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Death from unintentional poisoning is a growing problem worldwide and prevention requires a multi-disciplinary approach. Knowledge of appropriate decontamination techniques and timely administration of antidotes coupled with excellent supportive care may positively alter the outcome of poisoned patients.


A detailed history is essential in the evaluation of a potentially poisoned patient. In the conscious, cooperative person, the specific agent(s), time, route, amount, and intent of exposure need to be determined. In the uncooperative or altered patient, adjunctive information from friends, family, prehospital providers, police, or bystanders may provide more accurate details. Environmental clues such as drug paraphernalia, empty pill bottles, odors, or suicide notes may aid in the diagnosis. If available, review hospital records for recent prescriptions or any history of psychiatric illness. Loose pills with imprint codes may be identified by the pharmacy or Poison Center.

A thorough exam begins with a completely disrobed patient. Review all vital signs and perform a comprehensive physical examination. Focus on the general appearance, level of consciousness, pupil size, mucous membranes, respiratory rate, breath sounds, presence of bowel sounds, skin temperature, and muscle tone as the combination of findings may suggest a specific toxidrome (Table 100-1). Important clinical features in the poisoned patient include hypoglycemia, cardiac dysrhythmias, seizures, agitation, and temperature alterations.

Table 100-1

Common Toxidromes


A diagnosis of poisoning is established primarily through the history, though the physical examination may provide clues ...

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