====== Toxodromes ======
A toxidrome (toxic syndrome) is a specific constellation of clinical signs and symptoms caused by an overdose or exposure to a particular class of toxins or drugs. There are five major toxidromes: 

====Sympathomimetic====
This toxidrome involves overstimulation of the sympathetic nervous system, mimicking the body's "fight or flight" response. 
  * Common Agents
    * Cocaine
    * Amphetamines
    * Methylphenidate (Ritalin/Adderall)
    * MDMA (Ecstasy)
    * Bath salts
  * Key Symptoms
    * Agitation, anxiety, paranoia, hyperactivity, tremors, and seizures. 
  * Vital Signs & Exam
    * tachycardia
    * hypertension
    * hyperthermia
    * diaphoresis 
  * Eye Findings: [[drugs_cause_mydriasis|Mydriasis]] 

====Anticholinergic==== 
This occurs when drugs block the action of acetylcholine in the parasympathetic nervous system. 
  * Common Agents
    * Atropine
    * Antihistamines
    * Tricyclic antidepressants (TCAs)
    * Plants like Jimson weed. 
  * Key Symptoms
    * Delirium, hallucinations, confusion
    * Muscle twitching. 
    * Classic mnemonic: **"Mad as a hatter, blind as a bat, red as a beet, hot as a hare, dry as a bone."** 
  * Vital Signs & Exam: 
    * Tachycardia
    * Hyperthermia
    * Dry skin and mucous membranes (no sweating)
  * Eye Findings: [[drugs_cause_miosis|Miosis]] 

====Cholinergic====
This toxidrome is caused by overstimulation of parasympathetic nerves due to an excess of acetylcholine. 
  * Common Agents
    * Organophosphates (pesticides)
    * nerve agents (e.g., Sarin)
    * Meds like physostigmine. 
  * Key Symptoms:
    * Mnemonic **"SLUDGE: Salivation, Lacrimation, Urination, Diarrhea, Gastrointestinal cramps, and Emesis"** 
    * Severe cases cause pinpoint pupils, muscle fasciculations, and respiratory distress. 
  * Vital Signs & Exam: 
    * Profuse bodily secretions
    * Bradycardia
  * Eye Findings: [[drugs_cause_miosis|Miosis]]  
 

====Opioid====
This toxidrome suppresses the central nervous system, mainly through the activation of mu-opioid receptors. 

  * Common Agents
    * Opioids: Morphine, heroin, fentanyl, oxycodone, and codeine
  * Key Symptoms: 
    * CNS depression ranging from extreme drowsiness to unresponsiveness or coma. 
  * Vital Signs & Exam: 
    * Bradypnea
    * Hypotension
    * Hypothermia
  * Eye Findings: [[drugs_cause_miosis|Miosis]] 

====Sedative-Hypnotic====
This syndrome results from the enhancement of GABA receptors, which generally slows down brain activity. 
  * Common Agents:
    * Benzodiazepines (e.g., Valium, Xanax)
    * Barbiturates, 
    * Ethanol
    * Sleeping aids (Z-drugs)
  * Key Symptoms
    * Drowsiness, slurred speech, confusion, and ataxia
  * Vital Signs & Exam: 
    * Depressed breathing
    * Hyporeflexia
    * Hypotension
  * Eye findings: generally not a feature of this toxidrome.

====Resources====

  - [[https://www.youtube.com/watch?v=0UjhK1pCqJk|
Poisoning and Toxidromes: Definitions, Types & Diagnosis – Emergency Medicine]]
  - [[https://iem-student.org/2024/11/29/toxidromes-2024/ |Toxidrome Review]]
  - [[https://www.rch.org.au/clinicalguide/guideline_index/Toxidromes_poisoning/ |Toxidrome Poisioning Clinical Guide]]
  - [[https://www.youtube.com/watch?v=qwSaFlFvFeA | Toxicology And Toxidromes by EM Note]]
  - [[https://adc.bmj.com/content/110/9/681 |Paediatric emergency medicine: Toxidromes and a general approach to poisoning Free. Robert J Hoffman and Andrea Nillas. Archives of Disease in Childhood. 2025; 110(9):681-686]]
  - [[https://emergencycarebc.ca/clinical_resource/clinical-summary/common-toxidromes-diagnosis-treatment/ | Common Toxodromes]]
  - [[https://en.wikipedia.org/wiki/Toxidrome| Wikipedia:Toxidrome]]
  - [[https://foamed.ebmedicine.net/rapid-reference/toxidromes/|EbMedicine Rapid Reference: Toxidromes]]
  - [[https://chemm.hhs.gov/toxicsyndromes.htm|CHEMM Toxidromes]]

{{tag>drugs}}