Recognition and management of acute medication poisoning

Poisoning is a common cause of morbidity and mortality in the United States, with several million episodes reported annually. Acute medication poisonings account for nearly one half of all poisonings reported in the United States and should be considered in persons with an acute change in mental status. The initial approach to a person who has been poisoned should be to assess the airway, breathing, and circulation, and to take a thorough history. Less than 1 percent of poisonings are fatal; therefore, management in most cases is supportive unless a specific antidote is available. Single-dose activated charcoal is the gastrointestinal decontamination modality of choice, but should not be used universally. Toxidromes are constellations of symptoms commonly encountered with certain drug classes, including anticholinergics, cholinergics, opioids, and sympathomimetics. Evaluation of possible medication poisonings should include basic laboratory studies, such as a complete metabolic profile, to determine electrolyte imbalances and liver and renal function. Most other laboratory studies should be performed based on clinical presentation and history. Ongoing treatment of unstable patients with toxic medication ingestions should focus on correcting hypoxia and acidosis while maintaining adequate circulation. These patients can have rapid decline in mental or hemodynamic status even when they appear to be compensating. Children can experience more profound effects from small amounts of medication. Disposition of a person who has been poisoned warrants careful consideration of multiple factors, and those exhibiting signs or symptoms of toxicity must be monitored longer.