![]() With amphetamines, effects appear immediately when taken intravenously or smoked and within 5 minutes when snorted or ingested. With cocaine, effects appear immediately when taken intravenously, within 5 minutes when smoked, and within about 30 minutes when snorted. First, there’s the sympathomimetic toxidrome, for cocaine and amphetamine intoxications.īoth cocaine and amphetamines can be ingested, smoked, snorted or taken intravenously. Okay, so let’s start talking about toxidromes. With amphetamines, once the toxidrome has been identified, treatment shouldn't be delayed until the results of the urine drug test come.Ĭommon hallucinogens- like phencyclidine, LSD or Ecstasy aren’t detected by standard drugs-of-abuse screens, so the diagnosis is made clinically. Urine drug testing is done and that typically checks for substances like amphetamines, methamphetamines, benzodiazepines, barbiturates, cocaine and opioids such as methadone. If the individual is taking digoxin, serum levels of digoxin are checked as well. If the individual has a history of alcohol consumption, then serum ethanol levels are checked. If results show a high-gap metabolic acidosis, then levels of methanol and ethylene-glycol are checked. Initial lab testing includes a finger-stick glucose- to quickly look for hypoglycemia, as well as acetaminophen and salicylate levels- which are common intoxications, and a pregnancy test for females between age 18 and 45.Ī CBC is also done, along with BUN and serum creatinine levels- to assess renal function and electrolytes to check for electrolyte imbalance- like hyperkalemia with digoxin intoxication.Īdditionally, an ABG is done to see if the intoxication is associated with a high-gap metabolic acidosis, which is consistent with salicylates, methanol and ethylene- glycol intoxications. Now, if the individual presents within two hours from the ingestion of a substance- like salicylates or acetaminophen, activated charcoal can be given, because if the substance is still in the stomach, then activated charcoal can absorb it, preventing gastrointestinal absorption and toxicity.įinally, it’s important to assess the person’s vital signs, pupil size- because some toxidromes cause either mydriasis or miosis, check for dry skin like in an anticholinergic toxidrome, and level of consciousness. The dosage is then doubled every 2 minutes until reversal of respiratory depression. ![]() In this case, 0.05 milligrams of iv naloxone or 0.1 milligrams of intramuscular naloxone is administered. That’s usually caused by vitamin B1 deficiency, which is often due to ethanol abuse and can cause the triad of nystagmus, ataxia, and confusion.Īdditionally, if the individual presents with respiratory depression, then an opioid overdose is the most likely cause. Next, if the individual has neurological symptoms- like confusion or delirium, then IV thiamine is given to prevent Wernicke’s encephalopathy. ![]() If the individual is hypotensive, then 2 liters of IV isotonic crystalloid solution is given, followed by a norepinephrine drip. Next, an electrocardiogram is done along with continuous cardiac monitoring to assess for cardiac arrhythmias. In individuals with severe respiratory distress, intubation and mechanical ventilation may be needed right away. The respiratory rate and oxygen saturation should be assessed and if the oxygen saturation is lower than 92%, high-flow oxygen can be given by face mask. ![]() The initial step in evaluating a person who may have a toxidrome is to assess the A, B, C’s - airway, breathing and circulation. Individuals who present only mild toxicity can be observed in the emergency department until they are asymptomatic, while those with significant toxicity should be admitted to an intensive care unit or ICU. The general goals of management include stabilizing the clinical condition and controlling the symptoms, as well as finding the causing substance and give specific treatment. Sometimes there’s more than one substance that’s used, so there are a combination of findings. Accidental and intentional intoxications or drug overdoses produce toxidromes, which are a combination of symptoms and characteristic findings for a particular substance or class of substances. ![]()
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