1. Toxicology 101 Joshua Rocker, MD Schneider Children’s Hospital

2. Toxidromes 1. Anticholinergic 2. Sympathomimetic 3. Cholinergic 4. Opiod 5. Benzodiazepine

3. Anticholinergic Blind as a bat, hot as Hades, red as a beat, dry as a bone and mad as a hatter Skin- Dry and flushed skin, BS- decreased BS Eyes- dilated pupils MS- agitated Heart- tachy

4. Anticholinergic Rx: (block muscarinic receptor sites) –Antihistamines –TCAs –Antipsychotics –Skeletal muscle relaxants –Antiparkinson –Amantadine –Jimson weed/ Amanita

5. Sympathomimetic Similar to anticholinergic but diaphoretic, no urinary retention, hyperactive BS

6. Sympathomimetic Rx –Cocaine –Theophylline –Amphetamine –Caffeine –Decongestants Ephedrine, psuedoephedrine, phenylprpanolamine

7. Sympathomimetic Mechanism –Increase release of catechols (amphetamines) –Inhibit reuptake (cocaine) –Interfere with metabolism (MAOIs) –Direct stimulation of receptor (Epi)

8. Cholinergic Skin- WET BS- increased BS Eyes- pinpoint pupils MS- Agitated Heart- brady SLUDGE –Sialorrhea, lacrimation, urination, diaphoresis, gastric emptying

9. Cholinergic BIG bad Bs –Bronchorrhea –Bradycardia –Bronchospasm

10. Cholinergic Muscarinic –Miosis –Bradycardia –Bronchorrhea –Vomitting/diarrhea –Sialorrhea –Urinary incontinence Nicotinic –Mydriasis –Tachycardia –Bronchodilation –HTN –Diaphoresis –Weakness

11. Cholinergic Rx Organophosphates (pesticides) Carbamates (physostigmine) Mushrooms

12. Opiod Skin- BS- decreased BS Eyes- pinpoint pupils MS- depression Heart- brady, hypotension

13. Opiod Morphine Codeine Hydromorphone Antidote- narcan

14. Benzodiazepine Skin- BS- decreased BS Eyes- pinpoint pupils MS- depression Heart- brady, hypotension Antidote- Flumazenil

15. Factoids Hyperthermia –Agitation/Seizures Sympatho, PCP, hallucinogens –Inability to sweat anticholinergics –Increase muscle tone Serotonin syndrome, Neuroleptic malignant syndr –Uncouple oxidative phosphorylation ASA

16. Hypothermia CNS depression –Sedative-hypnotics, EtOH, opiods Reduce total body glucose –Insulin, Oral hypoglycemics

17. Hypoglycemia HOBBIES Hypoglycemia Oral hypoglycemics –(not metformin-> Lactic acidosis) BB- Beta Blockers Insulin Ethanol Salicylates

18. Hyperglycemia Stimulants (beta agonists, theophylline, caffeine, epi) CCB Thiazides Vacor Steroids

19. Miosis COPS Clonidine, Cholinergics Opiates, organophosphates Phenothiazine, phencyclidine Sedative hypnotics,

20. Mydriasis AAAS Antihistamines Antidepressants Anticholinergics Sympathomimetics

21. Anion gap with acidosis MUDPILES Methanol, Metformin Uremia DKA Paraldehyde, phenformin INH, iron, ibuprofen, inborn errors Lactic acid Ethanol, ethylene glycol Salicylates

22. Osmolar Gap Calculated Osmolarity - Measured Osmolarity Calculated Osmolarity 2 [Na] + glucose/18 + BUN/2.8

23. Radiodense substances CHIPS Chloral hydrate Heavy metals Iron Phenothiazides Sustained-release (enteric coated) pills