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
• benzodiazepinea: agitation/delirium
• titrated anti-adrenergics (avoid beta-blockers due to unapposed 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