Toxidromes

Question 1

What is involved in an anticholinergic toxidrome?

Causes

First investigation

Answer 1

Dilated pupils - myadrisis >5mm
DRY
Tachycardic
Urinary retention
Vision ∆
Facial flush
Confusion

Causes: TCAs, gravol, benadryl

ECG - TCAs can block Na channel leading to widened qrs, mx w/ NaHCO3

Question 2

What is involved in a sympathomimetic toxidrome?

Answer 2

Myadrisis, >5mm pupil [dilated]
WET
Diaphoretic
agitated
Tachycardic
HTN

Causes: cocaine, methamphetamines

Get ECG - to r/o STEMI, cocaine can block Na channel leading to widened qrs = tx w/ NaHCO3

Question 3

What is a opiate toxidrome

Mx

Answer 3

Pinpoint pupils <2mm
Low RR, Low BP, decreased LOC, no bowel sounds

Mx: naloxone

Question 4

What is a cholinergic toxidrome?

Causes?

Mx

What can mimic a cholinergic toxidrome?

Answer 4

Pinpoint pupils <2mm [miosis]
Increase salivation, urination, diarrhea, diaphoretic

Causes: organophosphates, Pilocarpine

Mx: Antidote - atropine

BB, CCB, Digoxin can all mimic cholinergic toxidrome

Question 5

What medication should you never give a pt who OD on cocaine and why?

Answer 5

BB

Leads to unopposed alpha adrenergic stimulation == more coronary vasospasm = could kill pt

Alpha receptors stim = vasoconstriction