Toxicology Mnemonic Challenge
aka Toxicology Conundrum 054
There are multiple learning tools used as an adjunctive aide memoire such as a pattern of letters, ideas, or associations. Here are a number of Toxicological related mnemonics used with varying frequency throughout the conundrums. Let us know if you have any more to add…
Agents Affecting Pupil Size
Miosis (COPS)
- Cholinergic, clonidine, carbamates
- Opioids, organophosphates
- Phenothiazines (antipsychotics), pilocarpine, pontine haemorrhage
- Sedative – hypnotics
Mydriasis (SAW)
- Sympathomimetics
- Anticholinergics
- Withdrawal syndromes
Agents Causing Coma or Seizures
Coma (LETHARGIC)
- Lead, lithium
- Ethanol, ethylene glycol, ethchlorvyol
- Tricyclic antidepressants, thallium, toluene
- Heroin, hemlock, hepatic encephalopathy, heavy metals, hydrogen sulphide, hypoglycaemics
- Arsenic, antidepressants, anticonvulsants, antipsychotics, antihistamines
- Rohypnol (sedative hypnotics), risperidone
- Gamma-hydroxybutyrate (GHB)
- Isoniazid, insulin
- Carbon monoxide, cyanide, clonidine
Seizures (OTIS CAMPBELL)
- Organophosphates, oral hypoglycaemics
- Tricyclic antidepressants
- Isoniazid, insulin
- Sympathomimetics, strychnine, salicylates
- Camphor, cocaine, carbon monoxide, cyanide, chlorinated hydrocarbons
- Amphetamines, anticholinergics
- Methylxanthines (theophylline, caffeine), methanol
- Phencyclidine (PCP), propranolol
- Benzodiazepine withdrawal, botanicals (water hemlock, nicotine), bupropion, GHB
- Ethanol withdrawal, ethylene glycol
- Lithium, lidocaine
- Lead, lindane
Cholinergic Toxidrome
Muscarinic (DUMBELLS)
Cholinergic Toxidrome (Flashcard)
- Diarrhoea, diaphoresis
- Urination
- Miosis
- Bradycardia
- Emesis
- Lacrimation
- Lethargic
- Salivation
Nicotinic: Days of the Week
- Mydriasis
- Tachycardia
- Weakness
- Tremors
- Fasiculations
- Seizures
- Somnolent
Anticholinergic
Reveal Mnemonics
Anticholinergic Toxidrome (Flashcard)
- Blind as a bat;
- Mad as a hatter;
- Red as a beet;
- Hot as Hades/Hell/Desert;
- Dry as a bone;
- The bowel and bladder lose their tone, and the heart runs alone.
Or…
- Can’t See (blurred vision);
- Can’t pee (urinary retention);
- Can’t spit (dry mouth);
- Can’t Shit (constipated)
Substances that cause bradycardia.
PACED
- Propranolol (Beta blockers), poppies (opiates), propoxyphene, physostigmine
- Anticholinesterase drugs (I.e. cholinergics like physostigmine), antiarrythmics
- Clonidine, calcium channel blockers
- Ethanol or other alcohols
- Digoxin, digitalis
Substances that cause tachycardia.
FAST
- Free Base or other forms of cocaine, Freon
- Anticholinergics, antihistamines, antipsychotics, amphetamines, alcohol withdrawal
- Sympathomimetics (cocaine, caffeine, amphetamines, phencyclidine [PCP]), solvent abuse, strychnine
- Theophylline, tricyclic antidepressants, thyroid hormones
Substances that cause hypothermia.
COOLS
- Carbon monoxide
- Opioids
- Oral hypoglycaemics, insulin
- Liquor (alcohols)
- Sedative-hypnotics
Substances that cause hyperthermia.
NASA
- Neuroleptic malignant syndrome, nicotine
- Antihistamines, alcohol withdrawal
- Salicylates, sympathomimetics, serotonin syndrome
- Anticholinergics, antidepressants, antipsychotics
Substances that cause hypotension
CRASH
- Clonidine, calcium channel blockers
- Rodenticides (containing arsenic, cyanide)
- Antidepressants, aminophylline, antihypertensives
- Sedative-hypnotics
- Heroin or other opioids
Substances causing hypertension.
CT SCAN
- Cocaine
- Thyroid supplements
- Sympathomimetics
- Caffeine
- Anticholinergics, amphetamines
- Nicotine
Substances that cause hyperventilation.
PANT
- PCP, paraquat pneumonitis, phosgene
- Acetylsalicylic acid (ASA) and other salicylates
- Noncardiogenic pulmonary oedema, nerve agents
- Toxin-induced metabolic acidosis
Substances that cause hypoventilation
SLOW
- Sedative-hypnotics (barbiturates, benzodiazepines)
- Liquor (alcohols)
- Opioids
- Weed (marijuana)
Substances causing a wide anion-gap acidosis.
CAT MUD PILES
- Cyanide, carbon monoxide, colchicine
- Alcohol, alcoholic ketoacidosis, acetaminophen (in large doses)
- Toluene
- Methanol, metformin
- Uraemia
- Diabetic Ketoacidosis
- Paraldehyde
- Isoniazid, iron
- Lactic acidosis
- Ethylene glycol
- Salicylates
Potentially lethal toxins where early activated charcoal maybe indicated.
Killer C’s
- Cyanide
- Colchicine
- Calcium channel blockers
- Cyclic antidepressants
- Cardiac glycosides
- Cyclopeptide mushrooms
- Cocaine
- Cicutoxin (water hemlock)
- Salicylates
Substances that do not bind to charcoal.
PHAILS
- Pesticides
- Heavy metals
- Acids/alkalis/alcohols
- Iron
- Lithium
- Solvents
Dialysable Toxins.
PLASMA TV
- Phenobarbitol
- Lithium
- Acidosis
- Salicylates
- Metformin
- Alcohols
- Theophylline
- Valproic Acid
Substances amenable to multi-dose activated charcoal.
ABCDQ
- Aminophylline / theophylline
- Barbiturates
- Carbamazepine / concretion forming drugs (salicylates)
- Dapsone
- Quinine
CLINICAL CASES
Toxicology Conundrum
Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.
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Substances causes bradycardia should be cholinergic not anticholinergic
Sorry, just looked at the post; it says anticholinesterase drugs – it’s a bit like a double negative, It’s referring to cholinergic drugs that have an anticholinesterase activity. I’ve changed the post slightly for clarification.