Toxicological Syndromes

Anticholinergic toxicrome

This condition develops against the background of consuming poisonous plants (belladonna tincture, henbane, thornapple) or drug overdoses (scopolamine, astmatin, beloid). The main diagnostic criteria are anamnesis data indicating a link to substance intake and the results of toxicological analysis.

The clinical picture is caused by profound damage to the parasympathetic nervous system. Basic manifestations include:

• Pronounced dry mouth.
• Mydriasis (persistent pupil dilation).
• Intense headache.
• Swallowing and speech disorders.
• Tachycardia and various cardiac arrhythmias.

A crucial aspect is the differential diagnosis with botulism. The key differences of anticholinergic poisoning lie in prominent symptoms of central nervous system excitation. Patients exhibit mental disorders, visual and auditory hallucinations, motor agitation (up to violent behavior), and general anxiety. In severe cases, clonic-tonic seizures develop. Additionally, facial hyperemia (flushing), fever, and a decrease in blood pressure (untypical for botulism) are recorded.

Antidote administration: physostigmine

In severe poisonings with anticholinergics capable of crossing the blood-brain barrier (e.g., atropine), physostigmine is used as a specific antidote.

Besides toxicology, this drug is widely used in ophthalmology, primarily as an indication for managing acute angle-closure glaucoma attacks. Its mechanism of action is based on a pronounced miotic effect (pupil constriction), which leads to mechanical facilitation of intraocular fluid outflow. Comparative characteristics show that in terms of intraocular pressure reduction efficacy, physostigmine significantly outperforms pilocarpine. However, the drug has serious drawbacks: it causes severe spastic contraction of the iris, which often provokes intense pain in the eyes and superciliary arches.

Complications of psychopharmacotherapy

When treating patients with neuroleptics or lithium preparations, strict somatic control is required. In particular, weekly weighing is necessary to monitor nutritional status and early detection of latent edema. Irrational therapy can lead to life-threatening conditions:

1. Serotonin syndrome. Occurs when using dangerous drug combinations, specifically the co-prescribing of antidepressants from the SSRI group (selective serotonin reuptake inhibitors) and MAO inhibitors (monoamine oxidase).
2. Neuroleptic malignant syndrome (NMS). A severe complication whose clinical picture includes critical hyperthermia and generalized muscle rigidity. Regular measurement of the patient's body temperature is required for effective control and prevention of NMS.

Specific toxicological symptoms also include signs of ketoacidosis and anorexia, which clinically manifest as persistent constipation and a sharp acetone breath odor.

Opioid toxicrome and detoxification methods

Opioid poisoning produces a classic toxicrome, whose specific signs include total miosis (pinpoint pupils) and bradypnea (respiratory depression and slowing). The specific antidote in this case is naloxone.

First aid for any oral poisonings should begin with an immediate attempt at gastric lavage. The procedure of forced diuresis is used for accelerated elimination of absorbed toxins from the bloodstream.

It is important to note that diuresis-stimulating drugs are prescribed not only in toxicology. Their clinical indications are extremely broad:

• Edematous syndrome of various origins: acute pulmonary edema, chronic heart failure, liver cirrhosis, angioedema.
• Cardiovascular pathology: management of hypertensive crisis and treatment of severe forms of hypertension.
• Obstetric pathology: complex treatment of preeclampsia.
• Electrolyte metabolism disorders: correction of hypercalcemia.

Intensive care and psychiatric nursing

When severe complications develop, such as life-threatening organic psychosis, baseline therapy should aim to correct metabolic disorders and concomitant somatic conditions. When performing a differential diagnosis of organic pathology, an intracranial tumor must be excluded.

Medical management of pronounced motor agitation or clonic-tonic seizures is carried out by intravenous administration of a benzodiazepine tranquilizer.

Special attention is required for patient management tactics when delirium develops or when the risk of its occurrence is high. Medical personnel are obliged to stay by the patient's bedside continuously. Continuous assessment of suicidal intent risk is mandatory. A demographic risk factor for severe psychosis is often the group of elderly men. Catatonic syndrome is usually observed in the clinical picture, and delusion of jealousy often becomes a specific form of thought disorder.

Class and exam questions

What else to study on this topic

• Methodology and features of forced diuresis in toxicology
• Differential diagnosis of organic psychoses and intracranial tumors
• Ophthalmological use and pharmacodynamics of physostigmine
• Management of seizure syndrome with benzodiazepine tranquilizers
• Management tactics for patients with catatonic syndrome and delusion of jealousy

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.