Clinical diagnosis with history and physical exam
Red as a beet: cutaneous vasodilation
Blind as a bat: nonreactive mydriasis (often delayed 12-24hr)
Mad as a hatter: delirium; attention deficit; hallucinations; dysarthria; lethargy
Full as a flask: urinary retention
Hot as a hare: anhydrotic hyperthermia (may become severe w/ agitation)
Dry as a bone: anhidrosis (esp axillae, mouth)
And the heart runs alone: Tachycardia (HR 120-160) and decreased/absent bowel sounds
Jimson weed
Sympathomimetic toxicity
Tapeworm
Red, dry skin and absent bowel sounds favors anticholinergic toxicity
Amanita mushrooms
Encephalitis
Inocybe
Head trauma