Sedative/hypnotic toxicity

Background

Clinical Features

Differential Diagnosis

Sedative/hypnotic toxicity

Evaluation

Toxic Alcohols Anion/Osmolar Gaps

Osmolar gap Metabolic acidosis Osmolar gap Anion gap Ketones Ca Oxolate stones Reduced vision Management
Ethanol + + + (if ketoacidosis) + - Mainly supportive
Ethylene glycol + + + - + - FomepizoleThiaminePyridoxine, +/- Dialysis
Methanol + + (early on, then disappears) + - - + Fomepizole or ethanol, Folinic acid, +/- Dialysis
Isopropyl alcohol - + - + - + Mainly supportive
Propylene gylcol + + (initially) + (converted to lactate) - - -

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

Management

Disposition

See Also