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Acute poisoning: understanding 90% of cases in a nutshell

National Poisons Information Service (London), Guy’s and St Thomas’s NHS Trust, UK

Correspondence to:
Correspondence to:
Dr S Greene
Medical Toxicology Unit, Avonley Road, New Cross, London SE14 5ER, UK; Shaun.Greene{at}gstt.nhs.uk

The acutely poisoned patient remains a common problem facing doctors working in acute medicine in the United Kingdom and worldwide. This review examines the initial management of the acutely poisoned patient. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination, and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed.

Abbreviations: ED, emergency department; NPIS, National Poisons Information Service; TCA, tricyclic antidepressant; NSAID, non-steroidal anti-inflammatory drug; IV, intravenous; IM, intramuscular; CNS, central nervous system; AC, activated charcoal; GI, gastrointestinal; MDAC, multidose activated charcoal; ALF, acute liver failure; NAC, N-acetylcysteine; LFT, liver function test; MI, myocardial infarction; SSRI, selective serotonin reuptake inhibitor; ACS, acute coronary syndrome

Keywords: overdose; paracetamol; poisoning

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