Fundamentals of toxicology, general management of intoxications

1. Big picture

Toxicology in Internal Medicine is mainly an emergency pattern-recognition topic. The examiner wants you to think like this:

Unknown poisoned patient → stabilize first → recognize toxidrome → check glucose/ECG/acid-base status → prevent further absorption → give antidote if indicated → enhance elimination if severe → monitor complications.

Most deaths in acute intoxication are not because the poison is “rare,” but because of airway loss, respiratory depression, shock, seizures, arrhythmias, severe acidosis, hyperthermia, hypoglycemia, aspiration, or delayed hepatic/renal failure.

Core rule: supportive care saves more lives than antidotes. Antidotes are important, but they come after Airway, Breathing, Circulation.

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