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

Common findings:

– Hyperthermia

– Tachycardia

– Hypertension

– Mydriasis

However, DIAPHORESIS is present only in sympathomimetic toxicity


Sympathomimetic toxidromes in children are not uncommon. Consider:

  • illicit drug use

  • ADHD abuse

  • breastfed infants (think cocaine, esp with seizures)

  • endogenous causes (pheochromocytoma, thyrotoxicosis)

Pheochromocytoma was the cause in this patient.