A practical approach to managing agitated toxidromes

Abstract

Agitated patients may present with life-threatening emergency. Differential diagnoses span a wide range, conveniently remembered by the acronym VITAMINS (Vascular, Infections, Toxins/Trauma, Auto-immune/-inflammatory, Metabolic, Iatrogenic, Neoplastic, and pSychiatric aetiology). Common toxidromes include anticholinergic syndrome, serotonin toxicity, sympathomimetic toxicity, neuroleptic malignant syndrome, and withdrawal from alcohol or sedative-hypnotics. Diagnosis is primarily clinical, based on exposure history and characteristic signs. A focused physical examination is often sufficient when history is unclear. Unlike routine medical evaluations that begin with a full history and examination, management starts with rapid behavioural control and stabilization of vital signs, followed by focused examination and targeted investigations. Specific antidote therapy is seldom required in the initial management.