Laboratory Studies

Standard laboratory tests for poisoned patients are indicated if the patient has significant symptoms. Such tests may include the following:

Rapid bedside glucose determination
Arterial blood gas determination - Indicated if a compromise in oxygenation or ventilation is suspected
Lactate level - May be useful in phases 2 and 3 of an acute overdose to help determine end-organ perfusion
Determination of serum electrolyte, calcium, and magnesium levels - Calculation of the anion gap possibly helpful in screening for co-ingestions (see the Anion Gap calculator)
Serum acetaminophen level and salicylate level - Indicated in intentional overdoses
Screening for serum levels of alcohol (ethanol, methanol, isopropyl alcohol) - Indicated if alcohol ingestion is clinically suspected
Urine pregnancy test - Indicated in all women of childbearing age
Urinalysis and urine pH determination - May be useful in the setting of rhabdomyolysis
Urine drug screening - Comprehensive drug screening and screening for commonly abused drugs is possibly helpful in assessing co-ingestions

Quantitative levels of monoamine oxidase inhibitors are not readily available and, therefore, are not clinically useful. Consider workup for hypertensive emergencies if any signs or symptoms are present.

Imaging Studies

Chest radiography is indicated if aspiration is a concern. Perform postintubation chest radiography to evaluate the position of the endotracheal tube in relation to the carina if respiratory support is needed.

Treatment & Management

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Author

Eddie Garcia, MD Resident Physician, Department of Emergency Medicine, Rutgers New Jersey Medical School

Eddie Garcia, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, Emergency Medicine Residents' Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Diane P Calello, MD, FAAP, FACMT, FAACT Executive and Medical Director, New Jersey Poison Information and Education System; Associate Professor, Department of Emergency Medicine, Rutgers New Jersey Medical School; Director of Toxicology, Attending Physician, Pediatric Emergency Department, Morristown Medical Center, Atlantic Health System

Diane P Calello, MD, FAAP, FACMT, FAACT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Attending Physician in Emergency Medicine and Medical Toxicology, Excela Health System

Fred Harchelroad, MD, FACMT, FAAEM, FACEP is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Chief Editor

Michael A Miller, MD Clinical Professor of Emergency Medicine, Medical Toxicologist, Department of Emergency Medicine, Texas A&M Health Sciences Center; CHRISTUS Spohn Emergency Medicine Residency Program

Michael A Miller, MD is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Additional Contributors

Richard Lavely, MD, JD, MS, MPH Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Steven Marcus, MD Professor, Department of Preventive Medicine and Community Health, Associate Professor, Department of Pediatrics, Rutgers New Jersey Medical School, Rutgers University School of Biomedical and Health Sciences; Executive and Medical Director, New Jersey Poison Information and Education System; Consulting Staff, Departments of Pediatrics and Internal Medicine, University Hospital; Consulting Staff, Department of Pediatrics, Newark Beth Israel Medical Center

Steven Marcus, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Clinical Toxicology, American Academy of Pediatrics, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Wirachin Hoonpongsimanont, MD Clinical Instructor, Department of Emergency Medicine, University of California, Irvine

Wirachin Hoonpongsimanont, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.