Classical toxidromes

There is no overall agreement in the literature about the exact toxidromes associated with toxic agents. Approaches vary, depending on the way toxic agents are defined. Thus, some classifications consider irritant gas and asph3rxiant gas syndromes which have considerable overlap since both of them cause ultimate toxic trauma through type 2 respiratory failure. In the hazardous materials world, corrosive syndromes have been described while the military focus on a vesicant syndrome to reflect the exposure to substances such as HD. 

The following broad toxidromes may be described, based upon the classification of toxic agents given in Chap. 3. 

Central nervous incapacitating and knockdown agent toxidromes 

S3mdromes following the blockage of carriage and use of oxygen in the body (chemical asphyxiant toxidromes) 

Lung-damaging agent and passive asphyxiant toxidromes 

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Acute toxicity induced by pentazocine is primarily associated with central nervous system (CNS) effects that include dizziness, anxiety, hallucinations, mood alterations, and seizures. Respiratory depression, increased PaCOi levels, pulmonary edema, and apnea may occur. Tachycardia, increased systolic and diastolic blood pressure, pinpoint pupils, nausea, vomiting, and abdominal pain have also been reported. In a recently published case series, 40% of acute pentazocine overdose patients did not have the classic opioid toxidrome of CNS and respiratory depression with miosis. 

A basic understanding of the differences between the classes of agents with high toxicity and short transmissibUity (notably classical chemical warfare agents) and recognition of the corresponding toxidromes... 

The expression of the classic cyanide toxidrome can be very variable depending on the degree of exposure. For example, there is a wide variation in the perception of the classic almond smell associated with hydrogen cyanide. 

The agent used in the attack was not recognised until about 2.5 h after the attack when the classic nerve agent toxidrome was recognised by physicians who had attended the patients in the Matsumoto attack. 

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