Many poisonous substances produce their primary toxic effects by affecting neurotransmission. Recognition of several known toxidromes may narrow the diagnostic focus and aid in management. The various types of toxidromes include: cholinergic syndrome, aticholinergic syndrome, adrenergic syndrome, sedative hypnotic syndrome, opioid syndrome, and withdrawal syndromes. Although many drugs depress the level of consciousness and respiratory drive, the agents most frequently responsible for these effects include opioids or sedative/hypnotics. The toxicity from any of these agents can cause hypotension, hypothermia, pulmonary edema, and hyporeflexia. Electrical injuries can result in numerous immediate and delayed neurological complications. The most common cause of death by either alternating current or direct current (lightning strike) is cardiorespiratory arrest. The most common cause of death in persons with significant thermal injury is multiple organ failure and its complications. Alternating current typically induces ventricular fibrillation and lightning strike (direct current) commonly causes asystole.