In last week’s blog, I introduced the concept of toxidromes—defined as a group of specific symptoms and clues which medical examiners use to identify the specific substance used to poison a victim.
In that blog, I discussed two of the most popular
toxidrome categories in modern fiction—Opiod/Opiate Toxidromes and Stimulant Drug Toxidromes. I stated that a central clue to identifying one of those lethal substances was to “look at the eyes” because depressant drugs such as opiates constrict the pupils and stimulant drugs dilate the pupils.
Today I’d like to continue the discussion of toxidromes by presenting two other drug categories that also have telltale clues involving the victim’s eyes and which can lead to a misdiagnosis of a lethal substance. A seasoned murder mystery writer always considers other hidden clues to construct a convincing story and to solve the murder in a believable and accurate fashion, and I hope this blog helps further that cause.
In last week’s blog, I mentioned that there were six general categories of toxidromes in modern toxicology: Opiod, Stimulant, Anticholinergic, Cholinergic, Sedative/Hypnotic and Serotonin Syndrome Substances.
Like those of opiod and stimulant drugs, anticholinergic and cholinergic toxidromes also affect the pupils in a specific telltale manner, and that might lead your medical professional character to a wrong conclusion about the lethal substance unless that character looks for further clues. Anticholinergic and cholinergic drugs produce more specific signs of an overdose that distinguish them from other toxic substances.
Without going into the complicated science behind the mechanism of how anticholinergic vs cholinergic drugs work in the body, the following is a brief discussion of the best ways to identify these drugs as lethal substances in a murder mystery.
Anticholinergic drugs involve several classes of drugs that include antihistamines, tricyclic antidepressants, muscle relaxants, 
antipsychotic drugs, anti-nausea patches and even some asthma medications. The common symptoms of an overdose for all of these drugs are stated as, “hot, dry, blind, red and mad!” The ways medical examiners remember toxic symptoms of these drugs are as follows: “hot as a hare, dry as a bone, blind as a bat, red as a beet and mad as a hatter.” Anticholinergic drugs also cause the pupils of the eye to dilate.
Therefore, it’s important to introduce other telltale signs of an overdose besides the size of the victim’s pupils in your writing. A combination of the above symptoms surely should provide interesting drama in a murder scene and give plenty of clues to your police and medical professional characters to identify the lethal substance and tie it back to your villain.
Cholinergic drugs, on the other hand, produce very WET side effects and the acronym SLUDGE is used most often to remember the symptoms of an overdose of these drugs. SLUDGE refers to Salivation, Lacrimation (tearing), Urination, Diarrhea, GI distress and Emesis. Substances in the general
cholinergic category include muscarine-containing mushrooms, several nerve agents, nicotine, and a variety of insecticides. Cholinergic drugs, however, produce constriction of the pupils of the eye and the combination of the above symptoms with pupil dilation help zero in on cholinergic substances as lethal weapons.
The entire subject of toxidromes can be very complicated and confusing. By doing some basic research into a few simple diagnostic clues, however, a writer can make solving the murder in his/her mystery novel very entertaining for the reader and achieve a level of believability that transforms good writing into GREAT WRITING!
Thoughts? Comments? I’d like to hear them!
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