ToxidromesToxidromesBrad Peckler MD

Lincoln Hospital CenterBronx, New York

Diagnostic OdorsDiagnostic OdorsCyanide Isopropanol

Placidyl Hemlock

Hydrogen sulfide Camphor

Phosgene Naphthalene

Op’s/ Arsenic Hydrocarbons

Methylsalicylate

Chloral hydrate

Zinc phosphate

Paradichlorobenzene

But as the world is But as the world is harmoniously confused:harmoniously confused:

Where order in variety we see,Where order in variety we see,And where, though all things And where, though all things

differ, all agree.differ, all agree.

Alexander Pope

69 y/o male with chronic low back pain presents with change in mental status.

28 y/o woman found in bathroom found unconscious with a syringe on the floor.

NarcoticsNarcoticsHypoventilation

Pinpoint pupils

Somnolence

~Hypotension

NarcoticsNarcoticsMeperidine Vagolytic

Serotonin syndrome

Noromeperidine

Propoxyphene Prolonged QT

Mixed agonist/antagonist

Synthetic opiates

Drug combinations

18 y/o male brought in by NYPD because he’s acting crazy and violent.

HR 144 BP 180/90 RR 22

Diaphoretic, 8mm pupils

SympathomimeticsSympathomimeticsHTN

Tachycardia

Mydriasis

Diaphoresis

CNS excitement

SympathomimeticsSympathomimeticsDrugs of abuse

Adrenergic agonists

Amphetamines

Cocaine

PCP

TCA

Early MAOI

Sedative/hypnotic withdrawal

70 y/o female used a flea bomb in her house and forgot to open the windows before entering the house

C/o eye tearing, SOB, vomiting

Cholinergic crisisCholinergic crisisOrganophosphates

Organophosphothionates

Carbamates

Insecticides

Nerve agents

2-PAM

OrganophosphatesOrganophosphatesAcetylcholinesterase

Acetylcholine No hydrolysis

Nervous tissue and RBC

Concentrated in CNS

Parasympathetic nerve endings

Sympathetic nerve endings

Somatic nerves

Autonomic ganglia

Pseudocholinesterase

Liver and serum

Muscarinic

Diarrhea

Urination

Meiosis

Bronchospasm/secretions

Emesis

Lacrimination

Salvation/sweating

SLUDGE

+ Bradycardia

Nicotinic

CNS

NMJ

Adrenal

Ganglia

Sweating

+Tachycardia

+Hypertension

18 y/o male BIBPD c/o

hallucinations and “cotton mouth”

OE: temp 102, distended abdomen

Visual HallucinationsVisual Hallucinations

Anticholinergics

Sympathomimetics

LSD

PCP

GHB

Psilocybin

Pentamidine

Nutmeg/Mace

Functional

Organic

Migraines

Encephalitis

Rabies

Digoxin/Methanol

Alcohol intoxication

Alcohol withdrawal

HallucinationsHallucinations

Olfactory

Migrane, Pre-seizure, Acidosis, FB

Frontal lobe tumor

Sensory

DT’s, Cocaine, Menapause, HCG, Liver dz

Auditory

Functional, ASA, CN VIII

25 y/o female took some pills

Comatose, dry mucous membrane, tachycardic, had a seizure at home.

AnticholinergicsAnticholinergics

TCA

Scopolamine/polo

Neuroleptics

Parkinson meds

Benzotropine/trihexphendyl

Jimson weed

Antihistamines Methylqualone

Piperdones Gyromitra

TCATCA

Anticholinesterase inhibitor

Alpha blocker

Sodium channel blocker (1A)

Amine uptake inhibitor

GABA inhibitor

AnticholinergicAnticholinergic vsvs SympathomimetcSympathomimetcDry Wet

Absent bowel sounds NL bowel sounds

Psychosis Agitated

Mydriasis Mydriasis

Hyperthermia Hyperthermia

Red Flushed

Tachy/BP ? Tachy/HTN

60 y/o prisoner with AMS and a suicide note. Had a seizure en route to hospital and has continued to seize for 45 minutes

After ABC’s

FS 402

7.22/22/360

Status EpilepticusStatus Epilepticus

INH

Theophylline

Hypoglycemia

SeizureSeizure Hyperglycemia Hyperglycemia

Metabolic Acidosis Metabolic Acidosis

INH

ASA

DKA

Theophylline

CO/CN

Anticholinergic

Phenytoin