🧑‍🚒 Protect staff (e.g. organophosphates).
🫁 ABC + Oxygen if SpO₂ <94%. GCS <9 → ITU review.
💧 Irrigate eyes/skin if contaminated.
🩸 Check CBG (>4.0 mmol/L). If unsure → give glucose.
💉 Suspected opioid → give Naloxone.
🔬 IV access + bloods (paracetamol, salicylate levels).
🧪 Activated charcoal 50 g PO if <1 hr (except iron, lithium, methanol, etc.).
🧍‍♂️ Top-to-toe exam: look for trauma, rashes, patches (e.g. fentanyl).
🧠 CT head/neck if cause unclear.
👀 Pupils: unilateral dilated = coning; bilateral small = opioids/GHB/OP; bilateral large = cocaine/TCA/ICH.
🌡️ Rewarm if hypothermic.
⚖️ Calculate anion gap: Na⁺ – (Cl⁻ + HCO₃⁻). High gap → alcohols, CO, salicylates, lactic acidosis, DKA.
✔️ Naloxone + glucose cause little harm if diagnosis unclear.
🧫 If no diagnosis on CT: consider IV cefotaxime + IV aciclovir ± LP.
🌍 Travel? Consider cerebral malaria (blood films).
📈 EEG if non-convulsive status suspected.
💊 Sepsis? Give broad-spectrum antibiotics + escalate to HDU/ITU.

⚠️ Risk Factors for Overdose

🧠 Psychiatric illness (depression, schizophrenia)
👤 Male sex, Living alone
💔 Recent bereavement/divorce
📝 Suicide note written
🎂 Age >45
💼 Unemployment
🩺 Chronic physical illness
🍷 Drug or alcohol misuse
🔄 Previous attempts (esp. violent methods)

🚨 Any septic patient with lactate >4 mmol/L = septic shock until proven otherwise → immediate IV fluids, antibiotics, ± inotropes (per sepsis bundle).

📖 About Lactate

Normal: <1 mmol/L
Raised: >2 mmol/L
Lactic acidosis: >4 mmol/L + pH <7.35

🧾 Classification of Lactic Acidosis

Type	Causes
⚡ Type A (Hypoxia-driven)	Shock, anaemia, hypoxia, bowel ischaemia, seizures, cholera, phaeochromocytoma, tumour lysis
🧪 Type B (Non-hypoxia)	Liver failure, DKA, ethanol abuse, drugs (metformin, methanol, ethylene glycol, salicylates, cyanide)

🤒 Clinical Features

Hypotension, shock, peri-arrest appearance.
Respiratory: Kussmaul breathing, tachypnoea.
Organ failure: renal, hepatic, cardiac involvement.

🔍 Clinical Clues in Toxicology

Finding	Possible Cause
🌸 Pink colour	Cyanide, CO poisoning
💙 Cyanosis	Methaemoglobinaemia
🤢 Nausea/vomiting	Paracetamol, NSAIDs, salicylates, iron
👁️ Small pupils	Opioids, GHB, organophosphates
👁️ Large pupils	Cocaine, TCA, anticholinergics
❤️ Hypertension	Cocaine, amphetamines
💔 Hypotension	TCAs, haloperidol
🐢 Bradycardia	Digoxin, β-blockers, CCBs
🐇 Tachycardia	TCAs, theophylline, digoxin
🍬 Hypoglycaemia	Insulin, sulphonylureas, alcohol
🍭 Hyperglycaemia	Organophosphates, theophylline
😮‍💨 Hyperventilation	Salicylates
🧪 Renal failure	Salicylates, paraquat, ethylene glycol
🔥 Hyperthermia	Serotonin syndrome, cocaine, MDMA
❄️ Hypothermia	CNS depressants, opioids
🟡 Jaundice	Paracetamol, solvents
⚡ Seizures	TCAs, opioids, cocaine
💪 Rhabdomyolysis	Amphetamines
🤯 Myoclonic jerks	GHB
❤️ Chest pain	Cocaine, CO
👄 Oral ulcers	Corrosives, paraquat
🧮 High osmolar gap	Methanol, acetone
➕ High anion gap	Metformin, methanol, iron, INH

💊 Specific Antidotes

Always check local toxicology/NPIS guidance before giving antidotes.

Drug	Antidote
Digoxin	Digibind (Fab)
Iron	Desferrioxamine IV
Opioids	Naloxone IV
Paracetamol	N-acetylcysteine or methionine
Warfarin	Vit K + PCC/FFP
Heparin	Protamine
Methanol, ethylene glycol	Fomepizole or ethanol
Benzodiazepines	Flumazenil (⚠️ seizure risk)
β-blockers	Atropine, glucagon
TCAs	IV sodium bicarbonate
Sulphonylureas	Glucose, octreotide
Organophosphates	Atropine + pralidoxime
Methotrexate	Folinic acid
CO poisoning	100% O₂ ± hyperbaric O₂
Methaemoglobinaemia	Methylene blue
Cyanide	Cyanide kit (amyl nitrite, thiosulfate)
Arsenic	Dimercaprol or succimer
Theophylline, salicylates	Haemodialysis

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.

Drug Toxicity Assessment and Management

🩺 General Measures (when diagnosis uncertain)