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Toxicology Information

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Additional Toxicology Information and References:

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  1. Antidotes. Life in the Fast Lane. https://litfl.com/tox-library/antidotes/

  2. Boehnert MT, Lovejoy FH.  Value of the QRS duration verus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants.  New England Journal of Medicine 1985; 313:474-479.

  3. Holstege CP, Eldridge DL, Rowden AK.  ECG manifestations: the poisoned patient.  Emergency Medicine Clinics of North America 2006; 159-177.

  4. Chan A, Isbister GK, Kirkpatrick CMJ et al.  Drug-induced QT prolongation and torsades de pointes: evaluation of a QT nomogram.  Quarterly Journal of Medicine 2007:100:609-615.

  5. Liebelt EL, Francis D, Woolf AD.  ECG lead AVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity.  Annals of Emergency Medicine 1995; 26:195-201.

  6. Niemann JT, Bessen HA, Rothstein RJ et al.  Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity.  American Journal of Cardiology 1986; 57:1154-1159.

  7. Wolfe TR, Caravati EM, Rollins DE.  Terminal 40-ms frontal plane QRS axis as a marker for tricyclic antidepressant overdose.  Annals of Emergency Medicine 1989; 18:348-351

  8. Acetaminophen. Drug Bank. https://go.drugbank.com/drugs/DB00316

  9. Amphetamine. Drug Bank. https://go.drugbank.com/drugs/DB00182

  10. Aripiprazole. Drug Bank. https://go.drugbank.com/drugs/DB01238

  11. Baclofen. Drug Bank. https://go.drugbank.com/drugs/DB00181

  12. Benzodiazepine. Drug Bank. https://go.drugbank.com/drugs/DB12537

  13. Benzonatate. Drug Bank. https://go.drugbank.com/drugs/DB00868

  14. Bupropion. Drug Bank. https://go.drugbank.com/drugs/DB01156

  15. Buspirone. Drug Bank. https://go.drugbank.com/drugs/DB00490

  16. Carbamazepine. Drug Bank. https://go.drugbank.com/drugs/DB00564

  17. Carbon monoxide. Drug Bank. https://go.drugbank.com/drugs/DB11588

  18. Chloroquine. Drug Bank. https://go.drugbank.com/drugs/DB00608

  19. Hydroxychloroquine. Drug Bank. https://go.drugbank.com/drugs/DB01611

  20. Clonazepam. Drug Bank. https://go.drugbank.com/drugs/DB01068

  21. Clonidine. Drug Bank. https://go.drugbank.com/drugs/DB00575

  22. Cocaine. Drug Bank. https://go.drugbank.com/drugs/DB00907

  23. Diphenhydramine. Drug Bank. https://go.drugbank.com/drugs/DB01075

  24. Duloxetine. Drug Bank. https://go.drugbank.com/drugs/DB00476

  25. Flecainide. Drug Bank. https://go.drugbank.com/drugs/DB01195

  26. Gabapentin. Drug Bank. https://go.drugbank.com/drugs/DB00996

  27. GHB. Drug Bank. https://go.drugbank.com/drugs/DB01440

  28. Iron. Drug Bank. https://go.drugbank.com/drugs/DB01592

  29. Lamotrigine. Drug Bank. https://go.drugbank.com/drugs/DB00555

  30. Lithium. Drug Bank. https://go.drugbank.com/drugs/DB14506

  31. MDMA. Drug Bank. https://go.drugbank.com/drugs/DB01454

  32. Metformin. Drug Bank. https://go.drugbank.com/drugs/DB00331

  33. Quetiapine. Drug Bank. https://go.drugbank.com/drugs/DB01224

  34. Salicylate. Drug Bank. https://go.drugbank.com/drugs/DB11201

  35. Sildenafil. Drug Bank. https://go.drugbank.com/drugs/DB00203

  36. Sertraline. Drug Bank. https://go.drugbank.com/drugs/DB01104

  37. Tricyclic Antidepressant. Drug Bank. https://go.drugbank.com/drugs/DB00540

  38. Trazadone. Drug Bank. https://go.drugbank.com/drugs/DB00656

  39. Venlafaxine. Drug Bank. https://go.drugbank.com/drugs/DB00285

  40. Khan,S. 2019. Createspace.The Ultimate Emergency Medicine Guide. Toxicology. pages 271-287.

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Anticholinergic

•This toxidrome can be associated with antihistamines, antipsychotics, and certain antidepressants.

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•Patients often exhibit symptoms of blurry vision (mydriasis), delirium, flushed skin, dry skin, hyperthermia, urinary retention, hypoactive bowel sounds, and seizures.

 

•In short, patients suffering from the anticholinergic toxidrome are found to be: “Blind as a bat, mad as a hatter, red as a beet, dry as a bone, hot as hell”

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Cholinergic

•This toxidrome can be caused by organophosphates.

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•Patients often exhibit symptoms of diaphoresis, urination, miosis, bradycardia, emesis, lacrimation, lethargy, and excessive salivation.

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•In short, patients suffer from the DUMBBELLS mnemonics

  Diarrhea, Diaphoresis

  Urination

  Miosis

  Bradycardia

  Bronchorrhea

  Emesis

  Lacrimation

  Lethargy

  Salivation

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Sympathomimetic

•This toxidrome can be caused by amphetamines, caffeine, certain drugs of abuse (cocaine and PCP).

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•Patients often exhibit symptoms of mydriasis, tachycardia, hyperthermia, tachypnea, hypertension, and diaphoresis.

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•Sympathomimetic and anticholinergic toxidromes are often confused however a major differentiating factor is diaphoresis in the setting of sympathomimetics vs. anhidrosis (dry skin) in the setting anticholinergics.

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Opioid

•This toxidrome can be caused by codeine, morphine, heroin, demerol, hydrocodone, diphenoxylate, etc.

 

•Patients suffering from this toxidrome often exhibit symptoms of respiratory depression, miosis, hypotension and coma.

 

•Antidote: Naloxone

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•Of note, clonidine toxicity can mimic opioid overdose.

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