Sympathomimetic toxidrome
AGENTS
- withdrawal states
- amphetamines
- cocaine
- theophylline
- BZP
- hypermetabolic syndromes (MH, NMS)
- MAO-I
- other novel recreational drugs (e.g. Meow-Meow)
CLINICAL FEATURES
- delusions
- paranoia
- tachycardia
- hypertension
- hypotension (severe)
- hyperthermia
- sweating
- piloerection
- mydriasis
- hyperreflexia
- seizures
SPECIFIC MANAGEMENT AND TRIGGERS FOR INTERVENTION
- activate charcoal: only post-intubation if risk of seizures or coma
- whole bowel irrigation: consider in body packers
- benzodiazepines: agitation/delirium
- titrated anti-adrenergics (avoid beta-blockers due to unopposed alpha agonism, except for theophylline)
- monitoring for end-organ ischaemia: MI, CVA
- CVVHDF:
-> not recommended in amphetamines, cocaine, BZP, MAO-I
-> recommended in theophylline - laparotomy: body packers with ruptured pack
References and Links
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC