Question:
A 30-year-old female abuser with suicidal tendency brought to hospital. Mydriasis, tachypnea, tachycardia +. Diagnosis
A 30-year-old female abuser with suicidal tendency brought to hospital. Mydriasis, tachypnea, tachycardia +. Diagnosis
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Mydriasis + tachypnoea + tachycardia = a sympathomimetic toxidrome – the opposite of the opioid (pinpoint pupil, slow breathing) picture.
Updated On: Jun 22, 2026
- Cocaine
- Morphine
- Heroin
- Chlorpheniramine
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The Correct Option is A
Solution and Explanation
Step 1: Build the toxidrome. The drug abuser presents with mydriasis (dilated pupils), tachypnoea (fast breathing) and tachycardia (fast heart rate). This triad of pupillary dilatation plus sympathetic/cardiorespiratory stimulation is a sympathomimetic toxidrome.
Step 2: Match the toxidrome to the drug. Among the options, cocaine is the classic sympathomimetic stimulant: by blocking re-uptake of dopamine, noradrenaline and serotonin it produces mydriasis, tachycardia, hypertension, tachypnoea, hyperthermia and agitation. This fits the patient perfectly.
Step 3: Eliminate the opioids.
• Morphine (B) and Heroin (C) are opioids and cause the OPPOSITE picture - the opioid toxidrome of pinpoint pupils (miosis), respiratory DEPRESSION (bradypnoea) and bradycardia/sedation. They cannot explain mydriasis with tachypnoea/tachycardia.
Step 4: Eliminate the antihistamine. Chlorpheniramine (D) is a first-generation H1 antihistamine with anticholinergic effects. Although it can dilate pupils and cause tachycardia, its classic picture is the ANTICHOLINERGIC toxidrome (dry mouth, hot dry flushed skin, urinary retention, delirium, often with respiratory depression in overdose) rather than the pure sympathomimetic stimulant pattern; the best single fit for mydriasis + tachypnoea + tachycardia in a drug abuser is cocaine.
Final answer: A - Cocaine.
Step 2: Match the toxidrome to the drug. Among the options, cocaine is the classic sympathomimetic stimulant: by blocking re-uptake of dopamine, noradrenaline and serotonin it produces mydriasis, tachycardia, hypertension, tachypnoea, hyperthermia and agitation. This fits the patient perfectly.
Step 3: Eliminate the opioids.
• Morphine (B) and Heroin (C) are opioids and cause the OPPOSITE picture - the opioid toxidrome of pinpoint pupils (miosis), respiratory DEPRESSION (bradypnoea) and bradycardia/sedation. They cannot explain mydriasis with tachypnoea/tachycardia.
Step 4: Eliminate the antihistamine. Chlorpheniramine (D) is a first-generation H1 antihistamine with anticholinergic effects. Although it can dilate pupils and cause tachycardia, its classic picture is the ANTICHOLINERGIC toxidrome (dry mouth, hot dry flushed skin, urinary retention, delirium, often with respiratory depression in overdose) rather than the pure sympathomimetic stimulant pattern; the best single fit for mydriasis + tachypnoea + tachycardia in a drug abuser is cocaine.
Final answer: A - Cocaine.
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