Contributor: JP Brewer, MD

Educational Pearls:

• Obtaining collateral is often vital to determine the potential drugs accessible to the patient - this may include
• After this, use ancillary sources such as EMS, family/friends, and police to determine the patient's last normal, PMH and medications
• To help separate toxidromes, pupillary exam and skin exam are helpful
• Important physical exam clues in toxicology include the pupils and the skin
• Adjunct laboratory evaluation may include liver function tests, acetaminophen level, salicylate levels, urine drug screens, particularly in unknown ingestions
• Your local toxicologist (if you are fortunate to have one) or the Poison Center can always provide assistance in treatment and workup - consider involving them early

References

Erickson TB, Thompson TM, Lu JJ. The approach to the patient with an unknown overdose. Emerg Med Clin North Am 2007; 25:249.