"Name That Toxidrome"
A 3-year-old presents with miosis, bradycardia, excessive salivation, lacrimation, diarrhea, and bronchorrhea after playing in a farm field.
Cholinergic: Organophosphate poisoning
Decontamination, Atropine, Pralidoxime Benzodiazepines (diazepam first-line)
What is N-acetylcysteine (NAC)?
This antidote replenishes hepatic glutathione stores and is for acetaminophen poisoning.
Tachycardia, HTN, hyperthermia, mydriasis, agitation (bath salts)
Sympathomimetic
"Hot as a hare…mad as a hatter"
Anticholinergic toxidrome
This centrally-acting antihypertensive, the #1 cause of pediatric intubation from single-substance ingestion, mimics the opioid toxidrome so closely that it responds to high-dose naloxone — yet it is NOT an opioid.
Clonidine
A 15-year-old presents with mydriasis, tachycardia, dry skin, decreased bowel sounds, urinary retention, and visual hallucinations after ingesting an unknown plant.
Anticholinergic Toxidrome
Supportive care, Benzodiazepine, Physostigmine, NO haloperidol
This muscarinic antagonist is the first-line antidote for organophosphate poisoning, targeting bronchorrhea and bradycardia but NOT reversing paralysis.
Atropine
This class of cardiac medications causes bradycardia, hypotension, and cardiogenic shock; high-dose insulin euglycemia therapy (1 unit/kg bolus, then 0.5 units/kg/hr) is a key treatment.
DUMBLES mnemonic
Cholinergic toxidrome
This toxic alcohol, found in antifreeze, produces an osmolal gap early and an anion gap metabolic acidosis later, with calcium oxalate crystals in the urine as a classic finding.
Ethylene glycol
A toddler found near an open pill bottle presents with respiratory rate of 8, pinpoint pupils, and stupor
Opioid
Airway protection + Narcan
This vitamin B12a analog scavenges cyanide on an equimolar basis and turns the patient's urine deep red.
hydroxocobalamin
This antidepressant class causes the "3 Cs" — Convulsions, Coma, and Cardiac dysrhythmias — with a hallmark wide QRS on ECG and a terminal R wave in aVR.
What are tricyclic antidepressants (TCAs)?
Treatment?
What is the typical breath odor clue for DKA
fruity odor
In acetaminophen poisoning, a single acute ingestion above this dose (in mg/kg) is considered potentially hepatotoxic in children.
150 mg/kg
A teenager on an SSRI who also took tramadol presents with agitation, tremor, hyperreflexia, spontaneous clonus, diaphoresis, and hyperthermia.
Serotonin syndrome: Benzodiazepine, Cyproheptadine, Severe cases (temp >41.1°C): airway, sedate and paralyze
Most effective within 1–2 hours of ingestion; contraindicated with caustics, hydrocarbons, or unprotected airway; does NOT bind iron, lithium, or alcohols
Activated charcoal
AMS, seizures, lactic acidosis, normal PaO₂ in fire victim
Cyanide poisoning
The buzzword "radiopaque substances on abdominal X-ray"
Iron poisoning
This toxic alcohol causes visual disturbances ("snowfield vision") and optic nerve damage
Methanol
A 2-year-old presents with tachypnea, hyperpnea, tinnitus, vomiting, and a mixed respiratory alkalosis/metabolic acidosis with an elevated anion gap
Salicylate toxicity
DigiFab
Digoxin: vomiting, bradycardia, hyperkalemia, arrythmia
This common OTC antihistamine causes anticholinergic toxicity in children, but also has sodium channel–blocking properties that can produce QRS widening and a Brugada-like pattern on ECG.
Benadryl!
"Lead-pipe rigidity", bradyreflexia, hyperthermia for days
NMS
This poisoning classically progresses through 5 stages: GI toxicity → apparent recovery → hepatic failure → multiorgan failure → bowel scarring.
IRON: deferoxamine chelation if serum iron >500