Hyperthermic Toxidromes
Five toxidromes may present with overlapping features: hyperthermia, rhabdomyolysis, altered mental status/seizures.
 • Sympathomimetic - Excess release of monoamines (epi, NE, DA, 5HT) leading to overstimulation of adrenergic receptors.
 • Anticholinergic - Blockade of muscarinic Ach receptors impairs acetylcholine signaling in the CNS, on cardiac & smooth muscle, and on sweat glands.
 • Serotonin Syndrome - Excessive release of 5HT, usually due to combination of 2 or more serotoninergic meds. Rarely it can occur with a single serotonergic agent.
 • Neuroleptic Malignant - Ideosyncratic reaction to dopamine blockers (e.g. anti-psychotic) or due to abrupt cessation of dopamine agonists (e.g. Parkinson’s Tx)
 • Malignant Hyperthermia - Rare pharmacogenetic disease caused by genetic susceptibility (AD mutations in ryanodine receptor) & triggered by inhaled anesthetics

by Nick Mark MD @nickmmark

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