Last reviewed: 27 Aug 2021
Last updated: 15 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • impaired mental status
  • drowsiness, slurred speech, ataxia
  • coma
  • respiratory depression

Other diagnostic factors

  • decreased deep tendon reflexes
  • nystagmus
  • paradoxical stimulation
  • hypothermia
  • rhabdomyolysis

Risk factors

  • depression
  • history of illicit drug or alcohol use
  • history of benzodiazepine use
  • drug administration error
  • comorbidity
  • history of polydrug or unknown substance ingestion
  • suicidal ideation or behaviour
  • older age
  • Severe liver disease
  • drug interaction
  • biogenetic susceptibility

Diagnostic investigations

1st investigations to order

  • pulse oximetry
  • arterial/venous blood gas
  • FBC
  • urea and electrolytes
  • liver function tests
  • ECG
  • creatine kinase
  • plasma paracetamol concentration

Treatment algorithm

Contributors

Expert advisers

Euan A. Sandilands, MBChB, BSc(Hons), MD, FRCP Edin

Consultant Clinical Toxicologist

Director

National Poisons Information Service (Edinburgh)

Royal Infirmary of Edinburgh

Edinburgh

UK

Disclosures

EAS declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Paul M. Gahlinger MD, PhD, MPH

General Practitioner

Paradise Medical Group

Paradise

CA

Peer reviewers

Marianne Gillings, BPharm(Hons), MBBS, MRCP(UK), PGDip(MedTox), FRCEM

Consultant in Emergency Medicine

Training Programme Director for the ACCS Emergency Medicine and Acute Medicine programmes

Severn Deanery

Bristol

UK

Disclosures

MG is a member of the RCEM Toxicology Steering Group (unremunerated).

Editors

Emma Quigley,

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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