Toxicology (main): Difference between revisions
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{| width="200" cellspacing="1" cellpadding="1" border="1"
{| width="200" cellspacing="1" cellpadding="1" border="1"
|-
|-
| '''<br>'''
|
| '''Cholinergic '''([[Organophosphates]])
| '''Cholinergic '''([[Organophosphates]])
| '''[[Anticholinergic Toxicity|Anticholinergic]]''' ([[Tricyclic (TCA) Toxicity|TCAs]], antihist, phenothiazines)'''  
| '''[[Anticholinergic Toxicity|Anticholinergic]]''' ([[Tricyclic (TCA) Toxicity|TCAs]], antihist, phenothiazines)'''  
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| '''Sedative/Hypnotic''' ([[Alcohol (ETOH) Intoxication|ETOH]])
| '''Sedative/Hypnotic''' ([[Alcohol (ETOH) Intoxication|ETOH]])
|-
|-
| ''Temp'''''<br>'''  
| ''Temp''
| Nl<br>
| Nl
| Nl/Inc<br>
| Nl/Inc
| Nl/Inc<br>
| Nl/Inc
| Nl/Dec<br>
| Nl/Dec
| Nl/Dec<br>
| Nl/Dec
|-
|-
| ''RR''<br>
| ''RR''
| Varriable<br>
| Variable
| Nl/Dec<br>
| Nl/Dec
| Varriable<br>
| Variable
| Nl/Dec<br>
| Nl/Dec
| Nl/Dec<br>
| Nl/Dec
|-
|-
| ''HR''<br>
| ''HR''
| Varriable<br>
| Variable
| Inc  
| Inc  
| Inc (sig)<br>
| Inc (sig)
| Nl/Dec<br>
| Nl/Dec
| Nl/Dec<br>
| Nl/Dec
|-
|-
| ''BP''<br>
| ''BP''
| Inc<br>
| Inc
| Inc<br>
| Inc
| Inc<br>
| Inc
| Nl/Dec<br>
| Nl/Dec
| Nl/Dec<br>
| Nl/Dec
|-
|-
| ''LOC''<br>
| ''LOC''
| Nl/Lethargic<br>
| Nl/Lethargic<
| Nl, agitated, psychotic, comatose<br>
| Nl, agitated, psychotic, comatose
| Nl, agitated, psychotic <br>
| Nl, agitated, psychotic
| Nl, Lethargic, or Comatose <br>
| Nl, Lethargic, or Comatose
| Nl, Lethargic, or Comatose <br>
| Nl, Lethargic, or Comatose
|-
|-
| ''Pupils''<br>
| ''Pupils''  
| Varriable<br>
| Varriable
| Mydriatic<br>
| Mydriatic
| Mydriatic<br>
| Mydriatic
| Nl/Miotic <br>
| Nl/Miotic  
| <br>
|  
|-
|-
| ''Motor''<br>
| ''Motor''
| Fasciculations, Flacid Paralysis&nbsp;<br>
| Fasciculations, Flacid Paralysis&nbsp;
| Nl<br>
| Nl
| Nl/Agitated<br>
| Nl/Agitated
| Nl<br>
| Nl
| <br>
|  
|-
|-
| ''Skin''<br>
| ''Skin''
| Sweating (sig)<br>
| Sweating (sig)
| Hot, dry<br>
| Hot, dry
| Sweating<br>
| Sweating
| Dry<br>
| Dry
| <br>
|  
|-
|-
| ''Lungs''<br>
| ''Lungs''
| Bronchospasm/ rhinorrhea <br>
| Bronchospasm/ rhinorrhea  
| Nl<br>
| Nl
| Nl<br>
| Nl
| Nl<br>
| Nl
| <br>
|  
|-
|-
| ''Bowel Sounds''<br>
| ''Bowel Sounds''
| Hyperactive (SLUDGE) <br>
| Hyperactive (SLUDGE)
| Dec/Absent<br>
| Dec/Absent
| Nl/Dec<br>
| Nl/Dec
| Nl/Dec<br>
| Nl/Dec
| <br>
|  
|}
|}


Revision as of 17:53, 26 September 2013

Background

Autonomic Nervous System

  1. Parasympathetic - ACh is transm
    1. Muscarinic
      1. receptors in heart, eye, lung, GI, skin and sweat glands
      2. Bradycardia
      3. Miosis
      4. Bronchorrhea / Bronchospasm
      5. Hyperperistalsis (SLUDGE)
      6. Sweating
      7. Vasodilation
    2. Nicotinic
      1. receptors in both sympathetic and parasympathetic nervous systems
      2. fasciculations, flaccid paralysis
      3. ?Mild bradycardia, hypotension
  2. Sympathetic
    1. ALPHA EFFECTS - vessels, eye, skin
      1. Mydriasis, HTN, Sweating
    2. BETA EFFECTS - heart, lungs
      1. Tachycardia, Bronchodilation

Diagnosis

Toxicological Exam

  1. All VS (Temp, RR,HR, BP)
  2. Neuro Exam
    1. Level of consciousness
    2. Pupillary exam
    3. Motor response
  3. Skin Exam - moisture, temp
  4. Lung Exam
  5. Bowel Sounds

Toxidromes

Cholinergic (Organophosphates) Anticholinergic (TCAs, antihist, phenothiazines) Sympathomimetic^ (Cocaine, Amphetamines, Ketamine) Sympatholytic^^ (Clonidine) Sedative/Hypnotic (ETOH)
Temp Nl Nl/Inc Nl/Inc Nl/Dec Nl/Dec
RR Variable Nl/Dec Variable Nl/Dec Nl/Dec
HR Variable Inc Inc (sig) Nl/Dec Nl/Dec
BP Inc Inc Inc Nl/Dec Nl/Dec
LOC Nl/Lethargic< Nl, agitated, psychotic, comatose Nl, agitated, psychotic Nl, Lethargic, or Comatose Nl, Lethargic, or Comatose
Pupils Varriable Mydriatic Mydriatic Nl/Miotic
Motor Fasciculations, Flacid Paralysis  Nl Nl/Agitated Nl
Skin Sweating (sig) Hot, dry Sweating Dry
Lungs Bronchospasm/ rhinorrhea Nl Nl Nl
Bowel Sounds Hyperactive (SLUDGE) Dec/Absent Nl/Dec Nl/Dec

^^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan

DDx for Specific Signs

Hyperthermia

  1. Altered Metabolism
    1. Aspirin (Salicylate) Toxicity
    2. withdrawal states
    3. thyroid hormones
    4. dinitrophenols
  2. Increased Muscle Activity
    1. withdrawal, sympathomimetics
    2. MAOI Toxicity
    3. PCP, LSD
    4. Lithium
    5. Amoxapine
    6. Serotonin Syndrome
  3. Impaired Heat Dissipation
    1. anticholinergics
    2. antihistamines
    3. antipsychotics (TCAs)
  4. Malignant Hyperthermia
    1. anesthestics
  5. Neuroleptic Malignant Syndrome
    1. phenothiazines, Lithium, LevoDopa

Hypothermia

  1. Exposure
    1. Ethanol Toxicity
    2. Sedative hypnotics
    3. Narcotics
    4. TCAs
    5. Phenothiazines
    6. Insulin (Hypoglycemia)

Increased Respiratory Rate

  1. Direct Stimulation
    1. Aspirin (Salicylate) Toxicity
    2. Metabolic Acidosis
    3. dintirophenol, pentachlorophenol
    4. hepatorenal failure
    5. CNS stimulants (cocaine, amphet, theophylline)
  2. Tissue Hypoxia
    1. CO
    2. Cyanide
    3. Hydrogen Sulfide
    4. Methemoglobinemia

Respiratory Depression

  1. Central Depression
    1. antipsychotics
    2. chlorinated hydrocarbons
    3. Ethanol Toxicity
    4. glycols
    5. sedative/hypnotics
    6. Tricyclic (TCA) Toxicity
    7. Lomitil
  2. Muscle Failure
    1. Organophosphates
    2. Marine Toxins
    3. nicotine
    4. strychnine
    5. botulinis
    6. Mojave rattlesnake, Cobra

See Also

Altered Mental Status (AMS)

Source

Originally adapted from BIRNBAUMER

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