Poisoning or overdose

🧭 When to suspect

Poisoning is common in UK primary care and spans deliberate self-poisoning, accidental exposure (especially exploratory ingestion in young children), recreational drug and alcohol toxicity, and therapeutic excess or iatrogenic error. Suspect it in any patient with an unexplained reduced level of consciousness, new confusion, agitation or seizures, an unexplained metabolic or cardiac disturbance, or behaviour that simply does not fit – particularly where there is access to medicines, alcohol or chemicals, or a background of mental illness or substance misuse.

The single most important principle in primary care is a low threshold: act on the worst plausible scenario, because patients under-report quantity and timing, co-ingestion (including alcohol) is common, and several important poisons – paracetamol, iron, lithium and modified-release preparations among them – cause little or nothing in the early hours yet are lethal if missed. The GP's task is not to name the toxin precisely but to recognise risk, resuscitate, and arrange emergency transfer, consulting TOXBASE (the National Poisons Information Service online clinical database) for agent-specific advice without ever delaying that transfer.

Source: NPIS · TOXBASE · NICE NG225