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Toxicology Information

Additional Toxicology Information and References:

  1. Antidotes. Life in the Fast Lane.

  2. Boehnert MT, Lovejoy FH.  Value of the QRS duration verus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants.  New England Journal of Medicine 1985; 313:474-479.

  3. Holstege CP, Eldridge DL, Rowden AK.  ECG manifestations: the poisoned patient.  Emergency Medicine Clinics of North America 2006; 159-177.

  4. Chan A, Isbister GK, Kirkpatrick CMJ et al.  Drug-induced QT prolongation and torsades de pointes: evaluation of a QT nomogram.  Quarterly Journal of Medicine 2007:100:609-615.

  5. Liebelt EL, Francis D, Woolf AD.  ECG lead AVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity.  Annals of Emergency Medicine 1995; 26:195-201.

  6. Niemann JT, Bessen HA, Rothstein RJ et al.  Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity.  American Journal of Cardiology 1986; 57:1154-1159.

  7. Wolfe TR, Caravati EM, Rollins DE.  Terminal 40-ms frontal plane QRS axis as a marker for tricyclic antidepressant overdose.  Annals of Emergency Medicine 1989; 18:348-351

  8. Acetaminophen. Drug Bank.

  9. Amphetamine. Drug Bank.

  10. Aripiprazole. Drug Bank.

  11. Baclofen. Drug Bank.

  12. Benzodiazepine. Drug Bank.

  13. Benzonatate. Drug Bank.

  14. Bupropion. Drug Bank.

  15. Buspirone. Drug Bank.

  16. Carbamazepine. Drug Bank.

  17. Carbon monoxide. Drug Bank.

  18. Chloroquine. Drug Bank.

  19. Hydroxychloroquine. Drug Bank.

  20. Clonazepam. Drug Bank.

  21. Clonidine. Drug Bank.

  22. Cocaine. Drug Bank.

  23. Diphenhydramine. Drug Bank.

  24. Duloxetine. Drug Bank.

  25. Flecainide. Drug Bank.

  26. Gabapentin. Drug Bank.

  27. GHB. Drug Bank.

  28. Iron. Drug Bank.

  29. Lamotrigine. Drug Bank.

  30. Lithium. Drug Bank.

  31. MDMA. Drug Bank.

  32. Metformin. Drug Bank.

  33. Quetiapine. Drug Bank.

  34. Salicylate. Drug Bank.

  35. Sildenafil. Drug Bank.

  36. Sertraline. Drug Bank.

  37. Tricyclic Antidepressant. Drug Bank.

  38. Trazadone. Drug Bank.

  39. Venlafaxine. Drug Bank.

  40. Khan,S. 2019. Createspace.The Ultimate Emergency Medicine Guide. Toxicology. pages 271-287.



•This toxidrome can be associated with antihistamines, antipsychotics, and certain antidepressants.

•Patients often exhibit symptoms of blurry vision (mydriasis), delirium, flushed skin, dry skin, hyperthermia, urinary retention, hypoactive bowel sounds, and seizures.


•In short, patients suffering from the anticholinergic toxidrome are found to be: “Blind as a bat, mad as a hatter, red as a beet, dry as a bone, hot as hell”


•This toxidrome can be caused by organophosphates.

•Patients often exhibit symptoms of diaphoresis, urination, miosis, bradycardia, emesis, lacrimation, lethargy, and excessive salivation.

•In short, patients suffer from the DUMBBELLS mnemonics

  Diarrhea, Diaphoresis










•This toxidrome can be caused by amphetamines, caffeine, certain drugs of abuse (cocaine and PCP).

•Patients often exhibit symptoms of mydriasis, tachycardia, hyperthermia, tachypnea, hypertension, and diaphoresis.

•Sympathomimetic and anticholinergic toxidromes are often confused however a major differentiating factor is diaphoresis in the setting of sympathomimetics vs. anhidrosis (dry skin) in the setting anticholinergics.


•This toxidrome can be caused by codeine, morphine, heroin, demerol, hydrocodone, diphenoxylate, etc.


•Patients suffering from this toxidrome often exhibit symptoms of respiratory depression, miosis, hypotension and coma.


•Antidote: Naloxone

•Of note, clonidine toxicity can mimic opioid overdose.

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