GPAtlas🧭 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
• 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
• Behaviour that simply does not fit
Particularly suspect it where there is access to medicines, alcohol or chemicals, or a background of mental illness or substance misuse.
Keep a low threshold: act on the worst plausible scenario, because:
• Patients under-report quantity and timing
• Co-ingestion (including alcohol) is common
• 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
You do not need to name the toxin precisely: 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
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