This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong. ====== Pupil size and Reaction ====== Large pupils suggest a toxin with anticholinergic effects ([[:wikitox:2.1.11.9.2.1_tricyclic_antidepressants|TCAs]]) or adrenergic drugs ([[:wikitox:2.1.11.4.8.1_cocaine|cocaine]], amphetamines). Adrenergic drugs do not usually lead to coma unless complicated by seizures or cerebrovascular events. Fixed and dilated pupils may suggest a nontoxic effect such as raised intracranial pressure or brain death but drug effects on the brain stem should still be suspected. Drugs that can be the cause include baclofen, [[:wikitox:quinine|]] or massive [[:wikitox:barbiturates|barbiturate]] or other sedative drug overdose (including [[:wikitox:3.4.2.3_carbamazepine|carbamazepine]]). Small pupils suggest [[:wikitox:2.1.1.3_opioids|opioids]] but neuroleptics, [[:wikitox:2.1.11.5.1_acute_management_of_alcohol_problems|alcohol]], [[:wikitox:benzodiazepines|]], isopropyl alcohol, [[:wikitox:2.1.11.9.4_mood_stabilizers|lithium]], and [[:wikitox:2.2.7.4.5_organophosphates|organophosphates]] may all lead to miosis - check response to naloxone. ===== PUPILS and HALLUCINATIONS ===== Large pupils are found with the [[:wikitox:3.2.1.3_toxidromes|anticholinergic]] syndrome and with amphetamines, cocaine and other [[:wikitox:2.1.11.4.8_sympathomimetics_eg_amphetamines_cocaine|sympathomimetic drugs]]. The absence of large pupils does not exclude any of these drugs as pupil size can be influenced by other co-ingested drugs. ===== PUPILS and ANTICHOLINERGICS ===== Dilated pupils are found in all these poisonings. However, [[:wikitox:2.1.11.9.3_antipsychotics|neuroleptics]] and carbamazepine may also cause small pupils. ===== PUPILS and BRADYARRHYTHMIAS ===== Drugs with anticholinergic effects (TCAs, [[:wikitox:2.1.11.4.1_anticholinergics|orphenadrine]], and neuroleptics) will cause dilated, poorly reacting pupils. ===== PUPILS and HYPOTENSION ===== Small pupils suggest [[:wikitox:2.1.1.3_opioids|opioids]], alcohol, barbiturates or organophosphates. Dilated pupils suggest TCAs are more likely. ===== PUPILS and SEIZURES ===== Not particularly helpful, though dilated pupils suggest [[:wikitox:3.2.1.3_toxidromes|adrenergic ]] or anticholinergic stimulation the pupils may be abnormal due to the seizures themselves. ===== PUPILS and TACHYARRHYTHMIAS ===== Dilated pupils suggest anticholinergic drugs (TCAs, orphenadrine, neuroleptics) or sympathomimetic drugs (cocaine, amphetamines, [[:wikitox:2.1.11.4.8.2_theophylline|theophylline]]). ===== PUPILS and SYMPATHOMIMETICS ===== Dilated pupils are usual with all these drugs. CKG Edit