Managing acute poisonings and drug overdoses in the ICU: Strategies for initial stabilization, toxin removal, supportive care

When confronted with a poisoned patient, first assess the airway, breathing, and circulation. Intubate the patient and institute mechanical ventilation if respiratory depression, obtundation, or copious respiratory secretions are present. Use isotonic fluids initially to correct any hypotension. Once the patient's condition is stable, a medical history, physical examination, ECG, and selected tests (such as arterial blood gas studies, toxicology tests on blood and urine, and measures of serum osmolality and electrolyte levels) may help identify the toxin. Administer the antidote, if one is available, or consider gastric lavage, activated charcoal, or whole bowel irrigation to prevent toxin absorption. Multiple doses of charcoal, hemoperfusion, urine alkalinization, or hemodialysis may enhance toxin elimination in selected patients.