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Potentially life-threatening emergency
Sympathomimetic toxicity
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Sympathomimetic toxicity

Contributors: Angela Regina DO, Shanna Yang MD, Benjamin L. Mazer MD, MBA, Abhijeet Waghray MD, Gerald F. O'Malley DO
Other Resources UpToDate PubMed

Synopsis

Emergent Care / Stabilization:
In the United States, the American Association of Poison Control Centers at 800-222-1222 is available 24 hours a day to connect callers directly to their region's poison center. They are also available online.

After identification of the sympathomimetic toxidrome, emergent care involves rapid sedation, hemodynamic stabilization, and active cooling for those with hyperthermia.

Diagnosis Overview:
The sympathomimetic toxidrome is a combination of vital sign abnormalities and physical examination findings that are characteristic of an overdose with certain classes of xenobiotics, most commonly cocaine and amphetamines. Signs of sympathomimetic toxicity are reflective of the overactivity of the sympathetic nervous system and include hyperthermia, tachycardia, hypertension, agitation and delirium, diaphoresis, tremor, and seizures.

Other sources include:
  • Naturally occurring versions of the khat plant (Catha edulis, which has been chewed for centuries due to its amphetamine-like effect).
  • Synthetic cathinones (known as "bath salts" in America and as "plant food" in Europe).
  • Tyramine-rich foods (eg, aged cheese, red wine, and other fermented products) in combination with certain medications that act as monoamine oxidase (MOA) inhibitors.
  • This toxidrome can also manifest after the overuse of certain pharmaceuticals, including Adderall (amphetamine salts), Ritalin (methylphenidate), and Wellbutrin (bupropion).
Sympathomimetic xenobiotics potentiate the effects of catecholamines (eg, epinephrine, norepinephrine, dopamine) by either directly releasing these biologic amines, inhibiting their reuptake, or inhibiting their metabolism by MOA. This causes increased sympathetic activity in the nervous system. They are separated into direct sympathomimetics (eg, epinephrine, phenylephrine), which bind directly to an adrenergic receptor; indirect sympathomimetics (eg, amphetamine, tyramine), which enhance the activity of catecholamines; and mixed (eg, ephedrine), which have both direct and indirect properties. Direct sympathomimetics are further separated based on their selectivity for a receptor (eg, alpha-1 receptor for phenylephrine) or lack of selectivity (eg, nonselective adrenergic receptor agents).

Related topics: cocaine intoxication and use disorder, cocaine-related cardiomyopathy, methamphetamine use disorder

Codes

ICD10CM:
T44.904A – Poisoning by unspecified drugs primarily affecting the autonomic nervous system, undetermined, initial encounter

SNOMEDCT:
45536007 – Poisoning by sympathomimetic drug

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

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Therapy

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Drug Reaction Data

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References

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Last Reviewed:03/19/2024
Last Updated:07/29/2024
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Potentially life-threatening emergency
Sympathomimetic toxicity
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A medical illustration showing key findings of Sympathomimetic toxicity : Agitation, Chemical substance abuse, Tachycardia, Diaphoresis, Hypertension, Mydriasis, Tremor, Hyperthermia
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