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Rapid recognition of a toxidrome, if present, can help determine whether a specific poison or class of toxin is involved. Table 1 lists selected toxidromes and their characteristics. It is important to note that patients may not present with all components of a toxidrome and that mixed ingestions may cloud the classic characteristics. Specific aspects of a toxidrome may have great significance when evaluating a patient. For example, noting the presence of dry axilla in a markedly agitated patient may be the only way of differentiating an anticholinergic patient from a sympathomimetic patient.

Testing for red blood cell cholinesterase or serum pseudocholinesterase is therefore not useful for acute organophosphate poisonings but is worthwhile to document and follow in cases of chronic exposure. Because blood and serum testing for many toxins is not well standardized, it is prudent to become familiar with the ranges and limits for abnormal values in your patient population. Your local clinical laboratory supervisor and poison control center may be able to help. 28 Only in rare instances will a neurophysiology study such as electroencephalography or electromyography definitively diagnose a neurointoxication.

22. Shamberger RJ. Validity of hair mineral testing. Biol Trace Elem Res. 2002;87(1–3):1–28. 29 CHAPTER 4 Toxin-Induced Neurologic Emergencies David Lawrence, Nancy McLinskey, J. Stephen Huff, and Christopher P. Holstege CHAPTER CONTENTS Introduction 30 Seizures 34 General Management 30 Acute Alteration of Mental Status 37 Toxicology-directed Physical Exam 32 Weakness 40 Toxidromes 32 Conclusion 43 Diagnostic Testing 32 INTRODUCTION Exposure to toxins may cause several common neurological emergencies, including toxin-induced seizures, acute change in mental status, and muscle weakness (see also specific chapters for these problems in the Neurotoxic Syndromes section of this book).

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