Common Toxic Syndromes

Anticholinergic

Tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, delirium (“mad as a hatter, blind as a bat, red as a beet, hot as a hare, and dry as a bone”*)

Antihistamines

Atropine

Belladonna alkaloids

Datura (angel's trumpet)

Jimson weed

Mushrooms (some)

Psychoactive drugs (many)

Scopolamine

Tricyclic antidepressants

Cholinergic, muscarinic

Salivation, lacrimation, urination, defecation, GI cramps, emesis (mnemonic device: SLUDGE)

or

Diarrhea; urination; miosis; bronchorrhea, bradycardia, and bronchoconstriction; emesis; lacrimation; and salivation (mnemonic device: DUMBELS)

Wheezing

Carbamates

Mushrooms (some)

Organophosphates

Physostigmine

Pilocarpine

Pyridostigmine

Cholinergic, nicotinic

Mydriasis, tachycardia, weakness, hypertension and hyperglycemia, fasciculations, sweating (mnemonic device: MTWT[h]FS)

Abdominal pain, paresis

Black widow spider bites

Carbamates

Nicotine

Organophosphates (some)

Opioid

Hypoventilation, hypotension, miosis, sedation, possibly hypothermia

Opioids (eg, buprenorphine, diphenoxylate, fentanyl, carfentanyl, norfentanyl, remifentanil, heroin, methadone, morphine, pentazocine, propoxyphene, oxycodone, hydromorphone)

Sympathomimetic

Tachycardia, hypertension, mydriasis, agitation, seizures, diaphoresis, hyperthermia, psychosis (after chronic use)

Amphetamines

Caffeine

Cocaine

Ephedrine

Herbal and synthetic marijuana and common substitutes

MDMA (Ecstasy)

Phenylpropanolamine

Substituted cathinones ("bath salts")

"Synthetic" marijuana

Theophylline

Withdrawal

Tachycardia, mild hypertension, mydriasis, diaphoresis, agitation, restlessness, anxiety, hyperreflexia, piloerection, yawning, abdominal cramps, lacrimation, flu-like symptoms, insomnia, vomiting and diarrhea

Withdrawal from the following sedating or recreational drugs:

• Marijuana

• Opioids

Agitation, hallucinations, confusion, disorientation, seizures, hyperreflexia, hypertension, tachycardia, arrhythmias, dehydration, autonomic instability, death

Baclofen: Severe muscle spasm

Withdrawal from the following drugs with sedative-hypnotic effects:

• Alcohol

• Baclofen

• Barbiturates

• Benzodiazepines

• GHB

Decreased mental alertness, lethargy, coma, decreased blood pressure, decreased heart rate

Withdrawal from the following drugs with sympathomimetic effects:

• Amphetamines

• Cocaine

• PCP

• Synthetic cathinones ("bath salts")

Mild flu-like symptoms, insomnia, restlessness and anxiety

Withdrawal from the following drugs with antidepressant effects:

• MAOIs

• SSRIs

• Tricyclic antidepressants