Toxicology (main)

Background

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
Sympathetic
- ALPHA EFFECTS - vessels, eye, skin
  - Mydriasis, HTN, Sweating
- BETA EFFECTS - heart, lungs
  - Tachycardia, Bronchodilation

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

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

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