🇬🇧 United Kingdom 🇬🇧 United Kingdom · TOXBASE · NPIS · A&E management

Acute poisoning pathway

UK acute poisoning management built around the canonical HCP resources: TOXBASE (NPIS clinical toxicology database), the NPIS HCP advice line, and emergency department (A&E) supportive care. This page orientates — it does not replace TOXBASE.

Emergency — act now

NPIS (National Poisons Information Service): 0344 892 0111 (24/7) — HCP only, UK-wide.
TOXBASE: www.toxbase.org — NHS subscription, primary HCP source.
A&E / ED if symptomatic — time-critical; do not delay for advice when the patient is unstable.

Poisoning classification

Four broad categories steer the TOXBASE search and the antidote/decontamination decision.

Drugs / pharmaceuticals

Intentional or accidental overdose — paracetamol, opioids, benzodiazepines, antidepressants, cardiac drugs.

Chemicals

Occupational and household — solvents, corrosives, pesticides, cleaning agents, gases.

Plants / fungi

Foraged or ornamental — Amanita species, foxglove, yew, deadly nightshade.

Animals

Envenomation — adder (Vipera berus), spider, wasp/bee anaphylaxis, jellyfish.

Occupational toxic exposures

Work-related poisoning often needs biological monitoring against a guidance value. Cross-reference the airborne limits in the EH40 Workplace Exposure Limits.

Carbon monoxide

→ End-tidal breath CO (BMGV)

Boilers, vehicle exhaust, furnaces, fires.

Lead

→ Blood lead (Pb-B) — CLAW suspension/action levels

Smelting, battery work, demolition, radiator repair.

Isocyanates

→ Urinary metabolites (BMGV)

Spray painting, polyurethane foam, MDI/TDI.

Solvents

→ Individual urinary/blood BMGVs

Toluene, xylene, n-hexane, trichloroethylene.

Core antidotes

UK products and indications (TOXBASE / BNF). Dosing always per TOXBASE or the NPIS advice line — see the full antidote set for all 16.

Naloxone

UK products: Nyxoid (intranasal 1.8 mg) · Prenoxad (IM)

Indication: Opioid overdose; take-home naloxone widening (sprint27)

Atropine + Pralidoxime (P2S in UK)

Indication: Organophosphate / carbamate poisoning

N-acetylcysteine (NAC, Parvolex)

Indication: Paracetamol overdose

Hydroxocobalamin (Cyanokit)

Indication: Cyanide / smoke inhalation

Calcium gluconate

Indication: Hydrofluoric acid burns / hyperkalaemia (semiconductor/glass etching)

Fomepizole

Indication: Methanol / ethylene glycol

Acute management essentials

ABCDE first. Specifics below complement, never replace, the TOXBASE entry for the agent.

Decontamination

▸Skin: remove clothing, copious water irrigation; protect staff.
▸Eye: immediate prolonged irrigation; check pH for corrosives.
▸GI: activated charcoal within 1 h (per TOXBASE); whole-bowel irrigation selected cases.

Supportive care

▸Airway protection, oxygen, ventilation as needed.
▸IV fluids, correct electrolytes and acid–base.
▸Seizure control, temperature management, specific antidote.

Monitoring + admission

▸ECG, observations, paracetamol/salicylate levels, blood gas.
▸Admit if symptomatic, delayed-toxicity agent, or intentional overdose.
▸Observation window per TOXBASE for the specific toxin.

HSE / RIDDOR

Work-related acute poisoning may be RIDDOR reportable — acute illness from a biological agent or from absorption of any substance is listed in RIDDOR 2013 Schedule 3. Check reportability with the RIDDOR notification wizard.

Under the physician's clinical judgement

TOXBASE is the canonical HCP resource — this page orientates and cannot replace it; always confirm management against the live entry.
The NPIS HCP advice line (0344 892 0111 (24/7)) is available 24/7 for complex or uncertain cases.
Obtain the patient's consent for toxicology screening where the situation is not immediately life-threatening; in an emergency, treat first.
Maintain confidentiality and safeguarding duties if the overdose is intentional — assess mental capacity and self-harm risk.
No patient data is stored by this tool.

Regulatory / clinical framework

primary: TOXBASE (NPIS — National Poisons Information Service)
url: https://www.toxbase.org/ (HCP registration)
hcp phone: 0344 892 0111 (NPIS HCP advice — 24/7)
dosing: BNF / BNFC