Toxicology (main): Difference between revisions
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==Background== | ==Background== | ||
===Autonomic Nervous System=== | ===Autonomic Nervous System=== | ||
* Parasympathetic - ACh is transm | *Parasympathetic - ACh is transm | ||
** Muscarinic | **Muscarinic | ||
***receptors in heart, eye, lung, GI, skin and sweat glands | ***receptors in heart, eye, lung, GI, skin and sweat glands | ||
*** Bradycardia | ***Bradycardia | ||
*** Miosis | ***Miosis | ||
*** Bronchorrhea / Bronchospasm | ***Bronchorrhea / Bronchospasm | ||
*** Hyperperistalsis (SLUDGE) | ***Hyperperistalsis (SLUDGE) | ||
*** Sweating | ***Sweating | ||
*** Vasodilation | ***Vasodilation | ||
** Nicotinic | **Nicotinic | ||
*** receptors in both sympathetic and parasympathetic nervous systems | ***receptors in both sympathetic and parasympathetic nervous systems | ||
*** fasciculations, flaccid paralysis | ***fasciculations, flaccid paralysis | ||
***?Mild bradycardia, hypotension | ***?Mild bradycardia, hypotension | ||
* Sympathetic | *Sympathetic | ||
**ALPHA EFFECTS - vessels, eye, skin | **ALPHA EFFECTS - vessels, eye, skin | ||
*** Mydriasis, HTN, Sweating | ***Mydriasis, HTN, Sweating | ||
**BETA EFFECTS - heart, lungs | **BETA EFFECTS - heart, lungs | ||
*** Tachycardia, Bronchodilation | ***Tachycardia, Bronchodilation | ||
==Diagnosis== | ==Diagnosis== | ||
===Toxicological Exam=== | ===Toxicological Exam=== | ||
* All VS (Temp, RR, HR, BP) | *All VS (Temp, RR, HR, BP) | ||
* Neuro Exam | *Neuro Exam | ||
**Level of consciousness | **Level of consciousness | ||
**Pupillary exam | **Pupillary exam | ||
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**DTRs | **DTRs | ||
*Skin Exam - moisture, temp | *Skin Exam - moisture, temp | ||
* Lung Exam | *Lung Exam | ||
* Bowel Sounds | *Bowel Sounds | ||
{{Template:Toxidrome Chart}} | {{Template:Toxidrome Chart}} | ||
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===Hyperthermia=== | ===Hyperthermia=== | ||
*Altered Metabolism | *Altered Metabolism | ||
** [[Aspirin (Salicylate) Toxicity]] | **[[Aspirin (Salicylate) Toxicity]] | ||
** withdrawal states | **withdrawal states | ||
** thyroid hormones | **thyroid hormones | ||
** dinitrophenols | **dinitrophenols | ||
* Increased Muscle Activity | *Increased Muscle Activity | ||
** withdrawal, sympathomimetics | **withdrawal, sympathomimetics | ||
** [[MAOI Toxicity]] | **[[MAOI Toxicity]] | ||
**[[PCP]], LSD | **[[PCP]], LSD | ||
** [[Lithium]] | **[[Lithium]] | ||
** Amoxapine | **Amoxapine | ||
**[[Serotonin Syndrome]] | **[[Serotonin Syndrome]] | ||
* Impaired Heat Dissipation | *Impaired Heat Dissipation | ||
** anticholinergics | **anticholinergics | ||
** antihistamines | **antihistamines | ||
** antipsychotics ([[TCAs]]) | **antipsychotics ([[TCAs]]) | ||
* [[Malignant Hyperthermia]] | *[[Malignant Hyperthermia]] | ||
** anesthestics | **anesthestics | ||
* [[Neuroleptic Malignant Syndrome]] | *[[Neuroleptic Malignant Syndrome]] | ||
** phenothiazines, [[Lithium]], LevoDopa | **phenothiazines, [[Lithium]], LevoDopa | ||
===Hypothermia=== | ===Hypothermia=== | ||
* Exposure | *Exposure | ||
** [[Ethanol Toxicity]] | **[[Ethanol Toxicity]] | ||
** Sedative hypnotics | **Sedative hypnotics | ||
** Narcotics | **Narcotics | ||
** [[TCAs]] | **[[TCAs]] | ||
** Phenothiazines | **Phenothiazines | ||
** [[Insulin]] ([[Hypoglycemia]]) | **[[Insulin]] ([[Hypoglycemia]]) | ||
===Increased Respiratory Rate=== | ===Increased Respiratory Rate=== | ||
* Direct Stimulation | *Direct Stimulation | ||
** [[Aspirin (Salicylate) Toxicity]] | **[[Aspirin (Salicylate) Toxicity]] | ||
** [[Metabolic Acidosis]] | **[[Metabolic Acidosis]] | ||
** dintirophenol, pentachlorophenol | **dintirophenol, pentachlorophenol | ||
** hepatorenal failure | **hepatorenal failure | ||
** CNS stimulants (cocaine, amphet, theophylline) | **CNS stimulants (cocaine, amphet, theophylline) | ||
*Tissue [[Hypoxia]] | *Tissue [[Hypoxia]] | ||
**[[CO]] | **[[CO]] | ||
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===Respiratory Depression=== | ===Respiratory Depression=== | ||
* Central Depression | *Central Depression | ||
** antipsychotics | **antipsychotics | ||
** Chlorinated hydrocarbons | **Chlorinated hydrocarbons | ||
** [[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols) | **[[Sedative/Hypnotics]] ([[Ethanol Toxicity]], glycols) | ||
** [[Tricyclic (TCA) Toxicity]] | **[[Tricyclic (TCA) Toxicity]] | ||
** Lomitil | **Lomitil | ||
* Muscle Failure | *Muscle Failure | ||
** [[Organophosphates]] | **[[Organophosphates]] | ||
**[[Marine Toxins]] | **[[Marine Toxins]] | ||
** [[Nicotine Poisoning|Nicotine]] | **[[Nicotine Poisoning|Nicotine]] | ||
** strychnine | **strychnine | ||
** botulinis | **botulinis | ||
** Mojave rattlesnake, Cobra | **Mojave rattlesnake, Cobra | ||
==See Also== | ==See Also== | ||
Revision as of 02:11, 7 July 2016
Background
Autonomic Nervous System
- Parasympathetic - ACh is transm
- Muscarinic
- receptors in heart, eye, lung, GI, skin and sweat glands
- Bradycardia
- Miosis
- Bronchorrhea / Bronchospasm
- Hyperperistalsis (SLUDGE)
- Sweating
- Vasodilation
- Nicotinic
- receptors in both sympathetic and parasympathetic nervous systems
- fasciculations, flaccid paralysis
- ?Mild bradycardia, hypotension
- Muscarinic
- Sympathetic
- ALPHA EFFECTS - vessels, eye, skin
- Mydriasis, HTN, Sweating
- BETA EFFECTS - heart, lungs
- Tachycardia, Bronchodilation
- ALPHA EFFECTS - vessels, eye, skin
Diagnosis
Toxicological Exam
- All VS (Temp, RR, HR, BP)
- Neuro Exam
- Level of consciousness
- Pupillary exam
- Motor response
- DTRs
- Skin Exam - moisture, temp
- Lung Exam
- Bowel Sounds
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
Differential Diagnosis for Specific Signs
Hyperthermia
- Altered Metabolism
- Aspirin (Salicylate) Toxicity
- withdrawal states
- thyroid hormones
- dinitrophenols
- Increased Muscle Activity
- withdrawal, sympathomimetics
- MAOI Toxicity
- PCP, LSD
- Lithium
- Amoxapine
- Serotonin Syndrome
- Impaired Heat Dissipation
- anticholinergics
- antihistamines
- antipsychotics (TCAs)
- Malignant Hyperthermia
- anesthestics
- Neuroleptic Malignant Syndrome
- phenothiazines, Lithium, LevoDopa
Hypothermia
- Exposure
- Ethanol Toxicity
- Sedative hypnotics
- Narcotics
- TCAs
- Phenothiazines
- Insulin (Hypoglycemia)
Increased Respiratory Rate
- Direct Stimulation
- Aspirin (Salicylate) Toxicity
- Metabolic Acidosis
- dintirophenol, pentachlorophenol
- hepatorenal failure
- CNS stimulants (cocaine, amphet, theophylline)
- Tissue Hypoxia
Respiratory Depression
- Central Depression
- antipsychotics
- Chlorinated hydrocarbons
- Sedative/Hypnotics (Ethanol Toxicity, glycols)
- Tricyclic (TCA) Toxicity
- Lomitil
- Muscle Failure
- Organophosphates
- Marine Toxins
- Nicotine
- strychnine
- botulinis
- Mojave rattlesnake, Cobra