Intended for healthcare professionals

Student Clinical review

Poisoning and overdose

BMJ 2013; 346 doi: (Published 26 June 2013) Cite this as: BMJ 2013;346:f3768
  1. W Stephen Waring, consultant in acute medicine and clinical toxicology1,
  2. Abigail M Green, undergraduate medical student2
  1. 1York Teaching Hospital NHS Foundation Trust, York YO31 8HE, UK
  2. 2Hull York Medical School, John Hughlings Jackson Building, University of York, Heslington, York YO10 5DD, UK

As common in emergency departments as heart attack

Poisoning is a major public health issue and each year gives rise to about 500 000 attendances to emergency departments in the United Kingdom and around 140 000 admissions to hospital.1 This equates to 1-2% of all emergency department attendances, which is similar to the number of patients who present to hospital as a result of heart attack. Emergency department attendances because of poisoning have gradually increased over recent years, although the reasons for this are poorly understood.2 In the UK, poisoning results in around 2000 deaths each year, and less than a third of these occur in hospital.23 Therefore, data from hospital attendances represent only the “tip of the iceberg,” and the true scale of self poisoning in the community might be much greater. We present an overview of common clinical presentations from poisoning, the general clinical approach to care, and an overview of the management of paracetamol toxicity as a specific example.

Patterns of poisoning

Intentional overdose

Self poisoning accounts for nearly all toxicology cases in acute healthcare services. Patients might have been exposed to any one of a wide variety of different drugs, chemicals, or other toxic hazards.4

In the UK attempted suicide was considered a criminal offence until the introduction of the Suicide Act 1961 in England and Wales. Since then, the suicide rate has fallen, although there has been an alarming recent increase in suicide among young men.25 The mode of suicide has evolved, and self poisoning has increased whereas violent deaths have decreased.5 Introduction of the Suicide Act led to a substantial increase in the number of patients seeking medical attention after self poisoning and emergence of specialist poisoning treatment units in the 1960s.6

The type of agent used in self poisoning depends on …

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