Red flags
- Coma, seizures, arrhythmia, severe acidosis
First steps
- ABCDE, glucose, identify substance + time + dose
- ECG, ABG, electrolytes, paracetamol & salicylate levels
Key investigations
- Anion + osmolar gap
- Drug levels where available
- ECG for QRS/QT
Differentials
- Cholinergic, anticholinergic, sympathomimetic, opioid, sedative-hypnotic, serotonin
Initial management
- Decontamination: activated charcoal 1 g/kg if airway protected & <1 h
- Naloxone, flumazenil (caution), atropine + pralidoxime for OP
- N-acetylcysteine for paracetamol per nomogram
- Sodium bicarbonate for TCA QRS >100 ms
Referral
- Toxicology / Poison centre
- ICU
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