Toxidrome Poison Control
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Transcript of Toxidrome Poison Control
Toxidromes in Acute Poisoning
Dr AP SamsonResident Physician
Department of Emergency Medicine
Dr AP Samson Toxidromes
What Is A Toxidrome?A toxidrome is a
combination of signs & symptoms which, when
taken collectively, characterise a suspected
toxicantToxidromic approach has been helpful
in identifying the offending agent when
dealing with an unknown substance.
Dr AP Samson Toxidromes
Bohol Incident – March 2005
Abdominal painDiarrhea
Vomiting?
Bacterialcontamination
Plant/marine toxin
Chemical contamination
Onset: 15 minutes – 3 hours (mean=2 h; mode=30 min)
B. cereus S. aureus
Cassava MushroomsShellfish/fish
PesticidesPetroleum distillatesArsenic
Signs and Symptoms
Food
Maruya (n=61)
Buchi (n=32)
Abdominal pain 22 (36.06%) 24 (75%)
Diarrhea 34 (55.74%) 8 (25.0%)
Dizziness 4 (6.56%) 11 (34.38%)
Headache 15 (24.59%) 10 (31.25%)
Malaise 4 (6.56%) 5 (15.62%)
Nausea 5 (8.20%) 0
Pinpoint pupils 39 (63.93%) 7 (21.88%)
Urinary incontinence
17 (27.87%) 4 (12.5%)
Vomiting 21 (34.4%) 12 (37.5%)
CHOLINERGIC SIGNS
Cholinesterase-
inhibitingcompound
Bohol Incident
Dr AP Samson Toxidromes
Toxidromic Approach 1. Check the
presenting signs:
• Level of sensorium • Vital signs • Pupils• Skin • Odour • Prominent symptom
Dr AP Samson Toxidromes
Toxidromic Approach
Check the presenting signs:• Level of sensorium
Toxicants that cause COMA :• Alcohols• Arsenic• Barbiturates• Benzodiazepines • Carbon monoxide
• Isoniazid• Lead• Lithium• Opioids• Phenothiazines
Dr AP Samson Toxidromes
Check the presenting signs:
•Vital signs
Blood pressureHeart rateRespiratory rateTemperature
Toxidromic Approach
Dr AP Samson Toxidromes
•Vital signs
Toxicants causing changes in blood pressure
Hypertension Hypotension
Anticholinergics Carbon monoxide
Sympathomimetics Cyanide
Cyclic antidepressants
Opiates
Caffeine Nitrites
Nicotine Sedative-hypnotics
Theophylline Anti-hypertensives
Toxidromic Approach
Dr AP Samson Toxidromes
•Vital signs
Toxicants causing changes in heart rate
Tachycardia Bradycardia
Iron -blockers
Carbon monoxide, cyanide
Anticholinesterases
Anticholinergics Clonidine
Sympathomimetics Ethanol
Salicylates Cardiac glycosides
Theophylline Opiates
Toxidromic Approach
Dr AP Samson Toxidromes
•Vital signs
Toxicants causing changes in respiratory rate
Hyperventilation Hypoventilation
Carbamates Clonidine
Organophosphates Opiates
Methanol Heavy metals
Ethylene glycol Aromatic hydrocarbons
Theophylline Digitalis
Salicylates Sedatives
Toxidromic Approach
Dr AP Samson Toxidromes
•Vital signs
Toxicants causing changes in temperature
Hyperthermia Hypothermia
Anticholinergics
MAO inhibitors Carbon monoxide
Metals Cholinergics
Phenothiazines Ethanol
Salicylates Hypoglycemics
Sympathomimetics
Sedative-hypnotics
-blockers
Toxidromic Approach
Dr AP Samson Toxidromes
Check the presenting signs:
• Pupils
Toxicants causing changes in pupillary size
Miosis Mydriasis
Cholinergics Anticholinergics
Clonidine Antihistamines
Opiates Antidepressants
Organophosphates Sympathomimetics
Phenothiazines Isoniazid
Sedative-hypnotics Meperidine
Toxidromic Approach
Dr AP Samson Toxidromes
Check the presenting signs:
• Skin Cutaneous bullae : barbiturates
Jaundice : Paracetamol, Watusi
Diaphoresis : pesticides
Hot and dry : anti-cholinergics
Flushed : alcohol
Reddish-orange: Rifampicin
Toxidromic Approach
Dr AP Samson Toxidromes
Check the presenting signs:
• Odour
Oil of wintergreen : salicylate
Garlic : arsenic,
organophosphates
Mothballs : camphor
Rotten fish : zinc phosphide
Rotten eggs : hydrogen sulfide
Toxidromic Approach
Dr AP Samson Toxidromes
Check the presenting signs:
• Prominent symptom
Seizure:IsoniazidTheophyllineCyanideCarbon monoxideTCAD
Toxidromic Approach
Dr AP Samson Toxidromes
Toxidromic Approach
2. Look for toxidromes:
Dr AP Samson Toxidromes
ComaSeizuresMetabolic acidosis
isoniazid
WHY?
Glutamic acid
GABAGlutamic aciddecarboxylase
Pyridoxal-5-phosphate
Pyridoxine Pyridoxal phosphokinase
SEIZURES
TOXIDROMES
Dr AP Samson Toxidromes
Anticholinergics
Hot has a hare (hyperthermia)Dry as a bone (dry mucosa)Red as a beet (flushed skin)Blind as a bat (dilated pupils)Mad as a hatter (confusion/delirium)
e.g. Antihistamines, scopolamine, angel trumpet, benztropine, atropine, TCADs
TOXIDROMES
Dr AP Samson Toxidromes
Diarrhea/diaphoresisUrinationMiosis/muscle fasciculationsBradycardia/bronchorrhea EmesisSalivation Lacrimation
organophosphates/ carbamates
WHY?
Acetylcholine Acetic acid + cholineAcetylcholinesterase
SalivationLacrimationUrinationDiarrheaGI crampsEmesis
TOXIDROMES
Dr AP Samson Toxidromes
TOXIDROMES
Rigidity/TremorsOpisthotonusTrismusHyperreflexiaChoreoathetosis
EXTRAPYRAMIDALSYNDROME
e.g. Haloperidol, Phenothiazines, Risperidone, Olanzapine
Dr AP Samson Toxidromes
TOXIDROMES
IrritabilityHyperreflexiaFlushingDiarrheaDiaphoresisFeverTrismusTremorsMyoclonus
SEROTONINSYNDROME
e.g. Fluoxetine, Paroxetine, Sertraline, Meperidine
Dr AP Samson Toxidromes
TOXIDROMES of Drugs of Abuse
Toxidrome LOC Pupils Heart
Rate
Respiration Others
OPIOID C Slow,
shallow
Nausea
SYMPATHETIC D BP; T
DEPRESSANT D Loss of
coordination
HALLUCINOGEN D Decreased
Pain
INHALANT D Headache.
Muscle weakness
Dr AP Samson Toxidromes
3. Look for other illnesses other than toxicologic
Toxidromic Approach
Dr AP Samson Toxidromes
Toxidromic Approach
Conditions/agents producing metabolic acidosis or elevated anion gap:
• M Methanol• E Ethylene glycol • T Toluene, theophylline• A Alcoholic ketoacidosis• L Lactic acidosis
• A Aminoglycosides• C Cyanide, CO• I Isoniazid, iron• D Diabetic ketoacidosis
• G Grand mal seizures• A Aspirin (salicylates)• P Paraldehyde, Phenformin
Dr AP Samson Toxidromes
The toxidromic approach is a helpful tool in identifying an unknown toxicant.
However, it is not the only tool.