Table 2

Recognisable poison syndromes

Poison syndromeAssociated signsPossible toxins
*Due to excessive cholinergic stimulation at the motor end plate.
Increased sympathetic nervous system activity (these features are common in disease generally)Pyrexia Flushing Tachycardia Hypertension Pupillary constriction SweatingCough and decongestant preparations Amphetamines Cocaine Ecstasy Theophylline
Anticholinergic activitySimilar clinical picture to sympathomimetics Clinical differences include: Pupillary dilatation Dry mouth Hot dry skinTricyclic antidepressants Antiparkinsonian drugs Antihistamines Atropine and nightshade Antispasmodics Phenothiazines Mushroom poisoning (Amanita species) Cyclopentolate eye drops
Increased parasympathetic nervous system activityPupillary constriction Diarrhoea Urinary incontinence Sweating Excessive salivation Muscle weakness* Fasciculation* Paralysis*Organophosphate insecticides Drugs for myasthenia gravis, e.g. pyridostigmine
Metabolic acidosisTachyopnoea Kussmaul breathing (sighing respiration)Ethanol Carbon monoxide Antifreeze Iron Diabetic medication Tricyclic antidepressants Salicylates
Chemical pneumonitisCough Respiratory distress Central nervous system depression A history of vomiting following ingestion need not be a featureWhite spirit Turpentine Essential oils
Acute ataxia or nystagmusAntihistamines Alcohol Anticonvulsants (especially phenytoin and carbamazepine) Piperazine Diphenylhydantoin Barbiturates Carbon monoxide Organic solvents Bromides
MethaemoglobinaemiaCyanosis resistant to oxygen therapyAlanine dyes Nitrates Benzocaine Phenacetin Nitrobenzene Chlorates Sulphonamides and metoclopramide (in neonates)
Renal failureOliguria or anuria Haematuria MyoglobinuriaCarbon tetrachloride Ethylene glycol Methanol Mushrooms Oxalates3
Violent emesisAspirin Theophylline Corrosives Fluoride Boric acid Iron3