Skip to main content

Toxic Ingestion — Toxidromes and Substance Effects — 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
  • Antihistamines
  • Atropine
  • Tricyclic antidepressants
  • Agitation
  • Delirium
  • Psychosis
Dilated (sluggish) Flushed, dry Urinary retention
Cholinergic
  • Organophosphate pesticides
  • Physostigmine

  • Confusion
  • Coma
  • Seizures
Constricted Diaphoretic
  • Diarrhea
  • Lacrimation
  • Rhinorrhea
  • Salivation
  • Vomiting
Opioids
  • Fentanyl
  • Methadone
  • Morphine
  • Coma
  • Somnolence
Constricted Hyporeflexia
Salicylates Aspirin
  • Agitation
  • Lethargy
  • Seizures
Diaphoretic Vomiting
Sedative-hypnotics
  • Barbiturates
  • Benzodiazepines
  • Ethanol
  • Agitation
  • Coma
  • Somnolence
Sympathomimetics
  • Amphetamines
  • Cocaine
  • Agitation
  • Delirium
  • Psychosis
  • Seizures
Dilated (reactive) Diaphoretic
  • Diarrhea
  • Hyperreflexia
  • Tremors

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
  • Phenol
  • Pine oil cleaners
  • Turpentine
Rotten Eggs
  • Hydrogen sulfide
  • Mercaptans
  • N-acetylcysteine
Fruity (Sweet)
  • Acetone (and DKA)
  • Isopropanol
  • Chloral hydrate (like pears)
  • Nitrites (amyl, butyl)
Garlic
  • Arsenic
  • Thallium
  • Selenium
  • Organophosphates
  • Sulfur mustard
Gasoline Hydrocarbon-based solvents
Hay Phosgene
Mothballs
  • Camphor
  • Naphthalene
  • P-dichlorobenzene
Burnt Rope Marijuana
Vinegar Acetic Acid
Violets Turpentine (metabolites in urine)
Wintergreen Methyl salicylate

 

 

Jump back to top