5 y/o F presents to the ED feeling “uneasy.” She is noted to have a pulse of 140 and BP of 180/110 and is profusely sweating. She is on imipramine for bedwetting, no other PMH. Pupils are PERRL. Exam is otherwise unremarkable. CBC, BMP, UA are negative. When considering a toxidrome, what is your differential?
Anticholinergic vs. Sympathomimetics
However, DIAPHORESIS is present only in sympathomimetic toxicity
Sympathomimetic toxidromes in children are not uncommon. Consider:
illicit drug use
breastfed infants (think cocaine, esp with seizures)
endogenous causes (pheochromocytoma, thyrotoxicosis)
Pheochromocytoma was the cause in this patient.