Table 4.
Signs and symptoms in adult and pediatric patients as recorded by the medical toxicologist
| Adult patients (>18 years) (n = 265) | Pediatric patients (≤18 years) (n = 75) | ||||
|---|---|---|---|---|---|
| Organ system | Number | Percent | Organ system | Number | Percent |
| Nervous system | 138 | 52.0 | Nervous system | 40 | 53.3 |
| Coma/central nervous system depression | 59 | 22.3 | Coma/central nervous system depression | 18 | 24.0 |
| Delirium/toxic psychosis | 38 | 14.3 | Agitation | 10 | 13.3 |
| Hyperreflexia/myoclonus/clonus/tremor | 12 | 4.5 | Hyperreflexia/myoclonus/clonus/tremor | 4 | 5.3 |
| Agitation | 10 | 3.8 | Delirium/toxic psychosis | 3 | 4.0 |
| Seizures | 7 | 2.6 | Hallucinations | 2 | 2.7 |
| Hallucinations | 4 | 1.5 | Extrapyramidal symptoms/dystonia/rigidity | 1 | 1.3 |
| Numbness/paresthesias | 3 | 1.1 | Seizures | 1 | 1.3 |
| Weakness/paralysis | 3 | 1.1 | Weakness/paralysis | 1 | 1.3 |
| Extrapyramidal symptoms/dystonia/rigidity | 1 | 0.4 | |||
| Peripheral Neuropathy | 1 | 0.4 | |||
| Toxidrome | 45 | 17.0 | Toxidrome | 16 | 21.3 |
| Sedative-hypnotic | 28 | 10.6 | Sedative-hypnotic | 9 | 12.0 |
| Anticholinergic | 6 | 2.3 | Anticholinergic | 3 | 4.0 |
| Serotonin syndrome | 5 | 1.9 | Opioid | 1 | 1.3 |
| Opioid | 3 | 1.1 | Serotonin syndrome | 1 | 1.3 |
| Cholinergic | 1 | 0.4 | Sympatholytic | 1 | 1.3 |
| Sympathomimetic syndrome | 1 | 0.4 | Sympathomimetic syndrome | 1 | 1.3 |
| Washout syndrome | 1 | 0.4 | |||
| Major vital sign abnormalities | 39 | 14.7 | Major vital sign abnormalities | 13 | 17.3 |
| Hypotension (SBP < 80) | 13 | 4.9 | Tachycardia (P > 140) | 6 | 8.0 |
| Hypertension (SBP > 200 and/or DBP > 120) | 9 | 3.4 | Hypotension (SBP < 80) | 5 | 6.7 |
| Tachycardia (P > 140) | 8 | 3.0 | Hypertension (SBP > 200 and/or DBP > 120) | 1 | 1.3 |
| Bradycardia (P < 50) | 8 | 3.0 | Bradycardia (P < 50) | 1 | 1.3 |
| Bradypnea (R < 10) | 1 | 0.4 | |||
| Metabolic | 22 | 7.9 | Dermatologic | 6 | 8.0 |
| Metabolic acidosis (pH < 7.2) | 10 | 3.8 | Rash | 2 | 2.7 |
| Hypoglycemia (BG < 50) | 5 | 1.9 | Angioedema | 2 | 2.7 |
| Elevated anion Gap (AG > 20) | 5 | 1.9 | Blisters | 2 | 2.7 |
| Elevated osmolal gap (OG > 20) | 2 | 0.8 | |||
| Gastrointestinal/hepatic | 18 | 6.8 | Metabolic | 5 | 6.7 |
| Hepatotoxicity (AST > 1000) | 14 | 5.3 | Metabolic acidosis (pH < 7.2) | 3 | 4.0 |
| Gastrointestinal bleed | 3 | 1.1 | Hypoglycemia (BG < 50) | 1 | 1.3 |
| Pancreatitis (lipase > 100) | 1 | 0.4 | Elevated anion gap (AG > 20) | 1 | 1.3 |
| Renal/muscle | 19 | 7.2 | Pulmonary | 4 | 5.3 |
| Acute kidney injury (creat > 2.0) | 13 | 4.9 | Aspiration pneumonitis | 2 | 2.7 |
| Rhabdomyolysis (CPK > 1000) | 4 | 1.5 | Respiratory depression | 2 | 2.7 |
| Hematologic | 13 | 4.9 | Cardiovascular | 1 | 1.3 |
| Significant leukocytosis (WBC > 20,000) | 6 | 2.3 | Prolonged QTc (≥500 ms) | 1 | 1.3 |
| Thrombocytopenia (PLTs < 20,000) | 4 | 1.5 | |||
| Significant coagulopathy (PT > 15) | 2 | 0.8 | |||
| Hemolysis (Hgb < 10) | 1 | 0.4 | |||
| Pulmonary | 10 | 3.8 | Hematologic | 1 | 1.3 |
| Aspiration pneumonitis | 6 | 2.3 | Significant leukocytosis (WBC > 20,000) | 1 | 1.3 |
| Respiratory depression | 3 | 1.1 | |||
| Acute lung injury/acute respiratory distress syndrome | 1 | 0.4 | |||
| Cardiovascular | 10 | 3.8 | |||
| Prolonged QTc (≥500 ms) | 8 | 3.0 | |||
| Ventricular dysrhythmias | 1 | 0.4 | |||
| Prolonged QRS (≥120 ms) | 1 | 0.4 | |||
| Dermatologic | 9 | 3.4 | |||
| Rash | 4 | 1.5 | |||
| Blisters | 3 | 1.1 | |||
| Angioedema | 2 | 0.8 | |||
| No signs or symptoms | 80 | 30.2 | No signs or symptoms | 24 | 32.0 |
| Two or more organ systems affected | 73 | 27.5 | Two or more organ systems affected | 19 | 25.3 |
Signs and symptoms are categorized by organ system and declining order of frequency. Percentages were calculated based on the number of adult or pediatric patients. Several patients may have had two or more organ systems affected; thus, the percentages do not add up to 100 %