Anticholinergic Toxidrome

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Tachycardia Dry skin Dilated pupils Raised body temperature

Myoclonus Urinary retention Decreased bowel sounds Agitation

Delirium Seizures Coma


Hot as a hare, Blind as a bat, Dry as a bone, Red as a beet, Mad as a hatter

Anticholinergic Toxidrome (Continued)

Toxins that Cause Anticholinergic Syndrome

Antihistamines Antipsychotic drugs Plants:

Antiparkinson drugs Antidepressants Jimsonweed

Atropine Antispasmodics Amanita

Amantadine Muscle relaxants

Sympathomimetic Toxidrome


Delusions Hyperpyrexia Hyperreflexia

Paranoia Diaphoresis Hypertension

Tachycardia Mydriasis Seizures

Note: Distinction from anticholinergic: diaphoresis and no urinary retention are characteristic of sympathomimetic; dry skin and absent bowel sounds more likely in anticholinergic.

Toxins that Cause Sympathomimetic Toxidrome

Cocaine Amphetamine Methamphetamine


Phenylpropanolamine, Ephedrine, Pseudoephedrine

Note: Caffeine and theophylline show similar physiological signs but differ from the sympathomimetics because they do not cause manic or hallucinatory symptoms.

Opiate Toxidrome


Hypotension Respiratory depression Bradycardia

Hypothermia Altered mental status Meiosis

Decreased bowel sounds

Note: Seizures secondary to hypoxia, trauma, multiple drugs, or hypoglycemia.

Toxins that Cause Opiate Toxidrome

Morphine Heroin Codeine

Synthetic opiates Semi-synthetic opiates

Note: Check for needle tracks. Reversal of symptoms with naloxone is essentially diagnostic.

Cholinergic Toxidrome


Confusion CNS depression Seizures Hypertension

Agitation Tremors

Delirium Coma

Meiosis Tachycardia Fasciculations


SLUDGE (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal sounds, Emesis)

Toxins that Cause Cholinergic Toxidrome

Organophosphate Carbamate Pilocarpine insecticides insecticides

Hallucinogenic Toxidrome


Perceptual distortions Depersonalization Lack of reality sense

Toxins that Cause Hallucinogenic Toxidrome

Amphetamines Cannabinoids Cocaine Phencyclidine

Sedative-Hypnotic Toxidrome



Loss of CNS function Coma





Drugs that Cause Sedative-Hypnotic Toxidrome

Anticonvulsants Antipsychotics Barbiturates Benzodiazepines

Ethanol Methadone

Fentanyl Methocarbamol

Glutethimide Opiates Meprobamate Tricyclic antidepressants

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