Toxic Ingestion Clinical Pathway — Emergency Department, ICU and Inpatient
Toxic Ingestion Clinical Pathway — Emergency Department, ICU and Inpatient
Toxidromes and Substance Effects
The following serves as a reference for key and/or pathognomonic substance effects.
Toxidromes
Examples | Temp | HR | RR | BP | Mental Status/CNS | Pupils | Bowel Sounds | Skin | Additional Findings | |
---|---|---|---|---|---|---|---|---|---|---|
Anticholinergic |
|
↑ | ↑ | ↔ | ↑ |
|
Dilated (sluggish) | ↓ | Flushed, dry | Urinary retention |
Cholinergic |
|
↔ | ↕ | ↑ | ↓ ↔ |
|
Constricted | ↑ | Diaphoretic |
|
Opioids |
|
↓ | ↓ | ↓ | ↓ |
|
Constricted | ↓ | — | Hyporeflexia |
Salicylates | Aspirin | ↑ | ↑ | ↑ | ↔ |
|
— | — | Diaphoretic | Vomiting |
Sedative-hypnotics |
|
↓ | ↔ | ↓ | ↓ |
|
— | — | — | — |
Sympathomimetics |
|
↑ | ↑ | ↑ | ↑ |
|
Dilated (reactive) | ↑ | Diaphoretic |
|
Substances Causing Nystagmus
- Anticonvulsants
- Barbiturates
- Phenytoin
- Carbamazepine
- Occasionally others
- Carbon monoxide
- Dextromethorphan
- Ethanol
- Ketamine
- May be horizontal, vertical or rotatory nystagmus
- Lithium
- MAO Inhibitors
- May be “ping pong gaze” eye movements
- Phencyclidine
- May be horizontal, vertical and rotatory nystagmus
- Synthetic cannabinoids
Odors and Causative Substances
Odor | Substance |
---|---|
Almonds (Bitter) | Cyanide |
Carrots | Water hemlock |
Disinfectants |
|
Rotten Eggs |
|
Fruity (Sweet) |
|
Garlic |
|
Gasoline | Hydrocarbon-based solvents |
Hay | Phosgene |
Mothballs |
|
Burnt Rope | Marijuana |
Vinegar | Acetic Acid |
Violets | Turpentine (metabolites in urine) |
Wintergreen | Methyl salicylate |