Are there other people involved?
Does the patient have a significant past medical
Is the patients condition improving/
The presence of a toxic syndrome or toxidrome can
help establish that a poison has been involved by
suggesting the class of poison(s) to which the patient may
have been exposed. Table 5-1 provides a list of commonly
encountered toxidromes, their sources and symptoms.
The non-syndrome syndrome is of special
importance. The only method to recognize the potential
for a delayed onset poisoning to occur is to suspect the
possibility from the history or presentation of a person.
In some cases, the individuals affect or behavior may
provide a clue. In other cases, the examiner must rely on
clinical experience or even a hunch.
Once poisoning has been established, the general
rule is to quickly remove as much of the toxic
substance from the victim as possible. The method of
removal of the poison varies depending upon how the
poison was introduced:
Ingested poisons: There is a choice between
emetics and gastric lavage, followed by
adsorbents and cathartics.
Inhaled poisons: Oxygen ventilation is the
method of choice.
Absorbed poisons: Removal of the poison is
primarily attained by cleansing the skin.
Injected poisons: Antidotal medications are
Ingested poisons are those poisons which have
been consumed, whether accidentally or intentionally,
by the victim. Ingestion is the most common route of
exposure to toxic materials in the home.
The local actions of an ingested poison can have
irritant, acidic (corrosive), or basic (caustic) effects at
the site of contact.
Signs & Symptoms
opiates, benzodiazepines, barbiturates
Abeady eyes,@ sunglasses, decreased blood pressure,
CNS and respiratory depression
alcohol, barbiturates, benzodiazepines,
diarrhea, dilated pupils, goose bumps, increased heart
rate, tearing, yawning, stomach cramps, hallucinations
theophylline, caffeine, LSD, PCP,
amphetamine, cocaine, decongestants
CNS excitation (confusion, incoordination, agitation,
hallucination, delirium, seizures), increased blood
pressure and heart rate
antihistamines, atropine, scopolamine,
antidepressants, anti-Parkinson L ,
antipsychotics, antispasmodics, mush-
rooms, hallucinogens, antidepressants
dry skin, increased heart rate, dilated pupils, fever,
urinary retention, decreased bowel sounds, CNS
organophosphates, carbamates, physostig-
mine, neostigmine, endrophonium
increased salivation, lacrimation,
urination, defecation, GI cramping, emesis; CNS
(headache, restless, anxiety, confusion, coma,
seizures); muscle weakness and fasciculations
n o n - s y n d r o m e
various chemicals with delayed onset due to
biotransformation, depletion of natural
detoxifying agent, accumulation of dose or
from Anothing@ to minor complaints that initially appear
to be trivial
Table 5-1.Commonly Encountered Toxidromes