| Toxidrome | Mental status | Vital signs | Skin | Pupils | Other manifestations | Examples of causative agents |
| Excitatory |
| Sympathomimetic | - Hypervigilance
- Agitation (can be violent)
- Hyperactive delirium
- Hallucinations
- Paranoia
| T: Increased HR: Increased RR: Increased BP: Increased | Wet | Dilated | - Seizures
- Widened pulse pressure
| - Amphetamines
- Cocaine
- Cathinones
- Ephedrine
- Phenylpropanolamine
- Pseudoephedrine
|
| Anticholinergic | - Hypervigilance
- Agitation (usually easily controlled)
- Hyperactive delirium
- Hallucinations (picking at objects in air)
- Mumbling speech (described as "mouth full of marbles")
| T: Increased HR: Increased (but may be normal in early poisoning) RR: Increased BP: Increased or normal | Dry and flushed | Dilated | - Dry mucous membranes
- Decreased bowel sounds
- Urinary retention
- Choreoathetosis
- Seizures (rare)
| - Diphenhydramine (and other antihistamines)
- Atropine and similar agents (hyoscyamine, dicyclomine, scopolamine, and naturally occurring belladonna alkaloids [eg, jimson weed])
- Tricyclic antidepressants
- Cyclobenzaprine
- Orphenadrine
- Phenothiazines
|
| Hallucinogenic | - Hallucinations
- Perceptual distortions (typically visual)
- Depersonalization
- Synesthesia
- Occasional agitation (with or without delirium)
| T: Increased or normal HR: Increased or normal RR: Increased or normal BP: Increased or normal | Variable | Dilated (usually) | - Nystagmus (phencyclidine, ketamine)
- Tachycardia, hypertension, agitated delirium (designer phenethylamines)
| - Designer phenethylamines and tryptamines (eg, MDMA ["ecstasy"], MDEA)
- Ketamine and methoxetamine
- LSD and psilocybin
- Phencyclidine
- Mescaline
|
| Serotonin syndrome (serotonin toxicity) | - Agitation
- Hyperactive delirium
- Confusion
- Awake and unresponsive
| T: Increased HR: Increased RR: Increased BP: Increased | Wet, flushed, or normal | Dilated | - Tremor, hyperreflexia, clonus (typically in lower extremities)
- Roving eye movements (ocular clonus)
- Diarrhea
| - MAOIs
- Tricyclic antidepressants
- SSRIs and SNRIs
- Dextromethorphan
- Meperidine
- Refer to UpToDate content on combinations of agents that can cause serotonin syndrome
|
| Inhibitory |
| Opioid | | T: Decreased or normal HR: Decreased or normal RR: Decreased or apneic BP: Decreased or normal | Variable | Constricted (may be pinpoint) | - Noncardiogenic pulmonary edema
- Needle marks
- Can develop hypotension
| - Opioids (eg, fentanyl and analogues, heroin, morphine, methadone, oxycodone, hydromorphone)
- Diphenoxylate
- Loperamide
|
| Sedative-hypnotic | - Sedation
- Confusion
- Stupor
- Coma
| T: Decreased or normal HR: Decreased or normal RR: Decreased, apneic, or normal BP: Decreased or normal | Variable | Variable | - Nystagmus
- Barbiturates can cause respiratory depression or apnea
- In most cases, isolated benzodiazepine ingestions do not cause respiratory depression
- Cyclical coma and myoclonic encephalopathy (carisoprodol, meprobamate, glutethimide)
| - Benzodiazepines
- Barbiturates
- Ethanol and other alcohols
- Gabapentin and pregabalin
- Zolpidem
- Carisoprodol
- Glutethimide
- Meprobamate
|
| Cholinergic | - Sedation
- Confusion
- Stupor
- Coma
| T: Normal HR: Low (may be increased in early poisoning) RR: Decreased or increased BP: Decreased or normal | Wet | Constricted | - Seizures (typically occur early)
- Salivation
- Urinary and fecal incontinence
- Vomiting, diarrhea, abdominal cramps
- Bronchorrhea and bronchoconstriction
- Muscle fasciculations and paralysis
- Weakness
| - Organophosphate and carbamate insecticides
- Nerve agents (eg, VX, tabun, sarin, soman, and Novichok)
- Nicotine
- Physostigmine
- Rivastigmine
- Bethanechol
- Pilocarpine
- Urecholine
|
