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Five commonly encountered toxidromes (toxicology syndromes) are described below along with a summary table of vital sign abnormalities and physical exam findings for each. The image below details one approach (of many) to differentiate between the toxidromes.

Jaelkoury, CC BY-SA 3.0, via Wikimedia Commons
ToxidromeHR & BPRespTempPupilsBowel SoundsSkin
AnticholinergicIncreasedIncreased or NormalIncreasedDilatedDecreasedDry
CholinergicIncreased HR+BP (Nicotinic), Decreased HR (Muscarinic)NormalNormalPinpointIncreasedWet

Anticholinergic Syndrome

Cholinergic Crisis




Basic Physiology:

The autonomic nervous system is divided in to the parasympathetic and sympathetic systems. The parasympathetic nervous system is responsible for functions such as digestion, urination, defacation, salivation, lacrimation, respiratory secretions, and sexual arousal. Acetylcholine is its chief neurotransmitter, found centrally and peripherally. It acts at nicotinic receptors (nerve to nerve, nerve to skeletal muscle) and muscarinic receptors (nerve to organ, nerve to smooth muscle). The sympathetic nervous system is responsible for the flight-or-flight response. Overstimulation is seen due to effects of chatecolamines.

Further Reading

Cannabinoids: Emerging Evidence in Use and Abuse

Date Release: Aug 2018

This issue reviews the pathophysiology and clinical findings associated with cannabinoid use, including acute intoxication, the recent emergence of cannabinoid hyperemesis syndrome, and novel treatments for its symptoms.

Synthetic Drug Intoxication in Children: Recognition and Management in the Emergency Department

Date Release: May 2018

The continually changing chemical formulations of synthetic drugs makes recognition and diagnosis of intoxication from these substances challenging. This issue outlines common presentations of intoxication from synthetic cannabinoids, cathinones, and phenethylamines and summarizes best practices for evaluating and managing patients who present with intoxication after consumption of these synthetic drugs of abuse. 

Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition and Treatment

Date Release: Mar 2017

A review of the pathophysiology, diagnostic decision-making tools, and pharmaceutical treatment options to create a patient-tailored approach to sedative-hypnotic withdrawal.

Pediatric Ingestions: Emergency Department Management (Pharmacology CME)

Date Release: Apr 2016

This issue provides a review of these studies as well as consensus guidelines addressing the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination, administration of antidotes for specific toxins, and management of ingested foreign bodies.

An Evidence-Based Approach To Cocaine-Associated Emergencies

Date Release: Jan 2008

This issue of Emergency Medicine Practice discusses the general management of cocaine-associated emergencies. Additionally, it will make evidence-based recommendations for the treatment and disposition of these patients.

When Kids Do Drugs: Evaluation And Treatment In The Emergency Department

Date Release: Oct 2006

Illicit drug use escalated in the youth population in the mid- 1960s and it remains a major concern for the nation. Smoking, drinking, and drug use are leading causes of morbidity and mortality, both during adolescence and later in life

Last Updated on January 25, 2023

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