Sympathomimetic toxicity: Difference between revisions
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{{Toxidrome Chart}} | {{Toxidrome Chart}} | ||
== | ==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 | *[[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: | [[Category:Toxicology]] | ||
== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 12:27, 3 November 2016
Types
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Differential Diagnosis
Altered mental status and fever
- Infectious
- Sepsis
- Meningitis
- Encephalitis
- Cerebral malaria
- Brain abscess
- Other
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
- Avoid succinylcholine due to potential for hyperkalemia in these patients
- Avoid antipyretics
- Avoid pure beta-blockers
Disposition
Complications
- Rhabdomyolysis is common complication [1]
- Bath Salts - 63% [1]
- Amphetamines - 40%
- Cocaine - 33%