Sympathomimetic toxicity
(Redirected from Sympathomimetic toxidrome)
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%