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Toxidromes: Clinical Features01:30

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Toxidromes are specific patterns of symptoms resulting from toxic substance exposure. They help in the identification and treatment of poisoning. The symptoms of each toxidrome group indicate poisoning by a certain class of chemicals or drugs.1. Sympathomimetic: Stimulates the sympathetic nervous system. Symptoms include agitation, increased heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature, and pupil size. Drugs like cocaine and amphetamines, along with tremors and...
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A Computerized Test Battery to Study Pharmacodynamic Effects on the Central Nervous System of Cholinergic Drugs in Early Phase Drug Development
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[Sympathomimetic syndrome caused by autointoxication with methylphenidate].

L F D van Vulpen1, M M Malingré, R Lange

  • 1Afd. Interne Geneeskunde, Meander Medisch Centrum, Postbus 1502, 3800 BM Amersfoort.

Nederlands Tijdschrift Voor Geneeskunde
|January 9, 2007
PubMed
Summary

A man survived a massive overdose of methylphenidate (a stimulant) and alcohol. Prompt treatment with activated charcoal and supportive care led to a full recovery from this potentially lethal poisoning.

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Area of Science:

  • Toxicology
  • Pharmacology
  • Emergency Medicine

Background:

  • Methylphenidate is a central nervous system stimulant commonly prescribed for ADHD.
  • Co-ingestion of substances can complicate overdose management and prognosis.

Observation:

  • A 31-year-old male presented after ingesting over 1000 mg of methylphenidate, 8000 mg of ibuprofen, and significant alcohol.
  • Clinical signs included agitation, hallucinations, mydriasis, and sinus tachycardia, indicative of a sympathomimetic syndrome.

Findings:

  • Toxicological analysis revealed a plasma-ethanol concentration of 0.27% and a peak serum-methylphenidate level of 176 µg/l.
  • Toxic concentrations of ethylphenidate, an active metabolite, were also detected.
  • The patient received activated charcoal and an oral laxative, followed by intensive care unit observation.

Implications:

  • This case highlights the importance of prompt medical intervention in severe methylphenidate overdose.
  • Management strategies include preventing further absorption, close monitoring of vital signs, and supportive care.
  • The presence of ethylphenidate underscores the complex metabolism and potential toxicity of methylphenidate co-ingestion.