Toxicologic brain death mimics

These agents/toxins have been reported to cause an examination that mimics brain death (ie, coma without some or all brainstem reflexes) and patient ultimately recovers. Drug screens are not sufficiently comprehensive. Thus, we recommend careful history and targeted toxicologic testing. A period longer than five drug half-lives is necessary when there is a possibility of an extremely large drug or toxin exposure, likelihood for delayed drug absorption or elimination, saturable elimination kinetics, or interactions with another agent. In a patient where brain death is considered but intoxication is unclear (eg, normal cerebral imaging), a medical toxicologist or clinical toxicologist should be consulted.