This document provides an overview of several toxin-induced toxidromes:
- Anticholinergic toxidrome results from drugs that block muscarinic receptors causing signs like delirium, mydriasis, tachycardia and dry mouth.
- Cholinergic toxidrome is caused by increased acetylcholine and includes salivation, lacrimation, bronchorrhea and bronchospasm.
- Opiate toxidrome presents with CNS depression, respiratory depression and miosis. Naloxone is used as an antidote.
- Hypnosedative toxidrome mimics alcohol intoxication with respiratory depression, hypotension and impaired coordination.
- Sympath
The presentation covers an easy method to manage acute poisoning in Ed. It elaborates the tox presentations through four toxidromes and an algorithmic approach to solve the puzzle
A brief account on major toxidrome and an explanation about how the clinical features occur. anticholinergic, cholinergic, sympathomimetic, opiate, sedative toxidrome and serotonin syndrome and neuroleptic malignant syndrome are explained with the management.
The presentation covers an easy method to manage acute poisoning in Ed. It elaborates the tox presentations through four toxidromes and an algorithmic approach to solve the puzzle
A brief account on major toxidrome and an explanation about how the clinical features occur. anticholinergic, cholinergic, sympathomimetic, opiate, sedative toxidrome and serotonin syndrome and neuroleptic malignant syndrome are explained with the management.
Toxicology on aluminium phosphide, the characteristics, fatal dose,fatal period, sign and symptoms, postmortem appearance and medicolegal importance are discussed.
Please find the power point on Paracetamol poisoning. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Dr Abdullah Ansari
PG-2 (Medicine)
AMU ALIGARH
A general approach to periodic paralysis....
(including hypokalemic periodic paralysis and thyrotoxic periodic paralysis, and other “Channelopathies” or “Membranopathies)
Pathophysiology
Epidemiology
Primary or familial periodic paralysis
Secondary periodic paralysis
Conventional classification of periodic paralysis
Classification of primary periodic paralysis based on ion-channel abnormalities
Clinical approach to a case of periodic paralysis
History of muscle weakness
Age of onset
Family history
Timing
Intensity
History of administration of certain drugs
Clinical examination
Differential Diagnosis
Laboratory investigations
Serum K+
CPK and serum myoglobin
ECG
EMG
Nerve conduction studies
Provocative Testing
Muscle biopsy
Treatment
Prognosis
Toxicology on aluminium phosphide, the characteristics, fatal dose,fatal period, sign and symptoms, postmortem appearance and medicolegal importance are discussed.
Please find the power point on Paracetamol poisoning. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Dr Abdullah Ansari
PG-2 (Medicine)
AMU ALIGARH
A general approach to periodic paralysis....
(including hypokalemic periodic paralysis and thyrotoxic periodic paralysis, and other “Channelopathies” or “Membranopathies)
Pathophysiology
Epidemiology
Primary or familial periodic paralysis
Secondary periodic paralysis
Conventional classification of periodic paralysis
Classification of primary periodic paralysis based on ion-channel abnormalities
Clinical approach to a case of periodic paralysis
History of muscle weakness
Age of onset
Family history
Timing
Intensity
History of administration of certain drugs
Clinical examination
Differential Diagnosis
Laboratory investigations
Serum K+
CPK and serum myoglobin
ECG
EMG
Nerve conduction studies
Provocative Testing
Muscle biopsy
Treatment
Prognosis
Post-operative apnoea fortunately rare can catch the anaesthetist off guard. A through knowledge is needed to make a quick differential diagnosis to correct the problem leading to prolonged apnoea
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. Anticholinergic Toxidrome
Anticholinergic drugs have
an affinity for the
acetylcholine receptor and
antagonise
muscarinic/nicotinic
receptors.
The majority of blockade is at
muscarinic receptors, but at
high doses some blockade
occurs at nicotinic receptors
in the autonomic ganglia and
at the motor end plates.
4. Anticholinergic Toxidrome
Muscarinic receptors:
M1: Central and enteric nervous
systems
M2: Heart
M3: Smooth muscle
Increases exocrine gland
secretion
Increases gut motility
Miosis via pupillary sphincter
Accommodation via ciliary
muscles
Bronchoconstriction
Bladder constriction
Therefore muscarinic blockade will
give the classic anticholinergic “dry
as a bone, red as a beet, hot as a
hare, mad as a hatter, blind as a
bat”
5. Anticholinergic Toxidrome
Central effects:
Agitated delirium (mad as a hatter)
characterised by:
Fluctuating mental status
Confusion
Restlessness and fidgeting
Picking at objects in the air
Mumbling slurred speech
Disruptive behaviour
Tremor
Myoclonus
Coma
Seizure (rare)
Peripheral effects:
Mydriasis (blind as a bat)
Tachycardia
Dry mouth (dry as a bone)
Dry skin
Flushing (red as a beet)
Hyperthermia (hot as a hare)
Urinary retention
Spares or absent bowel sounds
7. Anticholinergic Toxidrome
Signs and symptoms are
variable. No particular pattern
can accurately or reliably
diagnose this toxidrome.
Differential Dx:
Encephalitis
Hypoglycaemia
Hyponatraemia
Ictal phenomenon
NMS
Neurotrauma
Sepsis
Serotonin syndrome
Subarachnoid haemorrhage
Wernicke’s encephalopathy
8. Anticholinergic Toxidrome
Management: RRSIDEAD (as always!)
Avoid treating agitation with
anticholinergic drugs (e.g., droperidol,
haloperidol)
Antidote: Physostigmine
Reversible acetylcholinesterase inhibitor
Indications:
Agitated delirium not controlled by
benzodiazepine sedation
Isolated anticholinergic poisoning
Contraindications:
Bradyarrhythmias
Intraventricular block (QRS >100ms)
AV block
Bronchospasm
Duration of action shorter than delirium,
however repeat doses may not be
required
9. Cholinergic Toxidrome
Result of increased
acetylcholine activity at both
central and peripheral
nicotinic and muscarinic
receptors.
Can arise from either:
Cholinesterase inhibitors
(e.g., organophosphate and
carbamates)
Cholinomimetics - have
direct agonist action at
muscarinic or nicotinic sites
(e.g., pilocarpine, muscarine)
17. Cholinergic Toxidrome
Management
RRSIDEAD
Atropine: If signs of muscarinic
excess. Keep giving it until
drying of secretions is
achieved
Seizure control with benzos
Decontamination, but don’t let
it delay resus
Organophosphate/carbamate/
nerve agent poisoning:
Pralidoxime.
Initial bolus: 2g pralidoxime
in 100ml 0.9% NaCl over
15 minutes
Infusion: 500mg/hr (6g in
500ml 0.9% NaCl at
42ml/hr)
18. Opiate Toxidrome
Due to narcotics and narcotic
derivatives, binding to opiate
receptors in CNS and bowel.
Classical presentation:
CNS depression
Respiratory depression
Miosis
Other/complications
Tachycardia (response to
hypoxia, hypercarbia)
Decreased bowel sounds
Peripheral vasodilation with
hypothermia, hypotension
Resp depression and
subsequent coma can be fatal
19. Opiate Toxidrome
Special cases:
Dextropropoxyphene
(Darvon): 20mg/kg may
cause CNS depression,
seizures, cardiac
dysrhythmias (fast Na
channel blocking effect)
Pethidine: Repeated
therapeutic doses associated
with seizures
Implicated in serotonin
syndrome
20. Opiate Toxidrome
Management
RRSIDEAD
Sodium bicarbonate if
dextropropoxyphene
poisoning leading to
ventricular arrhythmias
Naloxone for CNS
depression
21. Opiate Toxidrome
Naloxone:
Competitive opioid
antagonist at mu, kappa, and
delta receptors
Treatment dose:
Initial bolus 100microg IV
(or 400microg IM/subcut)
Then give repeated
100microg boluses every
30-60 seconds until
adequate spontaneous
respiration
If necessary, infusion:
2/3 of the initial dose
required to wake the
patient up, per hour.
24. Hypnosedative Toxidrome
Baclofen
Being increasingly used as a
drug of abuse because it
induces euphoria at higher
doses (only small intrathecal
doses needed for therapeutic
effect)
Severe OD can mimic brain
death, nearly result in organ
harvesting in some cases!
25. Sympathomimetic Toxidrome
Sympathomimetics: drugs that
have an activating effect on the
sympathetic nervous system
through the direct or indirect effect
on catecholamines.
Direct acting: alpha-agonists,
dopaminergic agents
Indirect acting agents: cause
increased catecholamine release,
inhibition of enzymatic breakdown,
or delayed reuptake (e.g.,
pseudoephedrine, amphetamines,
cocaine).
Cross-reactivity:
Cocaine can affect dopamine
MDMA can contribute to serotonin
syndrome
27. Sympathomimetic Toxidrome
Treatment:
Hypertension and tachycardia:
Titrated benzos first
Phentolamine 1mg IV repeated every 5
minutes
Titrated vasodilator infusion (e.g., GTN)
NEVER give β-blockers (can lead to
unopposed alpha stimulation and
vasoconstriction)
Seizures: IV diazepam (second line: barbiturates)
Agitation: Benzos (second line: droperidol,
olanzapine)
Hyperthermia
>38.5: continuous core temp monitoring, benzo
sedation, fluid resus
>39.5: rapid external cooling. May need
paralysis, intubation, ventilation.
Hyponatraemia: If profound (<120mmol) + altered
mental state/seizures, give hypertonic saline
3% NaCl 4ml/kg over 30 mins. Keep repeating
to maintain Na >120mmol)
28. Sympathomimetic Toxidrome
Cocaine
Blockade of presynaptic catecholamine
uptake (sympathomimetic).
Also has calcium channel blockade,
which may lead to ventricular
dysrhythmia.
Treat with sodium bicarb. If
refractory to sodium bicarb and defib
lignocaine 1.5mg/kg IV
29. Serotonin Syndrome
Clinical manifestation of
excessive stimulation of
serotonin receptors in the
CNS
Life threatening toxicity rare
following single SSRI
ingestion.
Is more common with combo
of MAOI and SSRIs.
32. Serotonin Syndrome
Diagnosis: Hunter Criteria
Differentials:
NMS (has a slower onset,
development of acute
parkinsonism with
bradykinesia and lead-pipe
rigidity, and an absence of
neuromuscular excitation)
Anticholinergic toxidrome
Malignant hyperthermia:
Does not produce
neuromuscular excitation,
and requires a history of
volatile anaesthetic
exposure.
33. Serotonin Syndrome
Management (RRSIDEAD)
Supportive care
May need intubation +
ventilation +/- paralysis if
coma, recurrent seizures,
hyperthermia >39.5C
Antidote: cyproheptadine 8mg
(serotonin antagonist).
Efficacy not yet proven
Not indicated in severe SS
May be useful in mild-mod
serotonin syndrome
refractory to
benzodiazepines.
Requires ICU admission if
severe. Sx likely resolve with
complete recovery within 24-
48 hours.
34. Neuroleptic Malignant
Syndrome
Rare and potentially lethal,
due to the use of neuroleptic
medications.
Controversial aetiology, may
be due to deficiency/blockade
of dopaminergic
neurotransmission in
nigrostriatal, mesolimbic, and
hypothalamic-pituitary
pathways.
Suspect if the patient presents
with the following toxidrome,
and has a history of ingestion
of one or more neuroleptic
agents.
35. Neuroleptic Malignant
Syndrome
Clinical features:
Central nervous system:
Confusion, delirium, stupor, coma
Autonomic instability:
Hyperthermia, tachycardia,
hypertension, respiratory
irregularities, cardiac dysrhythmias
Neuromuscular:
Lead-pipe rigidity
Generalised bradykinesia or
akinesia
Mutism and staring
Dystonia and abnormal
postures
Abnormal involuntary
movements
Incontinence
36. Neuroleptic Malignant
Syndrome
Management:
Supportive
May need intubation +
paralysis if temperature >39.5
Role of benzos controversial
?may play a part in causing
NMS
Use specific agents like
bromocriptine (dopamine
agonist) in moderate or
severe cases
Dantrolene – severe muscle
rigidity
ECT – if refractory. May
increase central dopaminergic
activity.
37. Condition Obs Pupils Skin Bowel sounds Neuromuscular
tone
Reflexes Mental status
Anticholinergic Tachycardia
Hyperthermia
Mydriasis Hot, dry, red Sparse or absent Normal Normal Agitated delirium
Cholinergic Muscarinic:
Bradycardia
Nicotinic:
Tachycardia
and
hypotension
Miosis Diaphoretic Hyperactive Fasciculations
Muscle weakness
Normal Agitation,
confusion
Coma, seizures
Opiate toxicity Tachycardia
Bradypnoea
Hypotension
Hypothermia
Miosis Peripheral
vasodilation
May be
hypothermic, cool
Decreased Normal Normal CNS depression.
Coma
Hypnosedative Bradycardia
Bradypnoea
Hypotension
Hypothermia
Nystagmus Normal Normal Decreased
muscle tone
Ataxia
Normal Slurred speech,
stupor,
disinhibition, CNS
depression, coma
Sympathomimetic Tachycardia
Tachypnoea
Hypertension
Hyperthermia
Mydriasis Diaphoresis Normal Neuromuscular
excitation, tremor
Hyperreflexia Agitation,
pressured
speech, flight of
ideas, paranoia
Serotonin
syndrome
Tachycardia
Tachypnoea
Hypertension
Hyperthermia
Mydriasis Diaphoresis Hyperactive Increased,
especially lower
limbs
Hyperreflexia and
clonus
Agitation
progressing to
coma
Neuroleptic
malignant
syndrome
Tachycardia
Hypertension
Tachypnoea
Hyperthermia
Mydriasis or
normal
Sweaty but pale Normal Lead-pipe rigidity Bradyreflexia Mutism, staring,
bradykinesia,
coma
38. References
Murray L. Toxicology handbook. Sydney, N.S.W.: Churchill
Livingstone/Elsevier; 2011.
Kloss B, Bruce T. Toxicology in a Box. 1st ed. McGraw Hill;
2014.
The Hunter Serotonin Toxicity Criteria: simple and accurate
diagnostic decision rules for serotonin toxicity
Isbister G, Bucket N, Whyte I. Serotonin toxicity: a practical
approach to diagnosis and treatment. The Medical Journal
of Australia. 2007;187(6):361-365.
Katzung B, Masters S, Trevor A. Basic & clinical
pharmacology. New York: McGraw-Hill Medical; 2009.