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Poisoning, Emergency Medicine

Mark B. Mycyk Reviewed 06/2017



  • Poisoning may be intentional or unintentional.

  • Patients with change in mental status without clear cause should have poisoning (intoxication, overdose) considered in differential diag...


Signs and Symptoms

  • Neurologic:

    • Lethargy

    • Agitation

    • Coma

    • Hallucinations

    • Seizures

  • Respiratory:

    • Tachypnea, bradypnea, apnea

    • Inability to protect airway

  • Cardiovascular:

    • Dysrhythmias

    • Conduction blocks

  • Vital si...



  • Search for clues at scene:

    • Pills/pill bottles

    • Drug paraphernalia

    • Witnesses

    • Transport all drugs and pill bottles for identification.

  • Restrain uncooperative patients for patient and hea...



Admission Criteria

  • Altered mental status

  • Cardiopulmonary instability

  • Suicidal

  • Lab abnormalities

  • Potential for decompensation from delayed acting substance

Discharge Criteria

  • Psychiatrica...

Pearls and Pitfalls

  • Do not forget to consider nontoxicologic etiologies for altered mental status.

  • Do not rely on the urine drug screen to make a diagnosis: It only provides screening tests for a limit...

Additional Reading

  • Erickson  TB, Thompson  TM, Lu  JJ. The approach to the patient with an unknown overdose. Emerg Med Clin North Am.  2007;25(2):249–281.

  • Levine  M, Brooks  DE, Truitt  CA, et al....



  • 971.1 Poisoning by parasympatholytics (anticholinergics and antimuscarinics) and spasmolytics

  • 977.9 Poisoning by unspecified drug or medicinal substance

  • 977.9 Poisoning by unspecified drug or ...

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