Overdose & Poisoning

• Every poisoning gets ABCs + glucose + ECG (QRS/QT); call the poison center early.
• Key antidotes to remember: naloxone (opioids), NAC (paracetamol), fomepizole (toxic alcohols), NaHCO₃ (TCA; target pH 7.50–7.55), Fab (digoxin), atropine+pralidoxime (OP), lipid emulsion (local anesthetics).
• Alkalinize urine for salicylates (pH 7.5–8.5); dialyze if altered mental state or renal failure.
• Reserve gastric lavage/whole-bowel irrigation for select lethal ingestions; single-dose charcoal only within 1 h when the airway is protected.

Key Initial Steps in Managing the Poisoned Patient

• ABCs first! Airway — intubate when needed · breathing — oxygenate/ventilate/track SpO₂ · circulation — IV access, fluids for ↓BP, telemetry/EKG
• Confused, somnolent, or comatose?
• 1. Check blood glucose or give 1 amp D50W IV · 2. Give thiamine 100 mg IV · 3. Give naloxone 0.4–2.0 mg IV · 4. Head CT if warranted
• 1. Brief history and physical · 2. Critical labs: CBC · serum electrolytes and glucose · liver and renal profiles · serum levels: EtOH, acetaminophen, salicylates · urine drug screen with TCA
• Specific toxin(s) known or strongly suspected?
• Administer antidote/therapy; call Poison Control 1-800-222-1222
• Patient improving?
• 1. Keep up supportive care · 2. Psychiatry consult when ingestion was intentional
• 1. Go over available data · 2. Detailed H&P · 3. Think about coingestion(s) · 4. Toxicology consult
• 1. Review all available data · 2. Detailed H&P · 3. Think about coingestion(s) · 4. Toxicology consult → weigh nonpoisoning causes of the symptoms