Table 3

Toxic syndromes

Toxic syndrome (causative agents)VitalsPupilsOther findings
(cocaine, amphetamines and pseudoephedrine)
Hyperthermia, tachycardia, tachypnoea and hypertension.MydriasisAgitation, paranoia, diaphoresis, tremors and seizures.
(tricyclic antidepressants, antihistamines and scopolamine)
Hyperthermia, tachycardia, tachypnoea and hypertension.MydriasisHypervigilance, agitation, dry flushed skin and urinary retention.
Serotonin syndrome
(MAOIs, SSRIs, SNRIs, tricyclic antidepressants, triptans, tramadol and dextromethorphan)
Hyperthermia, tachypnoea, tachycardia and hypertension.MydriasisAgitation, tremor, diaphoresis, hyper-reflexia, clonus, myoclonus. Findings more prominent in lower extremities.
Neuroleptic syndrome
(typical and atypical antipsychotics)
Hyperthermia, tachypnoea, tachycardia and hypertension.NormalDecreased level of awareness, mutism, lead-pipe rigidity and hyporeflexia.
  • MAOI, monoamine oxidase inhibitor; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.