Sympathomimetic toxicity: Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
{{Template:Toxidrome Chart}}
{{AMS and fever DDX}}


==Treatment==
{{Toxidrome Chart}}
*Sedation with a [[Benzodiazepine]]
 
==Evaluation==
===Work Up===
'''Laboratory'''
*Finger stick glucose (to rule out hypoglycemia)
*Acetaminophen and Salicylate level
*Urine Drug Screen (to verify toxic substance, do not delay treatment for results)
*Serum electrolytes
*Serum creatine phosphokinase
*Creatinine and BUN
*Urine analysis with myoglobin
*Arterial or venous blood gas if respiratory symptoms present 
 
'''Cardiac'''
*[[ECG]] for prolongation of QTc or QRS intervals
 
==Management==
*Use [[Benzodiazepines]] as first line agent for agitation, hypertension, and hyperthermia
*May also use Nitroprusside or Phentolamine
*Treat with fluid resuscitation to avoid renal failure secondary to rhabdomyolysis (see below)
 
===Avoid===
*Avoid [[succinylcholine]] due to potential for [[hyperkalemia]] in these patients
*Avoid antipyretics
*Avoid pure [[beta-blockers]]
 
==Disposition==


==Complications==
==Complications==
*[[Rhabdomyolysis]] is common complication <ref name="tox">O'Connor AD, Padilla-Jones A, Gerkin AD, et al.  Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants. J Med Toxicol 2014</ref>
*[[Rhabdomyolysis]] is common complication <ref name="tox">O'Connor AD, Padilla-Jones A, Gerkin AD, et al.  Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants. J Med Toxicol 2015;11(2)195-200</ref>
 
**[[Bath Salts]] -  63% <ref name="tox"></ref>
*[[Bath Salts]] -  63% <ref name="tox"></ref>
**[[Amphetamines]] - 40%
*[[Amphetamines]] - 40%
**[[Cocaine]] - 33%
*[[Cocaine]] - 33%


==See Also==
==See Also==
*[[Toxidromes]]
*[[Toxidromes]]


[[Category:Tox]]
[[Category:Toxicology]]


==Sources==
==References==
<references/>
<references/>

Latest revision as of 12:27, 3 November 2016

Types

Sympathomimetics

Differential Diagnosis

Altered mental status and fever

Toxidrome Chart

Finding Cholinergic Anticholinergic Sympathomimetic Sympatholytic^ Sedative/Hypnotic
Example Organophosphates TCAs Cocaine Clonidine ETOH
Temp Nl Nl / ↑ Nl / ↑ Nl / ↓ Nl / ↓
RR Variable Nl / ↓ Variable Nl / ↓ Nl / ↓
HR Variable ↑ ↑ (sig) Nl / ↓ Nl / ↓
BP ↑ ↑ ↑ Nl / ↓ Nl / ↓
LOC Nl / Lethargic Nl, agitated, psychotic, comatose Nl, agitated, psychotic Nl, Lethargic, or Comatose Nl, Lethargic, or Comatose
Pupils Variable 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) ↓ / Absent Nl / ↓ Nl / ↓
^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
Withdrawal from substances have the opposite effect

Evaluation

Work Up

Laboratory

  • Finger stick glucose (to rule out hypoglycemia)
  • Acetaminophen and Salicylate level
  • Urine Drug Screen (to verify toxic substance, do not delay treatment for results)
  • Serum electrolytes
  • Serum creatine phosphokinase
  • Creatinine and BUN
  • Urine analysis with myoglobin
  • Arterial or venous blood gas if respiratory symptoms present

Cardiac

  • ECG for prolongation of QTc or QRS intervals

Management

  • Use Benzodiazepines as first line agent for agitation, hypertension, and hyperthermia
  • May also use Nitroprusside or Phentolamine
  • Treat with fluid resuscitation to avoid renal failure secondary to rhabdomyolysis (see below)

Avoid

Disposition

Complications

See Also

References

  1. ↑ 1.0 1.1 O'Connor AD, Padilla-Jones A, Gerkin AD, et al. Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants. J Med Toxicol 2015;11(2)195-200
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