Initial Evaluation:

• Patients with overdoses and poisonings should undergo initial evaluation to determine the specific poisoning for appropriate management options.
• History and physical examination are crucial to identify the possible toxidromes causing the patient’s presentation.

History and Physical Examination:

• Obtain a thorough poison history including route of exposure, suspected substance, amount ingested, time of ingestion, and possible coingestants.
• Perform a comprehensive physical examination to identify toxidrome-related signs and symptoms.

Laboratory Analysis:

• Common laboratory studies such as basic metabolic panel, ethanol, acetaminophen, and salicylate concentrations are helpful in determining the cause of poisoning.
• Toxicology laboratory tests like urine drug screens and quantitative serum drug testing aid in identifying specific toxins.

Gastrointestinal Decontamination:

• Gastrointestinal decontamination aims to decrease toxicity by removing toxins from the stomach before they are absorbed in the small intestine.
• Position statements recommend against routine use of ipecac, gastric lavage, single-dose activated charcoal, cathartics, and whole-bowel irrigation in poisoned patients.

Enhanced Elimination:

• Use of multiple-dose activated charcoal is recommended for patients who have ingested life-threatening amounts of certain substances like carbamazepine and phenobarbital.
• Urinary alkalinization is recommended for specific poisoning cases and not for others, as per the severity of poisoning.

Selected Antidotes:

• Specific antidotes like atropine, pralidoxime, physostigmine, naloxone, and other medications are used in the management of poisoned patients based on the identified toxin.

Supportive Care:

• Patients with poisonings and overdoses may also require supportive care depending on their clinical presentation and severity of toxicity.
• Monitoring and managing symptoms such as hypotension, cardiac arrhythmias, acute renal failure, seizures, and respiratory issues are essential in supportive care.