2025 – PAGE 204 – EMERGENCY MEDICINE & TOXICOLOGY
TOXIDROMES
| Toxidrome | BP | HR | RR | Temp | Pupils | Bowel Sounds | Diaphoresis |
| Anticholinergics | ~ | Up | ~ | Up | Large | Down | Down |
| Cholinergics | ~ | ~ | ~ | ~ | Small | Up | Up |
| Opioids | Down | Down | Down | Down | Small | Down | Down |
| Sympathomimetics | Up | Up | Up | Up | Large | Up | Up |
| Sedative-hypnotics | Down | Down | Down | Down | ~ | Down | Down |
| Serotonin syndrome | Up | Up | Up | Up | Large | Up | Up |
OSMOLAR AND ANION GAPS
PEARL: Osmolar gap = Measured Osmoles – ([Na+]*2 + Glucose/18 + BUN/2.8), with glucose and BUN measured in mg/dl. Normal is ≤ 10.
MNEMONIC: ME DIES from high osmolar gaps: Methanol, Ethylene glycol, Diuretic, Isopropyl alcohol, Ethanol, and Sorbitol.
PEARL: Anion Gap = Sodium – (Chloride + Bicarbonate), or Anion Gap = Sodium – Chloride – Bicarbonate. A normal anion gap is ≤ 12.
MNEMONIC: CAT MUDPILES. A high anion gap metabolic acidosis can be caused by Carbon monoxide/Cyanide/Congenital heart failure, Aminoglycosides, Theophylline/Toluene (glue sniffing), Methanol, Uremia, Diabetic ketoacidosis, Propylene glycol, Iron/Isoniazid, Lactic acidosis, Ethylene glycol and Salicylates.
SYRUP OF IPECAC
Syrup of Ipecac is no longer recommended for toxic ingestions.
CHARCOAL
Charcoal is used to treat ingestion of anticholinergics, aspirin, acetaminophen, tricyclic antidepressants, and theophylline. If the ingestion was less than one hour ago, give charcoal. If not, charcoal may still be appropriate for aspirin, anticholinergics, and theophylline. The typical dose of charcoal is 1 g/kg.
PEARLS: MULTIPLE and/or LATE doses are allowed for medications in which there is delayed transit time, or decreased GI motility (anticholinergics, ASPIRIN, and theophylline). For ASA and theophylline, absorption also occurs in the systemic circulation.
MNEMONIC: AAAA = A, A, A, and an Asthma medication = Anticholinergics, Aspirin, Acetaminophen, and an Asthma med (Theophylline). Also, note that all of these medications come in TABLET form.
PEARL/MNEMONIC/SHORTCUT: Charcoal is NOT useful for ingestion of MLL = METALS, LIQUIDS, and LITHIUM.
“METALS” = iron and lead. Can you imagine charcoal powder mixing well with an iron or a lead pipe? Not really.
“LIQUIDS” = Ethanol, Organophosphates, Acids, Bases, and Cyanide. For the test, assume they “are absorbed or act too quickly.”