Unfоrtunаtely, when it cоmes tо illicit drug overdose, toxidrome (toxic syndrome) clinicаl presentаtion is imperfect and complex synergistic symptoms from multiple co-ingested/co-injected/co-inhaled substances can overlap, clouding the clinical picture. In addition, sympathomimetic and parasympathomimetic drugs not only affect adrenergic and cholinergic diffuse modulatory systems but also dopaminergic and serotonergic diffuse modulatory systems as well as opioid receptors if opiates are on board. A good example of a challenging diagnostic case like this would be a patient that decided to mix the following opposing substances (hint: pick the 2 that have opposite effects on the body in terms of their mechanisms of action and/or drug category):
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