Table: Common Toxic Syndromes-Merck Manual Professional Edition

Common Toxic Syndromes

Syndrome	Symptoms	Common Causes
Anticholinergic	Tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, delirium (“mad as a hatter, blind as a bat, red as a beet, hot as a hare, and dry as a bone”*)	Antihistamines Belladonna alkaloids Datura (angel's trumpet) Jimson weed Mushrooms (some) Psychoactive drugs (many) Tricyclic antidepressants
Cholinergic, muscarinic	Salivation, lacrimation, urination, defecation, GI cramps, emesis (mnemonic device: SLUDGE) or Diarrhea; urination; miosis; bronchorrhea, bradycardia, and bronchoconstriction; emesis; lacrimation; and salivation (mnemonic device: DUMBELS) Wheezing	Carbamates Mushrooms (some) Organophosphates
Cholinergic, nicotinic	Mydriasis, tachycardia, weakness, hypertension and hyperglycemia, fasciculations, sweating (mnemonic device: MTWT[h]FS) Abdominal pain, paresis	Black widow spider bites Carbamates Organophosphates (some)
Opioid	Hypoventilation, hypotension, miosis, sedation, possibly hypothermia
Sympathomimetic	Tachycardia, hypertension, mydriasis, agitation, seizures, diaphoresis, hyperthermia, psychosis (after chronic use)	Amphetamines Herbal and synthetic marijuana and common substitutes MDMA (Ecstasy) Phenylpropanolamine Substituted cathinones ("bath salts") "Synthetic" marijuana
Withdrawal	Tachycardia, mild hypertension, mydriasis, diaphoresis, agitation, restlessness, anxiety, hyperreflexia, piloerection, yawning, abdominal cramps, lacrimation, flu-like symptoms, insomnia, vomiting and diarrhea	Withdrawal from the following sedating or recreational drugs: Marijuana Opioids
Agitation, hallucinations, confusion, disorientation, seizures, hyperreflexia, hypertension, tachycardia, arrhythmias, dehydration, autonomic instability, death	Withdrawal from the following drugs with sedative-hypnotic effects: Alcohol Barbiturates Benzodiazepines GHB
Decreased mental alertness, lethargy, coma, decreased blood pressure, decreased heart rate	Withdrawal from the following drugs with sympathomimetic effects: Amphetamines PCP Synthetic cathinones ("bath salts")
Mild flu-like symptoms, insomnia, restlessness and anxiety	Withdrawal from the following drugs with antidepressant effects: MAOIs SSRIs Tricyclic antidepressants
* From Carroll L: Alice's Adventures in Wonderland. London, MacMillan & Co., 1865.
GHB = gamma-hydroxybutyrate; MDMA = methylenedioxymethamphetamine; MAOI = monoamine oxidase inhibitor; PCP = phencyclidine; SSRI = selective serotonin reuptake inhibitor.

Syndrome

Symptoms

Common Causes

Anticholinergic

Tachycardia, hyperthermia, mydriasis, warm and dry skin, urinary retention, ileus, delirium (“mad as a hatter, blind as a bat, red as a beet, hot as a hare, and dry as a bone”*)

Antihistamines

Belladonna alkaloids

Datura (angel's trumpet)

Jimson weed

Mushrooms (some)

Psychoactive drugs (many)

Tricyclic antidepressants

Cholinergic, muscarinic

Salivation, lacrimation, urination, defecation, GI cramps, emesis (mnemonic device: SLUDGE)

Diarrhea; urination; miosis; bronchorrhea, bradycardia, and bronchoconstriction; emesis; lacrimation; and salivation (mnemonic device: DUMBELS)

Wheezing

Carbamates

Mushrooms (some)

Organophosphates

Cholinergic, nicotinic

Mydriasis, tachycardia, weakness, hypertension and hyperglycemia, fasciculations, sweating (mnemonic device: MTWT[h]FS)

Abdominal pain, paresis

Black widow spider bites

Carbamates

Organophosphates (some)

Opioid

Hypoventilation, hypotension, miosis, sedation, possibly hypothermia

Sympathomimetic

Tachycardia, hypertension, mydriasis, agitation, seizures, diaphoresis, hyperthermia, psychosis (after chronic use)

Amphetamines

Herbal and synthetic marijuana and common substitutes

MDMA (Ecstasy)

Phenylpropanolamine

Substituted cathinones ("bath salts")

"Synthetic" marijuana

Withdrawal

Tachycardia, mild hypertension, mydriasis, diaphoresis, agitation, restlessness, anxiety, hyperreflexia, piloerection, yawning, abdominal cramps, lacrimation, flu-like symptoms, insomnia, vomiting and diarrhea

Withdrawal from the following sedating or recreational drugs:

Agitation, hallucinations, confusion, disorientation, seizures, hyperreflexia, hypertension, tachycardia, arrhythmias, dehydration, autonomic instability, death

Withdrawal from the following drugs with sedative-hypnotic effects:

Decreased mental alertness, lethargy, coma, decreased blood pressure, decreased heart rate

Withdrawal from the following drugs with sympathomimetic effects:

Mild flu-like symptoms, insomnia, restlessness and anxiety

Withdrawal from the following drugs with antidepressant effects:

* From Carroll L: Alice's Adventures in Wonderland. London, MacMillan & Co., 1865.

GHB = gamma-hydroxybutyrate; MDMA = methylenedioxymethamphetamine; MAOI = monoamine oxidase inhibitor; PCP = phencyclidine; SSRI = selective serotonin reuptake inhibitor.