Sympathomimetic syndrome

a. Findings. Hypertension, diaphoresis, tachycardia, tachypnea, hyperthermia, and mydriasis. Restlessness, agitation, excessive speech, tremors, and insomnia also occur. Severe cases are associated with dysrhythmias and seizures.

b. Distinguishing features. May be difficult to distinguish from anticholinergic syndrome. Sweating and normal to hyperactive bowel sounds are associated with sympathomimetic overdose, whereas anticholinergic toxidrome manifests with dry skin and diminished bowel sounds.

c. Agents. Sympathetic agonists such as cocaine and amphetamine. Sympathomimetic effects may also be caused by over-the-counter decongestants such as phenylpropanolamine (no longer available legally), ephedrine, and pseudoephedrine. Theophylline and caffeine may cause many of these findings by enhancing catecholamine release. Overdoses with 02-adrenergic receptor agonists, methylphenidate, and Ephedra species such as ma huang cause sympathomimetic symptoms.

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