Overview
Clinical Meaning
The NP toxicology screening approach requires systematic recognition of toxidromes combined with targeted antidote administration.
The NP toxicology screening approach requires systematic recognition of toxidromes combined with targeted antidote administration. The five major toxidromes form the foundation of clinical toxicology assessment: (1) Cholinergic (organophosphates, nerve agents): SLUDGE/BBB with miosis, treated with atropine (titrated to dry secretions) and pralidoxime (reactivates acetylcholinesterase within 24-48 hours before aging occurs). (2) Anticholinergic (diphenhydramine, TCAs, scopolamine): hyperthermia, mydriasis, dry skin/mucosa, tachycardia, delirium, urinary retention — treated with physostigmine for severe cases (must exclude TCA co-ingestion due to seizure/cardiac risk). (3) Sympathomimetic (cocaine, amphetamines): hypertension, tachycardia, hyperthermia, diaphoresis, mydriasis — treated with benzodiazepines for agitation/seizures; avoid beta-blockers in cocaine toxicity (unopposed alpha stimulation). (4) Opioid: respiratory depression, miosis, CNS depression — treated with naloxone titrated to respiratory effort. (5) Serotonin syndrome (SSRIs, MAOIs, tramadol, linezolid combinations): hyperthermia, clonus (especially lower extremity), hyperreflexia, agitation, diaphoresis — treated with cyproheptadine (serotonin antagonist) and benzodiazepines; distinguished from neuroleptic malignant syndrome (NMS) by presence of clonus and hyperreflexia vs lead-pipe rigidity in NMS. Critical diagnostic tools include the anion gap (elevated in MUDPILES: Methanol, Uremia, DKA, Propylene glycol/Paraldehyde, INH/Iron, Lactic acidosis, Ethylene glycol, Salicylates) and...