Common Toxidromes Research Articles

Xylazine Complicating Opioid Ingestions in Young Children.

The authors of this report present 3 cases of synthetic opioid intoxication complicated by the concomitant presence of the additive xylazine, a nonopioid sedative analgesic and muscle relaxant used in veterinary medicine that potentiates respiratory depression associated with the opioid toxidrome. Three exposed children presented with severe signs and symptoms, 2 of whom experienced cardiac arrest, a need for continuous naloxone infusion or multiple naloxone doses, or mechanical ventilation to treat respiratory failure after their exposures. Additives were detected in urine studies only through the performance of specialized toxicology testing. Detection of xylazine among adult overdose deaths has recently increased sharply, particularly across the northeastern United States. Adulteration by xylazine is an emerging public health threat nationally. Our report reveals that pediatricians should be aware of sentinel drug trends among adults, including the emerging types of illicit, synthetic, or counterfeit formulations of recreational substances, because children may be harmed because of accidental or intentional exposure. Children exposed to dangerous substances also need child protection services that may entail safe relocation outside of the home and the referral of affected caregivers to necessary substance use treatment services. Given epidemic drug use among adults, pediatricians should be competent to recognize common toxidromes and be aware that signs and symptoms may be potentiated by synergistic novel additives or polysubstance exposures. Importantly, standard urine drug screens may not detect synthetic opioid derivatives or contributing additives, so that diagnosis will require specialized toxicology testing.

Antidotes for childhood toxidromes.

BackgroundPoisoning causes significant morbidity and sometimes mortality in children worldwide. The clinical skill of toxidrome recognition followed by the timely administration of an antidote specific for the poison is essential for the management of children with suspected poisoning. This is a narrative review on antidotes for toxidromes in paediatric practice.MethodsA literature search was conducted on PubMed with the keywords “antidote”, “poisoning”, “intoxication”, “children” and “pediatric”. The search was customized by applying the appropriate filters (species: humans; age: birth to 18 years) to obtain the most relevant articles for this review article.ResultsToxidrome recognition may offer a rapid guide to possible toxicology diagnosis such that the specific antidote can be administered in a timely manner. This article summarizes toxidromes and their respective antidotes in paediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are discussed. Antidotes are only available for a limited number of poisons responsible for intoxication. Antidotes for common poisonings include N-acetyl cysteine for paracetamol and sodium thiosulphate for poisoning by cyanide.ConclusionPoisoning is a common cause of paediatric injury. Physicians should be familiar with the recognition of common toxidromes and promptly use specific antidotes for the management of childhood toxidromes.

An Overview of the Pediatric Toxidromes and Poisoning Management.

Poisoning is one of the leading causes of childhood morbidity and mortality worldwide. Despite the advancement of poison detection by modern investigation methods, the clinical skill of toxidrome recognition by combining the findings from a detailed history, thorough physical examination, and the results of basic investigations is still indispensable for the management of children with suspected poisoning. The aim was to review pediatric toxidromes and poisoning management. A literature search was conducted on PubMed (between February 1 and 15, 2020) with keywords "toxidrome" "poisoning" "intoxication" "children" and "pediatric". The search was customized by applying the appropriate filters so as to get the most relevant articles to meet the objective of this review article. Toxidrome recognition may offer a quick guide to possible toxicology diagnosis so that specific antidote can be administered in a timely manner. This article discusses a few commonly encountered toxidromes in pediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are also discussed. Although most patients with intoxication can be managed with close observation, supportive measures and antidote treatment, it is unfortunate that antidotes are only available for a limited number of poisons responsible for intoxication. Extracorporeal toxin removal is being increasingly recognized as a mode of treatment for patients with rapid deterioration who are unresponsive to conventional management. The decision to apply such technique and the choice of modality are frequently individualized due to the paucity of high-level evidence. The various patient and toxin/medication factors involved in the decision- making process are discussed. Poisoning is a common cause of pediatric accidents and injuries. Physicians should be familiar with common toxidromes and poisoning management.

Common Toxidromes and the Role of Extracorporeal Detoxification.

Extracorporeal modalities have been used for detoxification for decades, with hemodialysis the preferred and most commonly used modality. Salicylates, lithium, methanol, and ethylene glycol are the most common poisonings treated with dialysis. For each of these common poisonings, a description of the toxidrome including pharmacokinetics, clinical presentation, an overview of treatment, and the role and application of dialysis is outlined. Inhibition of alcohol dehydrogenase to prevent the formation of toxic metabolites in methanol and ethylene glycol is discussed in detail, including the use of fomepizole and ethanol to complement and in some cases prevent the need for hemodialysis. Hemodialysis has been attempted to treat many poisonings, often without success. A description of EXTRIP (Extracorporeal Treatments in Poisoning), a multidisciplinary project examining the evidence for extracorporeal treatments in poisoning, is also described. Recommendations for poisoning with acetaminophen, baclofen, barbiturates, carbamazepine, digoxin, metformin, phenytoin, thallium, theophylline, tricyclic antidepressants, and valproic acid are provided in a comprehensive table.

Common toxidromes in movement disorder neurology

BackgroundPhysicians can come across patients who are exposed to certain prescription drugs or toxins that can result in adverse effects and complications which have high rates of morbidity and mortality.ObjectiveTo...

Toxicology in the Emergency Department

General assessment, resuscitation strategies, and risk assessment of the poisoned patient are explored in this article, including specific interventions for unresponsive patients and seizures. Sympathomimetic and anticholinergic toxidromes are described in terms of clinical presentation and treatment strategies and are compared with other common toxidromes. Controversies in gastric decontamination are also outlined, including consensus panel and national organizational recommendations. Despite available methods for toxin elimination, advances in medicine, and pharmacotherapy options, the cornerstone of toxicology remains supportive care. The purpose of this article is to equip the advanced practice nurse in the emergency setting with baseline knowledge to provide initial care of the poisoned patient.

Common toxidromes of plant poisonings in Taiwan

Objective. To describe the toxidromes associated with plant poisonings in Taiwan. Methods. Retrospective review of acute single-plant exposures with clinical signs and symptoms reported between January 1987 and December 2006 by hospitals to the network of Taiwan Poison Control Centers. Recorded data included demographic data, intent of exposures, exposure routes, clinical findings, and therapeutic strategies. Results. There were 389 cases that met the criteria. Each case was placed into one of the expected toxidromes: anticholinergic, mucosal inflammation, gastroenteritis, acute multisystem organ failure, delayed multisystem organ failure, cholinergic, cardiac dysrhythmia, hepatotoxicity, dermatitis, seizures, and dyspnea. Anticholinergic poisoning was the most common toxidrome. Conclusion. Plant poisonings can be classified into recognizable toxicologic syndromes. These toxidromes may guide a clinician's evaluation and management before a botanist can confirm the actual plant identity.

Part 10.2: Toxicology in ECC

Poisoning is an infrequent cause of cardiac arrest in older patients, but it is a leading cause of cardiac arrest in victims <40 years of age.1–4 When a patient with poisoning is in cardiac arrest or near-arrest, immediate support of airway, breathing, and circulation is essential. Urgent consultation with a medical toxicologist or certified regional poison center is recommended5,6 because standard guidelines for emergency cardiovascular care may not be optimal in the management of acute poisoning and overdose. This section presents recommendations for the care of the patient with a toxicologic problem. Some recommendations are evidence-based, but most toxicology research in this area consists primarily of small case series (LOE 5), case reports, and animal studies (LOE 6). Hence many of these recommendations are based on expert consensus, and further research is needed to validate them. Clinicians may see a patient with a history of ingestion of an unknown substance. In such cases the clinician must be familiar with common toxidromes and their therapies. To assist during such encounters, Table 1 lists drug-induced cardiovascular emergencies or altered vital signs, potential therapies to consider, and interventions that should be used with caution. View this table: TABLE 1. Drug-Induced Cardiovascular Emergencies or Altered Vital Signs * :Therapies to Consider † and Contraindicated Interventions Clinicians may also encounter patients with a history of known ingestion. Then the clinician must anticipate the complications from that substance and be prepared to treat them. Table 2 lists potentially cardiotoxic drugs, signs of toxicity, and therapy to consider. View this table: TABLE 2. Potentially Cardiotoxic Drugs: Cardiopulmonary Signs * of Toxicity and Therapy to Consider † ### Airway and Respiratory Management Poisoned patients may deteriorate rapidly. Providers must assess and frequently reassess airway, breathing, and circulation and support them as needed. Although consultation with a poison control center or toxicologist may be needed to identify a …