Clinical presentation of the main poisonings and toxidrome-based approach

Abstract

Acute poisonings represent a frequent cause of patient admission in the emergency department and intensive care unit. Diagnosis in clinical toxicology is based on medical history and clinical examination focused on the identification of toxidromes. Clinical examination is mandatory and should be evaluated several times and documented. Electrocardiogram as well as sampling for routine laboratory tests should be performed in any severely poisoned patient admitted to the intensive care unit. Despite no definitive predictive value, the clinical approach allows obtaining not only a positive diagnosis but also eliminating differential hypotheses. Administration of supportive treatments as well as emergency antidotes is based on clinical examination. Pharmacodynamic tests using specific antidotes including naloxone for opioids and flumazenil for benzodiazepines or analogs may complete the patient’s examination. Therefore, toxicological analysis allows only a retrospective confirmation of the initially suspected toxic etiology based on the clinical approach.