🧪 Toxicological emergencies are life-threatening situations caused by poisons, overdoses, or environmental exposures. Recognition of patterns + rapid supportive and antidote therapy saves lives 🚑.

⚡ Common Toxicological Emergencies (Quick Reference Table)

⚕️ Toxin / Poison	🧠 Key Clinical Features	🔬 Investigations	💉 Antidote / Key Management	💡 Notes / Pearls
💊 Paracetamol (Acetaminophen)	RUQ pain, nausea, vomiting, ↑LFTs, coagulopathy after 24–72 h	Plasma paracetamol level (use Rumack–Matthew nomogram), LFTs, INR	N-acetylcysteine (NAC) IV (start if >8 h post-ingestion or level above line)	Early NAC prevents hepatic necrosis; check for staggered overdose pattern.
📉 Tricyclic Antidepressants (TCA)	Anticholinergic toxidrome, QRS widening, seizures, arrhythmias	ECG (QRS > 100 ms → high risk), ABG for acidosis	IV sodium bicarbonate, benzodiazepines for seizures	Avoid class Ia/III antiarrhythmics; monitor in HDU/ICU.
☠️ Paraquat	Oral ulceration, vomiting, pulmonary fibrosis, multi-organ failure	Urine dithionite test, renal & LFTs	Supportive; early activated charcoal; ICU care	Highly fatal; O₂ can worsen oxidative injury-use minimal FiO₂.
🌾 Organophosphates	SLUDGE: salivation, lacrimation, urination, defecation, GI upset, emesis; fasciculations, bradycardia	Cholinesterase activity levels	Atropine + Pralidoxime (2-PAM), airway protection	Remove contaminated clothing; continue atropine until lungs dry.
💉 Opioids	Coma, pinpoint pupils, respiratory depression	ABG, glucose, toxicology screen	Naloxone (IV/IM/IN), airway and ventilation support	May require infusion if long-acting opioid (e.g. methadone).
🔥 Carbon Monoxide	Headache, dizziness, confusion, cherry-red skin, metabolic acidosis	Carboxyhaemoglobin (venous), ABG, ECG	100% O₂ via non-rebreather; Hyperbaric O₂ if severe	Pulse oximetry unreliable; look for co-exposed family members.
🍺 Alcohol Poisoning	CNS depression, hypoglycaemia, hypothermia, metabolic acidosis	Glucose, ethanol level, ABG, electrolytes	IV fluids, glucose, thiamine, rewarming	Always give thiamine before glucose in at-risk patients (Wernicke risk).
🧲 Iron Overdose	GI upset, haematemesis, shock, hepatic failure (after latent phase)	Serum iron level at 4–6 h, ABG, LFTs	Deferoxamine chelation, IV fluids, correct acidosis	Charcoal ineffective; serum iron > 90 µmol/L → chelate.
🐍 Snake Bite	Local pain/swelling, bleeding, coagulopathy, shock	Coagulation profile, FBC, renal function	Antivenom, fluids, wound care, tetanus prophylaxis	Immobilise limb, avoid tourniquets or incision.
💔 Beta-Blockers	Bradycardia, hypotension, hypoglycaemia, bronchospasm	Glucose, ECG, electrolytes	Glucagon, atropine, pacing if refractory	High-dose insulin euglycaemic therapy (HIET) if severe.
💊 Calcium Channel Blockers	Bradycardia, hypotension, hyperglycaemia	Glucose, ECG, calcium level	IV calcium, vasopressors, high-dose insulin therapy	Glucose infusion required during HIET; monitor K⁺ closely.
🌈 Digoxin Toxicity	Nausea, vomiting, confusion, visual halos, arrhythmias	ECG (scooped STs), serum digoxin level, K⁺	Digoxin-Fab antibodies, atropine, pacing if needed	Hyperkalaemia = poor prognostic sign; avoid calcium in arrest.

💬 Remember: Always secure the airway, support circulation, and seek early NPIS / TOXBASE advice for all poisonings. Activated charcoal is most effective within 1 hour for many ingestions, provided the airway is protected.

🩺 Core Principles in Management

🔄 ABCs first: Airway, Breathing, Circulation – always stabilise before specific therapy.
🧴 Decontamination: Activated charcoal if within 1–2 hours (selected poisons only).
💉 Antidotes: Use where available – time critical.
💊 Supportive care: Fluids, O₂, seizure control, correction of electrolytes.
📞 Poison Centre: Always involve early for specialist guidance.

🧪 Toxidrome Map – Clinical patterns of poisoning to rapidly identify likely agents and guide antidote use 🚑.

😴 Sedative–Hypnotic Toxidrome

🧠 CNS depression → drowsy, ataxic, coma
💨 Respiratory depression
❤️ Bradycardia, hypotension
👀 Normal pupils
⚠️ Causes: Benzodiazepines, Barbiturates, Alcohol
💉 Antidote: Flumazenil (benzos), supportive care

⚡ Sympathomimetic Toxidrome

🧠 Agitation, seizures, paranoia
👀 Mydriasis (dilated pupils)
❤️ Tachycardia, hypertension, arrhythmias
🌡️ Hyperthermia, sweating
⚠️ Causes: Cocaine, Amphetamines, MDMA
💉 Antidote: Benzodiazepines, cooling, supportive

🌿 Cholinergic Toxidrome (SLUDGE)

💦 Salivation, Lacrimation, Urination, Diarrhoea
🤢 GI cramps, Emesis
👀 Miosis (pinpoint pupils)
💨 Bronchospasm, bronchorrhoea → respiratory failure
⚠️ Causes: Organophosphates, Carbamates
💉 Antidote: Atropine + Pralidoxime

🚬 Anticholinergic Toxidrome

🧠 Agitation, hallucinations, delirium
👀 Mydriasis (dilated pupils)
🌡️ Hyperthermia, flushed skin, dry mouth
🧍 Urinary retention, ↓ bowel sounds
⚠️ Causes: Antihistamines, TCAs, Atropine, Antipsychotics
💉 Antidote: Physostigmine (with caution), supportive

💉 Opioid Toxidrome

🧠 CNS depression, coma
💨 Respiratory depression → apnoea
👀 Miosis (pinpoint pupils)
❤️ Bradycardia, hypotension
⚠️ Causes: Morphine, Heroin, Methadone, Fentanyl
💉 Antidote: Naloxone

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Toxicological Emergencies