Link to 3.2.1.3 Toxidromes Teaching Resources


Neuroleptic Malignant Syndrome



ANTICHOLINERGIC TOXIDROME

(e.g. antidepressants, antipsychotics, antihistamines, Brugmansia (Datura))


CHOLINERGIC TOXIDROME


  • Muscarinic effects
  • Nicotinic effects

See organophosphates and carbamates.

Muscarinic effects

  • defaecation
  • urination
  • miosis (small pupils)
  • bradycardia
  • emesis
  • lachrymation
  • increased secretions
  • sweating

Nicotinic effects

  • tachycardia
  • hypertension
  • muscle fasciculation
  • paralysis

OPIOID TOXIDROME

(e.g. heroin, morphine, methadone, codeine)

  • CNS depression
  • Hypoventilation
  • Hypotension
  • Miosis
  • Pulmonary oedema
  • Rapid response to naloxone
Also see differential diagnosis of coma and explore the opioid module.

SYMPATHOMIMETIC TOXIDROME

(e.g. amphetamines, theophylline, salbutamol, cocaine)

  • CNS excitation
  • Seizures
  • Tremor
  • Hyperreflexia
  • Hyper/hypotension
  • Tachycardia
  • Low potassium, raised blood glucose, acidosis
Also, see differential diagnosis of sympathomimetic syndrome
and explore,
Theophylline
MAO Inhibitor
Cocaine

Serotonergic Toxidrome

e.g. MAO inhibitors, clomipramine, SSRIs, tryptophan (particularly in combination).

A primary neuroexcitation spectrum of toxicity involving predominantly 5-HT2 receptors with abnormalities of
  • Mental status
    • agitation/restlessness/confusion/hypomania
  • Motor system
    • clonus/myoclonus
      • inducible/spontaneous/ocular
    • tremor/shivering
    • hyperreflexia/hypertonia/rigidity
  • Autonomic nervous system
    • diaphoresis/tachycardia/flushing/mydriasis
>
Explore serotonin toxicity module
Explore MAO inhibitor module
Explore selective serotonin reuptake inhibitor module
Explore tricyclic antidepressant module