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Nerves involved in the resizing of the pupil connect to the pretectal nucleus of the high midbrain, bypassing the lateral geniculate nucleus and the primary visual cortex. From the pretectal nucleus neurons send axons to neurons of the Edinger-Westphal nucleus whose visceromotor axons run along both the left and right oculomotor nerves .
The symptoms of an opiate toxidrome include the classic triad of coma, pinpoint pupils and respiratory depression [3] as well as altered mental states, shock, pulmonary edema and unresponsiveness. Complications include bradycardia, hypotension and hypothermia. Substances that may cause this toxidrome are opioids.
Pinpoint pupils, or miosis, caused by opioids. Because of their effect on the part of the brain that regulates breathing, opioids can cause very slow or stopped breathing, during overdoses, leading to hypoxia [16] or death if left untreated. [1] Hypoxia is typically caused by respiratory depression.
Organophosphate poisoning is poisoning due to organophosphates (OPs). [4] Organophosphates are used as insecticides, medications, and nerve agents. [4] Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion. [2]
Serotonin syndrome (SS) is a group of symptoms that may occur with the use of certain serotonergic medications or drugs. [1] The symptoms can range from mild to severe, and are potentially fatal. [ 4 ] [ 5 ] [ 2 ] Symptoms in mild cases include high blood pressure and a fast heart rate ; usually without a fever . [ 2 ]
The symptoms can often be divided into differing toxidromes. This can help one determine what class of drug or toxin is causing the difficulties. Symptoms of opioid overdoses include slow breathing, heart rate and pulse. [6] Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of oxygen in the blood.
After buprenorphine became an accepted treatment in France in the mid-’90s, other countries began to treat heroin addicts with the medication. Where buprenorphine has been adopted as part of public policy, it has dramatically lowered overdose death rates and improved heroin addicts’ chances of staying clean.
As a result of cholinergic crisis, the muscles stop responding to the high synaptic levels of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms reminiscent of organophosphate poisoning. Other symptoms include increased sweating, salivation, bronchial secretions along with miosis (constricted pupils).