IDENTIFICATION OFTHE POISON(S)
The key pieces of information are:
• the identity of the substance(s) taken
• the time that has since elapsed. Adults may be sufficiently conscious to give some indication of the poison or may have referred to it in a suicide note, or there may be other circumstantial evidence. Rapid (1-2 h) biochemical 'screens' of plasma or urine are available but are best reserved for seriously ill or unconscious patients in whom the cause of coma is unknown. Analysis of plasma for specific substances is essential in suspected cases of paracetamol or iron poisoning, to indicate which patients should receive antidotes; it is also required for salicylate, lithium and some sedative drugs, e.g. trichloroethanol derivatives, phenobarbitone, when a decision is needed about using urine alkalinisation, haemodialysis or haemoperfusion. Response to a specific antidote may provide a diagnosis, e.g. dilatation of constricted pupils and increased respiratory rate after i.v. naloxone (opioid poisoning) or arousal from unconsciousness in response to i.v. flumazenil (benzodiazepine poisoning).
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