Toxidromes/ Poison Syndromes, signs & symptoms.pptx

Must Know Toxidromes of MBBS UG Student
Emergency signs & Symptoms of various Toxidromes
A toxidrome is a syndrome caused by a dangerous level of toxins in the body. It is often the consequence of a drug overdose. Common symptoms include dizziness, disorientation, nausea, vomiting and oscillopsia. It may indicate a medical emergency requiring treatment at a poison control center
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.
The toxic syndromes or toxidromes noted in the pptx. are derived from expected clinical effects after exposure to those chemicals most often reported to be involved in accidental spills, those with likelihood of causing significant health impact upon release, and those with emergent treatments available.
The drugs which causes toxidromes involve heroin, fentanyl, methadone, oxycodone, oxymorphone and a host of other opiate medications. Opioids depress the central nervous system, and it is expected that the patient will exhibit a decreased level of consciousness, bradypnea, bradycardia, and pinpoint pupils (miosis)
The classic toxidrome consists of miosis plus respiratory and CNS depression. Although pinpoint pupils are often associated with opioid poisoning, one should not rely on them exclusively in making the diagnosis.
The typical toxidrome in organophosphate (OP) poisoning comprises of the Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms.
delayed toxidromes are organized into four classes: specific pharmaceuticals, biologicals, pharmaceutical dosage forms, and chemicals. There are five basic mechanisms for delayed toxicity: delayed absorption, distribution factors, metabolic factors, cellular and organ capacity effects, and unknown.
Common presenting signs are lethargy, coma, seizures, flaccid muscle weakness, miosis (pupillary constriction), tachycardia, and excessive salivation.
The clinical evaluation to determine a toxidrome includes: a qualitative assessment of vital signs, assessment of pupils (dilated or constricted); respiratory status (hyperventilating, hypoventilating or some degree of respiratory distress); neurological status (depressed neurological system such as coma etc.
Always consider anticholinergic toxicity in young children who present somnolent or lethargic. Remember the mnemonic "red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare, full as a flask."
The symptoms of a cholinergic toxidrome include bronchorrhea, confusion, defecation, diaphoresis, diarrhea, emesis, lacrimation, miosis, muscle fasciculations, salivation, seizures, urination and weakness. Complications include bradycardia, hypothermia and tachypnea.
Increasing toxicity can cause nystagmus on forward gaze, miosis, somnolence, marked ataxia with falling, confusion, stupor, respiratory depression, and, ultimately, death.

1. TOXIDROMES synonym: POISON SYNDROMES By Medico hindustani This Photo by Unknown author is licensed under CC BY-SA-NC .

2. Toxidromes – Clinical signs /symptoms associated with classes of Toxins.

3. Traditional Toxidromes Sympathomimetic Anticholinergic Cholinergic Sedative/hypnotic Serotonin syndrome (similar findings with neuroleptic malignant syndrome)  Salicylates 

4. Sympathomimetic Toxidrome: Clinical indicators Heat rate Blood Pressure Cardiac Rhythm Respiratory rate temperature Mental status Eyes Skin Secretions findings Fast High Sinus tachycardia,tachyarrhythmias may occur Normal to high Normal to high Agitation, psychosis, delirium, violence  Mydriation Normal to diaphoretic Normal 

5. Anticholinergic Toxidrome: Clinical Indicators Heart rate Blood pressure Cardiac rhythm Respiratory rate Temperature Mental status Eyes Skin Secretions Findings Fast  High Fast Normal to high High Agitated, delirium, coma, seizures Midriatic Dry Dry 

6. Anticholinergic Mnemonic:

7. Cholinergic toxidrome:  Clinical indicators Heart rate Blood pressure  Cardiac rhythm  Respiratory rate  Temperature  Mental status Eyes  Skin Secretions  Findings  Normal to low Sinus bradycardia Low Normal to low Normal to low Confusion, coma, fasciculations  Miotic Profusely diaphoretic Copious 

8. Cholinergic mnemonics

9. or D - Diarrhea U – Urination M - Miosis/muscle weakness B - Bronchorrhea B - Bradycardia E - Emesis L - lacrimation S – salivation/sweating

10. Sedative – hypnotic toxidrome Clinical indicators Findings  Normal to decreased Normal to decreased Respiratory depression Normal to decreased Somnolence,coma (sedation –hallmark) Small or normal  Normal  Normal  Heart rate  Blood pressure  Respiratory rate  Temperature  Mental status Eyes Skin Secretions 

11. Opioids toxidrome It is similar to sedative hypnotics Except ( propoxyphene, meperidine, and pentazocine ) , Miosis is universally present  Respiratory depression is common & often fatal.

12. Serotonin syndrome (similar findings with neuroleptic malignant syndrome) Clinical indicators Blood pressure Cardia rhythm Temperature Mental status Eyes  Skin Secretions others Findings  Hypertension/Hypotension ( autonomic instability ) Tachycardia Hyperthermia Agitation, confusion, coma Dilated Diaphoretic Increased Neuromuscular hyperexcitability: clonus, hyperreflexia (lower > upper extremities) 

13. Salicylates toxidrome: Clinical indicators Cardiac rhythm Respiratory rate  Temperature Mental status Eyes Skin Secretions Others- Findings   Tachycardia  Tachypnea & hyperpnea Hyperthermia  Agitation , confusion, coma Normal  Diaphoretic Normal Nausea, vomiting, tinnitus, ABGs with primary respiratory alkalosis and primary metabolic acidosis; tinnitus or difficulty hearing

14. Withdrawal (sedative hypnotic)

15. Withdrawal (opioid)

16. Thank you   hope it is useful This Photo by Unknown author is licensed under CC BY .