toxicology Pathways

Risk stratification and N-acetylcysteine treatment for paracetamol (acetaminophen) overdose.

Cardiovascular and CNS management of tricyclic antidepressant overdose, including sodium bicarbonate therapy.

Recognition and titrated naloxone reversal of opioid overdose, including delayed-action and long-acting agents.

Recognition and management of anticholinergic poisoning, including supportive care and the role of physostigmine.

Supportive management of benzodiazepine overdose; selective use of flumazenil.

Bradycardia, hypotension and shock from β-blocker overdose — atropine, glucagon, high-dose insulin and intralipid.

Calcium, high-dose insulin euglycaemia and intralipid for severe calcium-channel-blocker poisoning.

Recognition (Hunter criteria) and management of serotonin syndrome from SSRI/SNRI/MAOI/triptan/linezolid combinations.

Acid–base management, urinary alkalinisation and indications for haemodialysis in salicylate poisoning.

Risk-stratification by elemental iron dose, role of whole-bowel irrigation, and desferrioxamine for severe poisoning.

Differentiating acute, acute-on-chronic and chronic lithium toxicity; indications for haemodialysis (EXTRIP).

Recognition of digoxin toxicity including arrhythmia patterns, hyperkalaemia and digoxin-specific antibody (DigiFab) indications.

Recognition of toxic alcohol ingestion (osmolar gap, anion gap), fomepizole/ethanol blockade and dialysis.

Cholinergic crisis from anticholinesterase agents — atropine titration to drying of secretions plus pralidoxime for organophosphates.

Hypertension, tachyarrhythmia, hyperthermia and end-organ injury from cocaine, amphetamines and MDMA — benzodiazepines first.

Recognition, oxygen therapy and indications for hyperbaric oxygen in carbon monoxide poisoning.

Rapid-onset coma and bradycardia from gamma-hydroxybutyrate / gamma-butyrolactone; supportive airway care and recognition of withdrawal.

Recurrent hypoglycaemia from sulfonylurea or insulin overdose — glucose, octreotide and prolonged observation.

Restrict supplemental oxygen, urgent decontamination and prognostication for paraquat — a highly lethal herbicide.

Reversal of life-threatening bleeding from DOACs — idarucizumab for dabigatran, andexanet alfa or PCC for factor Xa inhibitors.

Time-critical management of button battery ingestion — risk of caustic oesophageal injury within 2 hours.

Local anaesthetic systemic toxicity (LAST) and other Na⁺-channel blocker overdose — bicarbonate, intralipid and prolonged resuscitation.

Acute sedation, propofol infusion syndrome (PRIS) and ketamine recreational use — including urological complications.

Assessment of Vipera berus (UK adder) bite and indications for ViperaTAb antivenom.

First aid and management of UK and tropical marine envenomation (jellyfish, weever fish, sea urchin).

Syndromic approach to mushroom ingestion, with emphasis on amatoxin (Amanita phalloides) hepatotoxicity.

Refractory seizures and metabolic acidosis from isoniazid — pyridoxine antidote in gram-for-gram dosing.

Isopropyl alcohol (rubbing alcohol) ingestion — ketosis without acidosis, supportive care; HD only if severe.

Refractory tachyarrhythmia, seizures and hypokalaemia from theophylline — multi-dose charcoal and haemodialysis.

Smoke inhalation / industrial exposure / suicide; lactic acidosis + cardiovascular collapse; hydroxocobalamin first-line antidote.

Drug-specific toxidromes — phenytoin (cerebellar), carbamazepine (anticholinergic + cardiac), valproate (hyperammonaemia + hepatic).

Strong acid / alkali ingestion — DO NOT induce vomiting, no neutralisation, urgent endoscopy 12–24h, surgical input for full-thickness injury.

Severe pain disproportionate to skin signs; calcium gluconate gel topical + intra-arterial / IV; hypocalcaemia + hypomagnesaemia + cardiac arrhythmia.

Identify exposure (occupational, paint, water, traditional remedies); blood lead level; chelation for severe; address source.

Chronic cannabis use + recurrent severe vomiting + relief by hot showers; supportive + cessation curative.

β2-agonist toxicity — tachycardia, tremor, hypokalaemia, hyperglycaemia, lactic acidosis; supportive + cardiac monitoring.

'Spice', synthetic cathinones, NPS — variable presentation, supportive care, avoid haloperidol in stimulant.