Management protocol of poisoning (specific and non-specific antidotes)

Investigations

Toxidromes are created to assist diagnosis. History may be inaccurate; therefore, the following laboratory tests should usually be obtained for guidance:

• Complete blood count

• Liver function test

• Serum lactate

• Arterial blood gas

• Electrocardiogram

• Urine pregnancy test in all women of childbearing age

• Basic serum electrolytes, blood urea nitrogen (BUN), and creatinine

Sympathomimetic poisoning investigations

• Random blood glucose (bedside)

• ECG

• Serum electrolytes and renal function test

• Liver function test

• Creatinine kinase

• Clotting screen: PT/PTT/INR

• Full blood count

• Arterial blood gas

• Serum osmolality and osmolality gap

• Abdominal X-ray may be useful in diagnosis

Cholinergic poisoning investigations

• Glucose

• BUN

• Electrolytes

• Prothrombin time

• Liver function test

• Cholinesterase measurements

Drug/toxin level measurement

Measurement of drug or toxin concentrations in body fluids is not required in most poisonings, but in some exposures it does influence management.

Drugs or toxins requiring measurement of concentrations

• Paracetamol

• Methanol

• Carbamazepine

• Methotrexate

• Carbon monoxide

• Organophosphorus compounds

• Digoxin

• Paraquat

• Ethanol

• Phenobarbital

• Ethylene glycol

• Phenytoin

• Iron

• Salicylate

• Lithium

• Theophylline

• Methemoglobin

• Valproic acid

Supportive care

Respiratory and cardiovascular conditions

Psychosocial intervention

• Investigations depend on the poison ingested

• If the toxin cannot be identified, toxidromes (signs and symptoms) can be used