycardia, sweating, fever, excitationpsychomotor agitation, tremor, seizures, dilated pupils
◾ Causes: Amphetamines/diet drugs, cocaine, theophylline, caffeine, methylphenidate; over-the-counter (OTC) cold medications, especially phenylpropanolamine (PPA), ephedrine, and pseudoephedrine
Hypermetabolic Toxidrome ◾ Features: “Uncoupling of oxidative phosphorylation” with high fever, tachycardia,
hyperpnea, tachypnea, restlessness, convulsions, combined metabolic acidosis and respiratory alkalosis
◾ Causes: Salicylates (ASA), chlorphenoxyacetic acid herbicides (2,4-D and 3,4,5-T), dinitrophenol, phenol, triethyl tin, SMFA, and bromethalin
◾ Features: “Coma with stable vital signs,” mild sedation-to-complete unresponsiveness, amnesia, respiratory depression, loss of airway protective reexes, mild hypotension
Extrapyramidal Toxidrome ◾ Features: “Drug-induced Parkinsonism,” tremor, rigidity, opisthotonus, torticollis,
dysphonia, oculogyric crisis = tardive dyskinesias ◾ Causes: Phenothiazines, butyrophenones (haloperidol, droperidol), metoclopramide,
clomipramine ◾ Antidote: Diphenhydramine
◾ Features: Pinpoint pupils, somnolence, CNS depression, respiratory depression, bradycardia, hypotension, hypothermia, decreased GI motility, constipation
◾ Causes: All opioids, natural and synthetic, including propoxyphene, tramadol, codeine. Exception: α-2-agonists = clonidine and the imidazolines, oxymetazoline, and tetrahydrolozine
Withdrawal Toxidrome ◾ Features: Yawning, sneezing, runny nose, lacrimation, piloerection aka “goose bumps,”
abdominal cramps, diarrhea, restlessness, hallucinations, tachycardia, and hypertension
nists for maintenance (naltrexone) ◾ Drug withdrawal syndromes
◾ Chem: Pyrolyzed carbonaceous materials steamed and then CO2-activated to create pores and ↑ adsorptive surface area
◾ Mech: Adsorption by H2 ion bonding and van der Waals forces of agents that are nonionized, undissociated, not protein-bound, poorly-to-slowly absorbed, distributed (anticholinergics ↓ GI motility), and excreted
◾ Contra indications: Coma, seizures, vomiting, ileus, SBO, simultaneous PEG; alcohols, HCs, metals (except thallium), caustics, lithium
Applications ◾ Use: Most organic and inorganic materials, ASA, acetaminophen, anticonvulsants-
barbiturates, phenytoin, glutethamide, theophylline, TCAs, pesticides ◾ Dose: Early (within 1-4 h) administration of a avored 8:1 water slurry, 10:1 AC:drug,
1 g/kg bw. MDAC: 0.5 mg/kg ◾ Side Effects (SE): Vomiting, aspiration, diarrhea → constipation → SBO; AC is usu-
ally combined with a cathartic, particularly 70% sorbitol > Mg citrate, 4 mL/kg
◾ Chem: Provides constant intestinal clearance by maintaining a continuous diffusion gradient between blood and gut (known as “gut dialysis”)
◾ Mech: GI tract dialysis, especially for large ingestions, enteric or slow/sustained release-drug ingestions; to halt enterohepatic circulation of poisons
◾ Contra: Same as AC-coma, seizures, vomiting, ileus, SBO, simultaneous WBI; all alcohols, HCs, metals, caustics, lithium
Applications ◾ Uses: Digoxin, phenobarbital, carbamazepine, phenylbutazone, dapsone, methotrex-
ate, naldolol, theophylline, ASA, TCAs, cyclosporine, propoxyphene ◾ Dose: 0.5 g/kg q 2-6 h, starting within 1 h of ingestion ◾ SE: Same as AC-vomiting, aspiration, diarrhea → constipation → Small Bowel
◾ Chem: Saline and glucose-based cathartics composed of nonabsorbable cations (Mg, Na) that establish an osmotic gradient to draw water into gut.
