Toxidrome

A toxidrome is a concept derived from a portmanteau of the terms toxic and syndrome, and it represents a group of clinical symptoms corresponding to a specific class of toxicants. The genesis of the term can be traced back to 1970 when it was coined by Mofenson and Greensher.

Toxidrome

Symptoms	BP	HR	RR	Temp	Pupil size	Bowel sounds	Diaphoresis
anticholinergic	~	up	~	up	up	down	down
cholinergic	~	~	~	~	down	up	up
hallucinogenic	up	up	up	~	up	up	~
sympathomimetic	up	up	up	up	up	up	up
sedative-hypnotic	down	down	down	down	~	down	down

Toxidrome FlowChart Diagnosis

Origin and Definition

The term "toxidrome" is the marriage of "toxic" and "syndrome" and serves to denote specific clusters of symptoms related to particular toxic substances. Such symptoms often surface due to drug overdose but can occasionally be attributed to systemic infections. Accurate identification of a toxidrome is pivotal for diagnosing and addressing potentially fatal poisonings.

Symptoms

Toxidromes manifest differently depending on the particular toxic agent in play. Commonly observed symptoms across various toxidromes encompass:

• Dizziness
• Disorientation
• Nausea
• Vomiting
• Oscillopsia

Classification of Toxidromes

Certain "classic" toxidromes have been identified, even though the combined ingestion of multiple drugs can modulate the manifestation of a toxidrome. Some of the classic examples are:

• Anticholinergic Toxidrome:
  • Characteristics: Dry skin, dry mucous membranes, flushed complexion, fever, mydriasis (dilated pupils), tachycardia.
  • Typical Agents: Atropine, scopolamine, antihistamines, tricyclic antidepressants.

• Cholinergic Toxidrome:
  • Characteristics: Salivation, lacrimation, urination, diarrhea, miosis (pinpoint pupils), bradycardia.
  • Typical Agents: Organophosphate pesticides]], nerve agents.

• Opioid Toxidrome:
  • Characteristics: Respiratory depression, miosis, bradycardia, hypothermia.
  • Typical Agents: Morphine, heroin, fentanyl.

• Sympathomimetic Toxidrome:
  • Characteristics: Tachycardia, hypertension, mydriasis, hyperthermia, agitation.
  • Typical Agents: Cocaine, methamphetamine, caffeine.

• Sedative-Hypnotic Toxidrome:
  • Characteristics: Respiratory depression, hypothermia, slurred articulation, ataxia.
  • Typical Agents: Alcohol, benzodiazepines, barbiturates.

Management & Intervention

Rapid action is imperative once a toxidrome has been identified, especially in severe cases. Consulting with a poison control center or medical toxicologist can yield insights into specific antidotes or treatment methods. Immediate supportive care, emphasizing respiratory and hemodynamic stabilization, is of paramount importance.

Related Topics

• Poisoning
• Drug overdose
• Toxicology
• Antidote

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