TOXIDROMES: Solving The Poison Puzzle

Toxic SubstanceThe murders that occur in my novels and short stories often involve a lethal medicine or a poison. To create a believable plot, I make sure to do my homework to get the toxic effects of those substances correct. That’s where toxidromes play a key role in that research.

Toxidromes are a groups of signs and symptoms that constitute the basis for a diagnosis of a specific poison. They are the telltale signs as to what type of substance the murder weapon is. These key details help determine which specific substance was responsible for the lethal outcome.

Many times in the real world of clinical detective work to identify aTox Screne Test poison, a tox screen is not as helpful as one would think. This is because it only detects the most common drugs or toxins, and there is also a chance for false positive or negative results with general toxicology screening.

An astute medical professional first looks for obvious telltale signs of a poison and attempts to understand how the patient was acting in the moments before death to narrow down the type of poison before testing for drugs/poisons that could be the likely toxic substance.

There are six general categories of toxidromes in modern toxicology: Opiod, Stimulant, Anticholinergic, Cholinergic, Sedative/Hypnotic and Serotonin Syndrome Substances.

Murder scenes in fiction often focus on substances that create interesting drama as the offending drug or poison generates its lethal effects. Two toxidrome categories are the most popular in modern fiction writing: opiate and stimulant overdoses. Each produces interesting, dramatic and specific lethal effects.

Opiod/Opiate Drug Toxidromes: Opiates (natural opium plant derivatives such as morphine) and opiods (synthetic variations of natural opiates such as Opium Plantfentanyl, acetyl fentanyl and desmorphine) each create lethargy, confusion, slurred speech and then lead to a coma prior to death. Respiratory depression is often the cause of death. The victim simply ceases to breathe. Heroin is a common lethal drug in this category.

Opiod/opiate tox screens often don’t give reliable positive results and further testing is required to identify the specific lethal substance. If the victim is found alive, chances for a full recovery are good with the opiod reversal drug naloxone. This drug binds to the opiate drug receptors to block the lethal depressant effects ofNaloxone Auto-Injector opiates and opiods and is the usual treatment of first responders and law enforcement when an overdose is suspected. Naloxone auto-injectors with a premeasured opiod-antidote dose are available for rapid use by first responders on a suspected overdose victim.

Stimulant Drug Toxidromes: Drugs/poisons that create these toxidromes produce extreme agitation, hallucinations and paranoia. Often the victim has a dramatic rise in blood pressure and the heart races. Hyperthermia that includes hot skin, a fever and extreme sweating are telltale signs of a stimulant drug overdose. Tremors and seizures often precede death. “Hot and mad” are the usual telltale signs of stimulant overdoses.

The offending drugs in the stimulant category include amphetamines (speed), MDMA (ecstasy), “bath salts”, herbal stimulants, pseudoephedrine and caffeine. Cocaine is a common lethal stimulant drug. If the victim is found alive, benzodiazepine sedatives (such as Ativan, Valium and Xanax) are often administered to prevent or stop seizures and the other lethal side effects.

Dilated PupilsIt’s often said that the eyes tell the story in many overdose situations, at least until death occurs. Depressant drugs such as opiods constrict the pupils; whereas, stimulant drugs dilate the pupils.

Both of these drug categories on either end of the depressant/stimulant spectrum produce dramatic lethal effects and toxidrome-specific manifestations as the victim progresses toward death. Identification of the actual deadly substance can become its own nightmare for the medical examiner in your story, however. Solving the murder usually includes an intricate mix of clinical testing, old-fashion detective snooping and the recreating of the last moments of a victim’s life.

Thoughts? Comments? I’d love to hear them!




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About James J. Murray, Fiction Writer

With experience in both pharmaceutical manufacturing and clinical patient management, medications and their impact on one’s quality of life have been my expertise. My secret passion of murder and mayhem, however, is a whole other matter. I’ve always loved reading murder mysteries and thrillers, and longed to weave such tales of my own. Drawing on my clinical expertise as a pharmacist and my infatuation with the lethal effects of drugs, my tales of murder, mayhem and medicine will have you looking over your shoulder and suspicious of anything in your medicine cabinet.
This entry was posted in A How To Blog on Murder Plot Ideas, A How To Blog on Murder Weapons, About James J. Murray, About Murder, All About Murder, Blog Writers, Blogging, Bloodless Death Scene Writing, Bloodless Death Scenes, Chemical Poisons, Deciding How to Kill Off a Character in a Novel, Depressant and Stimulant Toxidromes, Designing Murder Plots, Developing Story Plots, Developing Storyline Ideas, Dramatic Murder Weapons, Drug Poisoning, Drugs For Murder Plots, Drugs Used For Murder, How to Choose a Murder Weapon for a Plot Idea, How To Write A BloodLess Murder Scene, Ideas for Murder Scenes, Instruments of Death, James J. Murray Blog, Killing a Villain in a Novel, Killing Off Characters in Writing, Killing Off Characters in Your Novel, Lethal Chemical Poisons, Lethal Chemicals in Murder Mysteries, Methods of Murder, Murder Mayhem and Medicine, Murder Weapon Groupings and Categories, Murder Weapons Discussed, Murder With Drugs, New Blog, New Methods To Kill Characters in Your Novel, Plotting Interesting Murder Scenes, Plotting Murder Scenes, Poisons and Murder, Poisons Used For Murder, Prescription For Murder Blog, The Science of Murder, The Writings of James J. Murray, Tools of Murder, Toxidrome's, Toxidromes and Murder, Toxidromes in Murder Mysteries, Toxidromes to Identify a Poison, Unique Murder Plots, Unique Murder Weapons, Ways to Murder, Writing Death Scenes, Writing Dramatic Murder Scenes and tagged , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

2 Responses to TOXIDROMES: Solving The Poison Puzzle

  1. Thanks for the mini-primer, James. That’s a reference keeper for the novel I’m working on.

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