Regarding Signs And Symptoms Of Drug Overdose.

A patient presents to the hospital with a diphenhydramine overdose. Which of the following signs and symptoms are you likely to find in this patient?
A) Bradycardia, dilated pupils, flushing.
B) Bradycardia, pinpoint pupils, flushing.
C) Tachycardia, dilated pupils, diaphoresis.
D) Tachycardia, dilated pupils, flushing.
E) Tachycardia, pinpoint pupils, flushing.

Answer And Discussion: The correct answer is
“D.” Tachycardia, dilated pupils, flushing.

This patient has an anticholinergic TOXIDROME. Toxidromes are symptom complexes associated with a particular overdose that should be immediately recognized by the clinician.

Common toxidromes are listed in below:

1. Anticholinergic: examples: Tricyclics, diphenhydramine,scopolamine, loco weed (jimson weed), some mushrooms, etc.
Signs and symptoms: Tachycardia, flushing, dilated pupils, low-grade temperature, and confusion. Mnemonic: Dry as a bone, red as a beet, mad as a hatter, blind as a bat.

2. Opiates: examples:Morphine, heroin, codeine, oxycodone, etc.
Signs and symptoms: Pinpoint pupils, hypotension, hypopnea, coma, hypothermia

3. Cholinergic:  examples: Organophosphate or carbamate pesticides, some mushrooms
Signs and symptoms: Lacrimation, salivation, muscle weakness, diarrhea, vomiting, miosis. Mnemonic: SLUDGE BBB (salivation, lacrimation, urination, diarrhea, GI upset, emesis . . . Bradycardia, bronchorrhea, bronchospasm).

4. Sympathomimetic: examples:Cocaine, ecstasy, methamphetamine
Signs and symptoms: Tachycardia, hypertension, elevated temperature, dilated pupils (mydriasis)

5. Gamma-hydroxybutyrate (GHB):  examples: GHB, liquid ecstasy, etc.
Signs and symptoms: Alternating coma with agitation, hypopnea while comatose, bradycardia while comatose, and myoclonus.