This flowchart describes the etiology, pathophysiology, and manifestations of sympathomimetic toxidrome.
ADDITIONAL TAGS:
Risk factors / SDOH
Cell / tissue damage
Nervous system path
Sympathomimetic toxidrome
Medicine / drugs
Infectious / microbial
Biochem / organic chem
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Diet / food
Neoplasm / cancer
Flow physiology
Pathophysiology
Etiology
Manifestations
Sudden and dramatic increase in catecholamine (epinephrine, norepinephrine) activity →
↑ sympathetic nervous system
Direct catecholamine activity
Indirect catecholamine activity
Indirect agonist
Reuptake inhibitor
Releases catechol.
Amphetamines
Cocaine
Ephedrine
α1 activity
α2 agonists
β1 activity
β2 activity
Vasoconstriction
Contraction of bladder neck
Reflex bradycardia
Hypertension
Ischemia → necrosis
Urinary retention
Piloerection
Vasodilation
Reflex tachycardia
Hypotension
Agitation
Tremor
Diaphoresis
Insomnia
Hypokalemia
Hyperglycemia
Arrhythmias
Tachycardia
Angina → myocardial infarctions
CAD
Hypovolemia
Symptoms from sympatholytic effects (blocking other receptors)
Respiratory depression
CNS depression (sedation)
Hypotension
Bradycardia
Miosis
Phenylephrine, oxymetazoline
α1 α2
Norepinephrine α1 α2 β1
Epinephrine β α at low doses;
α β at high doses
Dopamine D1 = D2 β ≈ α chronotropic (β) at low doses; vasoconstriction (α) at high doses
Dobutamine β1 β2, α
Albuterol, salmeterol, formoterol, terbutaline β2 β1
Isoproterenol β1 = β2
Methyldopa, clonidine, guanfacine α2
Midodrine α1
Pheochromocytoma (medullary tumor of the adrenal glands
Mydriasis
Paranoia
Seizures
Hyperactive bowel
Delusions
Head trauma → subarachnoid hemorrhage → irritates meninges
Tyramine displaces stored catechol. from synaptic vesicles
High tyramine diet (wine, chocolate, aged cheese, cured meat) in patient taking MAOIs