Nelson Textbook of Pediatrics 22nd Edition โ Chapter 94 | Table 94.2: Selected Historical and Physical Findings in Poisoning (odor, ocular, cutaneous, oral, GI, cardiac, respiratory, CNS signs) | Table 94.3: Recognizable Poison Syndromes (Anticholinergic, Cholinergic, Opioid, Sympathomimetic, Sedative-Hypnotic, Serotonin Syndrome, Neuroleptic Malignant Syndrome).
๐ paeds.online โ Pakistan's Pediatric Platform| Finding | Associated Toxin(s) |
|---|---|
| Odor | Bitter almonds (cyanide), acetone (isopropyl alcohol, methanol), rotten eggs (HโS), wintergreen (methyl salicylate), garlic (arsenic, organophosphates), mothballs (camphor, naphthalene) |
| Ocular (miosis) | Opioids, organophosphates, clonidine, phenothiazines, sedative-hypnotics |
| Ocular (mydriasis) | Anticholinergics (atropine, antihistamines, TCAs), sympathomimetics (amphetamines, cocaine, PCP) |
| Nystagmus | Anticonvulsants (phenytoin, carbamazepine), alcohols, PCP, ketamine, dextromethorphan |
| Cutaneous (diaphoresis) | Cholinergics (organophosphates), sympathomimetics, salicylates, withdrawal syndromes |
| Cutaneous (dry skin) | Anticholinergics (TCAs, antihistamines, atropine) |
| Cyanosis (unresponsive to Oโ) | Methemoglobinemia (benzocaine, dapsone, nitrites) |
| Oral burns | Caustics (acids/alkalis), oxalate-containing plants |
| Cardiac (tachycardia) | Sympathomimetics, anticholinergics, salicylates, theophylline, withdrawal |
| Cardiac (bradycardia) | Beta-blockers, calcium channel blockers, digoxin, clonidine, opioids, organophosphates |
| Respiratory depression | Opioids, sedative-hypnotics, alcohol, clonidine |
| Tachypnea | Salicylates, sympathomimetics, metabolic acidosis (methanol, ethylene glycol) |
| CNS (seizures) | Sympathomimetics, TCAs, isoniazid, camphor, lindane, salicylates, tramadol, bupropion |
| CNS (coma) | Opioids, sedative-hypnotics, TCAs, alcohols, clonidine, GHB |
| Hyperthermia | Anticholinergics, sympathomimetics, serotonin syndrome, NMS, salicylates |
| Toxidrome | Vital Signs | Pupils | Skin/Mucosa | Bowel Sounds | Mental Status | Examples |
|---|---|---|---|---|---|---|
| Anticholinergic | โHR, โTยฐ (hyperthermia) | Mydriasis (dilated) | Dry, flushed | โ (decreased) | Agitation, delirium, hallucinations ("mad as a hatter") | Atropine, antihistamines (diphenhydramine), TCAs, antipsychotics, plants (jimsonweed) |
| Cholinergic | โHR (bradycardia), normal/low BP | Miosis (pinpoint) | Diaphoresis (sweating), lacrimation | โ (hyperactive, diarrhea) | Confusion, coma | Organophosphates, carbamates, nicotine, physostigmine |
| Opioid | โHR, โRR, โBP, โTยฐ (hypothermia) | Miosis (pinpoint) | Normal to cool | โ (decreased) | Sedation, coma, respiratory depression | Morphine, heroin, fentanyl, methadone, codeine |
| Sympathomimetic | โHR, โRR, โBP, โTยฐ | Mydriasis | Diaphoretic | Normal to โ | Agitation, paranoia, psychosis | Cocaine, amphetamines, methamphetamine, MDMA, caffeine, theophylline |
| Sedative-Hypnotic | โHR, โRR, โBP, โTยฐ | Normal or miotic | Normal | Normal | Drowsiness, ataxia, slurred speech, coma | Benzodiazepines, barbiturates, ethanol, GHB, zolpidem |
| Serotonin Syndrome | โHR, โBP, โTยฐ (hyperthermia) | Mydriasis | Diaphoretic, flushing | โ (hyperactive) | Agitation, clonus, hyperreflexia, myoclonus | SSRIs, SNRIs, MAOIs, meperidine, tramadol, linezolid |
| Neuroleptic Malignant Syndrome (NMS) | โHR, โBP, โTยฐ (hyperthermia) | Normal | Diaphoretic | Normal | Altered mental status, rigidity, bradykinesia, elevated CK | Haloperidol, risperidone, olanzapine, metoclopramide |