• Deliberate and accidental self-poisoning

• Principles of treatment

• Poison-specific measures

• General measures

• Specific poisonings: cyanide, methanol, ethylene glycol, hydrocarbons, volatile solvents, heavy metals, herbicides and pesticides, biological substances {overdose of medicinal drugs is dealt with under individual agents)

• Incapacitating agents: drugs used for torture

Deliberate self-poisoning. A curious by-product of the modern 'drug and prescribing explosion' is the rise in the incidence of nonfatal deliberate self-harm. The majority of people who do this lack serious suicidal intent and are therefore termed parasuicides. In over 90% of instances in the UK, poisoning is the means chosen, usually by medicines taken in overdose and these amount to at least 70 000 hospital admissions per annum in England and Wales (population 51 million). Two or more drugs are taken in over 30% of episodes, not including alcohol which is also taken in over 50% of the instances; the use of hypnotic and sedative drugs, and psychotropic drugs is increasing. Repeated episodes are not rare.1 Prescribed drugs are used in over 75% of episodes but teenagers tend to favour nonprescribed analgesics available by direct sale, e.g. paracetamol, which is important bearing in mind its potentially serious toxicity. The mortality rate of self-poisoning is very low (less than 1% of acute hospital admissions), but 'completed' suicides by poisoning still number 3500 per annum in England and Wales.

Accidental self-poisoning causing admission to hospital occurs predominantly amongst children under 5 years, usually with medicines left within their reach or with domestic chemicals, e.g. bleach, detergents.

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