A 32-year-old male is tachycardic, agitated and has dilated pupils. Which toxidrome is most likely?

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The signs point to a sympathomimetic (stimulant) toxidrome. When stimulants like amphetamines are ingested, they increase catecholamine activity (norepinephrine and dopamine), leading to a fight-or-flight response. That results in rapid heart rate, agitation or agitation/psychomotor excitement, and pupil dilation from iris-sympathetic stimulation.

In contrast, opioids such as morphine or heroin typically cause sedation, respiratory depression, and pinpoint (constricted) pupils, not dilated ones. Nerve agents produce a cholinergic toxidrome with sweating, bronchorrhea, muscle fasciculations, and often miosis (constricted pupils) along with bradycardia in severe cases.

So the combination of tachycardia, agitation, and dilated pupils best fits amphetamine intoxication, reflecting the stimulant/toxidrome.