See also:
Poisoning – acute guidelines for initial management
Resuscitation
Recreational drug use and overdose
Key points
- A toxic syndrome or toxidrome is a 'clinical fingerprint', characterised by a classic constellation of symptoms and signs due to toxic effects of chemicals in the body
- Toxic syndrome or toxidrome recognition is important for rapid detection of the suspected cause and helps focus the differential diagnosis to those few chemicals which have similar toxic effects
For 24 hour advice, contact the Poisons Information Centre 13 11 26
Common Toxic Syndromes/Toxidromes
|
The Agitated/Confused Child |
|
|
Vitals
|
|
|
Toxidrome |
T |
HR |
BP |
RR |
Mental status |
Pupils |
Other findings |
Examples |
Antidote |
|
Anticholinergic |
↑
|
↑ |
-
/
↑ |
↑ |
Delirium
Hallucinations
Agitation |
Dilated |
Dry, flushed skin
Urinary retention |
Sedating antihistamines (eg promethazine, doxylamine, cyproheptadine, pheniramine, alimemazine)
Tricyclic antidepressants
Atropine
Hyoscine
Antispasmodics
Atypical antipsychotics (eg
risperidone,
quetiapine)
Plants (eg Angels trumpet) |
Physostigmine
Sodium bicarbonate (tricyclic antidepressants) |
|
Hallucinogen |
↑ |
↑ |
↑ |
- |
Hallucinations
Synaesthesia
Agitation |
Dilated |
Nystagmus |
LSD
Mescaline
Psilocybe mushrooms |
|
|
Neuroleptic Malignant syndrome |
↑ |
↑ |
- |
↑ |
Confusion |
Dilated |
Muscle rigidity
Diaphoretic
Metabolic acidosis
Liver failure
Renal failure
Hyperkalaemia
Rhabdomyolysis
Blood clots (veins and arteries) |
Antipsychotics (eg
risperidone,
quetiapine)
Antiemetic agents (eg domperidone, droperidol, metoclopramide, promethazine) |
Dantrolene (decreases muscle rigidity) |
|
Sympatho-mimetic |
↑ |
↑ |
↑ |
↑ |
Agitation
Hypervigilance Paranoia |
Dilated |
Diaphoretic
Tremors
Hyperreflexia
Seizures |
Cocaine, amphetamine, pseudoephedrine,
nicotine, caffeine, cold and flu medications beta agonist (eg phenylephrine) |
|
|
Serotonin Toxicity
|
↑ |
↑ |
↑ |
↑ |
Confusion Agitation
Coma |
Dilated |
Tremor
Myoclonus
Diaphoretic
Hyperreflexia
Trismus
Rigidity |
Monoamine oxidase inhibitors
Selective serotonin reuptake inhibitors
Tramadol
Tapentadol
MDMA/ecstasy
Amphetamines
Lamotrigine |
Cyproheptadine
|
|
Withdrawal from ethanol /sedatives-hypnotics |
↑ |
↑ |
↑ |
↑ |
Agitated Confusion |
Dilated |
Diaphoretic
Diarrhoea
Tremor
Seizure |
Alcohol
Benzodiazepines
Barbiturates (eg
Phenobarbitone) |
|
|
The Sedated/Confused Child |
|
|
Vitals |
|
|
Toxidrome |
T |
HR |
BP |
RR |
Mental status |
Pupils |
Other findings |
Examples |
Antidote |
|
Opioid
|
↓ |
↓ |
↓ |
↓ |
CNS depression Coma |
Constricted |
Hyporeflexia
Pulmonary oedema |
Opioids (heroin, morphine, methadone, fentanyl, oxycodone)
Cough syrups with codeine derivates (dihydrocodeine, pholcodine) |
Naloxone |
|
Sedative-hypnotic
Ethanol |
-
/↓ |
↓ |
↓ |
↓ |
CNS depression
Confusion
Coma |
Constricted |
Hyporeflexia |
Alcohol
Benzodiazepines
Barbiturates (eg
Phenobarbitone)
GHB |
Flumazenil (benzodiazepines) |
|
Cholinergic |
± |
± |
-
/
↑ |
- |
Confusion
Coma |
Constricted |
Salivation
Lacrimation
Urination
Diarrhoea
Vomiting |
Organophosphates
Nerve agents
Physostigmine |
Atropine |
Management
Management of individual conditions can be found under the
specific guideline.
Consider consultation with local paediatric team when
Admission should be considered for all children and young people with an intentional overdose.
Consult Victorian Poisons Information Centre 13 11 26 for advice
Consider transfer when
Children requiring escalation of care beyond the comfort of the hospital and local paediatric team.
For emergency advice and paediatric or neonatal ICU transfers, see
Retrieval Services
Assessing risk and connecting to community services
- Prior to discharge, adolescents who present with deliberate ingestions need a risk assessment regarding the likelihood of further ingestions or other attempts to self-harm
- Assessment of other drug and alcohol use should also be undertaken
- If, after risk assessment, it is deemed safe to discharge a patient from hospital, but ongoing mental health or drug and alcohol needs are identified, the adolescent should be linked with appropriate services (see links below for services in the State of Victoria)
Discharge information and follow-up
Parent Information: Poisoning prevention for children
Prevention of poisoning (Victorian Poisons Information Centre)
Poisons Information Centre : phone 13 11 26
Victoria
Poisons Information Centre
Child & Adolescent Mental Health Services (CAMHS): Victorian government mental health services are region-based.
Orygen Youth Health: Specialist mental health services for people aged 15–25 years, residing in the western and north-western regions of metropolitan Melbourne. Triage/intake - 1800 888 320.
YSAS (Youth Support and Advocacy Service): Outreach teams across Melbourne and regional Victoria for young people experiencing significant problems with alcohol and/or drug use.
YoDAA: Victoria's Youth Drug and Alcohol Advice service - provides information and support for youth AOD needs or anyone concerned about a young person.
Infoxchange Service Seeker: Search for local community support services eg local doctor, dentist, counselling services, drug and alcohol services.
Last Updated October 2020