Summary

Acute poisoning is exposure to a toxic substance that causes harm, which can occur through ingestion, inhalation, injection, or skin contact. Think of poisoning as your body being overwhelmed by a toxic substance—the substance interferes with normal body functions, causing symptoms that range from mild (nausea, dizziness) to severe (coma, cardiac arrest, death). Poisoning is common, with millions of cases each year worldwide, and can be accidental (especially in children, elderly) or intentional (suicide attempts, substance abuse). The key to management is a systematic approach: immediate assessment (ABCs, identify toxidrome), supportive care (maintain ABCs, treat symptoms), decontamination if appropriate (activated charcoal, gastric lavage in specific cases), antidotes if available (specific antidotes for specific poisons), elimination enhancement if needed (dialysis, urinary alkalinization), and close monitoring. Most poisonings can be managed with supportive care, but some require specific antidotes or advanced interventions. Early recognition and appropriate management can save lives.

Key Facts

• Definition: Exposure to toxic substance causing harm
• Incidence: Very common (millions of cases/year worldwide)
• Mortality: Low overall (<1%), but varies by substance
• Peak age: Bimodal (children 1-5 years accidental, adults 20-40 years intentional)
• Critical feature: History of exposure, toxidrome recognition, supportive care
• Key investigation: Clinical assessment, toxidrome identification, specific tests if needed
• First-line treatment: ABCs, supportive care, decontamination if appropriate, antidotes if available

Clinical Pearls

"ABCs first, always" — Airway, Breathing, Circulation come first in all poisonings. Don't get distracted by the poison—support the patient first.

"Toxidromes are your friend" — Recognizing toxidromes (anticholinergic, cholinergic, opioid, sympathomimetic, sedative-hypnotic) helps identify the poison and guide treatment even if the substance is unknown.

"Most poisonings are managed supportively" — Most poisonings don't have specific antidotes and are managed with supportive care (ABCs, treat symptoms, time). Don't over-treat.

"Activated charcoal is selective" — Activated charcoal is only useful for certain poisons and only if given within 1-2 hours. Don't use it for everything.

Why This Matters Clinically

Poisoning is common and can be life-threatening. A systematic approach (ABCs, toxidrome recognition, supportive care, specific treatments) is essential for good outcomes. Most poisonings can be managed with supportive care, but some require specific antidotes or advanced interventions. This is a condition that emergency clinicians manage frequently, and a systematic approach saves lives.

Structured Approach: ABCDE

A - Airway

• Assessment: May be compromised (altered mental status, respiratory depression)
• Action: Secure if compromised (intubation if needed)

B - Breathing

• Look: May have respiratory depression
• Listen: May have decreased air entry
• Measure: SpO2 (may be low), respiratory rate (may be low)
• Action: Support if needed (oxygen, ventilation)

C - Circulation

• Look: May have signs of shock
• Feel: Pulse (may be abnormal), BP (may be abnormal)
• Listen: Heart sounds (usually normal)
• Measure: BP (may be abnormal), HR (may be abnormal)
• Action: Support if needed (IV fluids, inotropes)

D - Disability

• Assessment: Mental status (GCS), pupils, tone
• Action: Assess for toxidrome

E - Exposure

• Look: Full examination, look for toxidrome signs
• Feel: Skin (dry/moist, temperature)
• Action: Complete examination, identify toxidrome

Specific Examination Findings

Neurological Examination:

• Mental status: May be altered (confusion, coma)
• Pupils: May be abnormal (pinpoint = opioid, dilated = anticholinergic)
• Tone: May be abnormal
• Reflexes: May be abnormal

Cardiovascular Examination:

• Pulse: May be fast or slow
• BP: May be high or low
• Heart sounds: Usually normal

Respiratory Examination:

• Rate: May be slow (respiratory depression)
• Air entry: May be decreased
• Chest: Usually normal

Skin Examination:

• Temperature: May be hot or cold
• Moisture: May be dry (anticholinergic) or sweaty (cholinergic, sympathomimetic)
• Color: May be flushed (anticholinergic) or pale (shock)

Special Tests

Natural History (Without Treatment)

Untreated Poisoning:

• Varies by substance: Some recover, some die
• Severe cases: High mortality if not treated
• Mild cases: Usually recover

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Mild cases: Usually recover completely
• Supportive poisonings: Usually recover
• Specific antidotes available: Better outcomes

Poor Prognosis:

• Delayed treatment: Higher mortality
• Severe cases: Higher mortality
• No antidote available: May have worse outcomes
• Organ damage: May have permanent damage

Prognostic Factors

Key Guidelines

1. TOXBASE — UK National Poisons Information Service. TOXBASE

Key Recommendations:

• Systematic approach (ABCs first)
• Toxidrome recognition
• Specific antidotes
• Evidence Level: Expert opinion, evidence-based

2. AACT Guidelines — American Academy of Clinical Toxicology. AACT

Key Recommendations:

• Similar approach
• Evidence Level: Expert opinion, evidence-based

Landmark Trials

Multiple studies on specific antidotes, decontamination.

Evidence Strength

What is Acute Poisoning?

Acute poisoning is exposure to a toxic substance that causes harm, which can occur through swallowing, breathing in, injection, or skin contact. Think of poisoning as your body being overwhelmed by a toxic substance—the substance interferes with normal body functions, causing symptoms that range from mild (nausea, dizziness) to severe (coma, cardiac arrest).

In simple terms: You've been exposed to something toxic that's making you unwell. With proper treatment, most people recover completely, but some poisonings can be serious and need urgent treatment.

Why does it matter?

Poisoning can be life-threatening if not treated promptly. Early recognition and appropriate management (supportive care, specific antidotes if available) can save lives. The good news? Most poisonings can be managed with supportive care, and most people recover completely.

Think of it like this: It's like your body being overwhelmed by a toxic substance—with the right care, your body can usually clear it and recover.

How is it treated?

1. Immediate Care (Most Important):

• ABCs: Your doctor will make sure your airway, breathing, and circulation are supported
• Why: This is the priority—keeping you alive and stable
• What: Oxygen, IV fluids, monitoring, may need help breathing

2. Identify the Poison:

• History: If you know what you were exposed to, tell your doctor
• Examination: Your doctor will examine you to identify signs that help identify the poison
• Tests: You may have blood tests to check for specific poisons

3. Decontamination (If Needed):

• Activated charcoal: If you swallowed something, you may get activated charcoal (if appropriate and within 1-2 hours)
• Why: To prevent more of the poison from being absorbed
• Skin: If it got on your skin, your doctor will wash it off

4. Specific Antidotes (If Available):

• Some poisons have antidotes: Medicines that reverse the effects
• Examples: Naloxone for opioids, N-acetylcysteine for paracetamol
• Why: To reverse the toxicity if possible

5. Supportive Care:

• Treat symptoms: Your doctor will treat your symptoms as they arise
• Monitor: Close monitoring to watch for complications
• Time: Most poisonings clear with time and supportive care

The goal: Keep you stable, prevent further harm, and help your body clear the poison.

What to expect

Recovery:

• Most cases: Start feeling better within hours to days
• Symptoms: Should improve as the poison clears
• Full recovery: Most people recover completely

After Treatment:

• Monitoring: You'll be monitored until stable
• Discharge: When you're stable and asymptomatic
• Follow-up: Usually not needed unless complications

Recovery Time:

• Mild cases: Usually recover within hours to days
• Moderate cases: Usually recover within days
• Severe cases: May take longer, may have complications

When to seek help

Call 999 (or your emergency number) immediately if:

• You've been exposed to a toxic substance and feel unwell
• You have severe symptoms (difficulty breathing, altered mental status, seizures)
• You feel very unwell
• You're not sure if it's serious

See your doctor if:

• You've been exposed to a toxic substance and have mild symptoms
• You're not sure if you need help
• You have concerns

Remember: If you've been exposed to a toxic substance and feel unwell, especially if you have severe symptoms, call 999 immediately. Don't wait—early treatment can save your life. Also, if you know what you were exposed to, tell your doctor—this helps guide treatment.