Poisoning / toxic exposure
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- Toxic exposure can injure through receptor effects, cellular hypoxia, corrosive damage, metabolic disruption, or delayed organ toxicity depending on agent and route.
- Respiratory depression, corrosive airway symptoms, dysrhythmia, seizure, shock, hyperthermia, or altered LOC requires immediate escalation.
- Keep medical illness or mixed ingestion in the differential; overlapping or concurrent illness remains possible.
- For poisoning / toxic exposure, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
CardiotoxicTime-sensitive high-risk possibility
HPI
Clarify agent, amount/concentration, route and exact time; intentional vs accidental; co-exposures.
Signs & symptoms
ECG change, airway injury, acidosis pattern, shock, or delayed deterioration.
Focused exam
Assess pupils, skin, bowel sounds, temperature, mental status, respiratory pattern, rhythm, and signs of trauma or concealed co-ingestion; Repeat observations because drug effects may evolve.
Brief pathophysiology
Cardiotoxic may cause poisoning / toxic exposure through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Toxic effects vary by agent and co-exposure. Ventilation, rate/rhythm, pressure, and temperature are the most useful four observations for recognizing an evolving toxidrome.
Respiratory rate (breaths/min)
May rise or fallVentilation can be depressed or stimulated depending on the agent.
Heart rate (bpm)
Rate / rhythm may changeObtain ECG monitoring when cardiotoxicity is plausible.
Blood pressure (mmHg)
May rise or fallPressure direction depends on agent, dose, and stage.
Temperature (°C)
May rise or fallTemperature disturbance can identify severe stimulant, anticholinergic, sedative, or environmental toxicity.
Front-load in the triage report
- Cardiotoxic: ECG change, airway injury, acidosis pattern, shock, or delayed deterioration.
- Agent, amount/concentration, route and exact time.
- Intentional vs accidental.
CorrosiveTime-sensitive high-risk possibility
HPI
Clarify intentional vs accidental; co-exposures; symptoms/toxidrome.
Signs & symptoms
ECG change, airway injury, acidosis pattern, shock, or delayed deterioration.
Focused exam
Repeat observations because drug effects may evolve; Use a toxidrome examination and identify container, route, dose, timing, workplace or household exposure, and contamination risk.
Brief pathophysiology
Corrosive may cause poisoning / toxic exposure through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Toxic effects vary by agent and co-exposure. Ventilation, rate/rhythm, pressure, and temperature are the most useful four observations for recognizing an evolving toxidrome.
Respiratory rate (breaths/min)
May rise or fallVentilation can be depressed or stimulated depending on the agent.
Heart rate (bpm)
Rate / rhythm may changeObtain ECG monitoring when cardiotoxicity is plausible.
Blood pressure (mmHg)
May rise or fallPressure direction depends on agent, dose, and stage.
Temperature (°C)
May rise or fallTemperature disturbance can identify severe stimulant, anticholinergic, sedative, or environmental toxicity.
Front-load in the triage report
- Corrosive: ECG change, airway injury, acidosis pattern, shock, or delayed deterioration.
- Intentional vs accidental.
- Co-exposures.
Cellular toxin exposureTime-sensitive high-risk possibility
HPI
Clarify co-exposures; symptoms/toxidrome; container/product info.
Signs & symptoms
ECG change, airway injury, acidosis pattern, shock, or delayed deterioration.
Focused exam
Repeat observations because drug effects may evolve; Use a toxidrome examination and identify container, route, dose, timing, workplace or household exposure, and contamination risk.
Brief pathophysiology
Cellular toxin exposure may cause poisoning / toxic exposure through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Toxic effects vary by agent and co-exposure. Ventilation, rate/rhythm, pressure, and temperature are the most useful four observations for recognizing an evolving toxidrome.
Respiratory rate (breaths/min)
May rise or fallVentilation can be depressed or stimulated depending on the agent.
Heart rate (bpm)
Rate / rhythm may changeObtain ECG monitoring when cardiotoxicity is plausible.
Blood pressure (mmHg)
May rise or fallPressure direction depends on agent, dose, and stage.
Temperature (°C)
May rise or fallTemperature disturbance can identify severe stimulant, anticholinergic, sedative, or environmental toxicity.
Front-load in the triage report
- Cellular toxin exposure: ECG change, airway injury, acidosis pattern, shock, or delayed deterioration.
- Co-exposures.
- Symptoms/toxidrome.
MedicationCommon presentation pattern
HPI
Clarify agent, amount/concentration, route and exact time; intentional vs accidental; co-exposures.
Signs & symptoms
Symptoms depend on the known agent and timing.
Focused exam
Assess pupils, skin, bowel sounds, temperature, mental status, respiratory pattern, rhythm, and signs of trauma or concealed co-ingestion; Repeat observations because drug effects may evolve.
Brief pathophysiology
Medication may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Toxic effects vary by agent and co-exposure. Ventilation, rate/rhythm, pressure, and temperature are the most useful four observations for recognizing an evolving toxidrome.
Respiratory rate (breaths/min)
May rise or fallVentilation can be depressed or stimulated depending on the agent.
Heart rate (bpm)
Rate / rhythm may changeObtain ECG monitoring when cardiotoxicity is plausible.
Blood pressure (mmHg)
May rise or fallPressure direction depends on agent, dose, and stage.
Temperature (°C)
May rise or fallTemperature disturbance can identify severe stimulant, anticholinergic, sedative, or environmental toxicity.
Front-load in the triage report
- Symptoms depend on the known agent and timing.
- Agent, amount/concentration, route and exact time.
- Intentional vs accidental.
Household exposureCommon presentation pattern
HPI
Clarify intentional vs accidental; co-exposures; symptoms/toxidrome.
Signs & symptoms
Symptoms depend on the known agent and timing.
Focused exam
Repeat observations because drug effects may evolve; Use a toxidrome examination and identify container, route, dose, timing, workplace or household exposure, and contamination risk.
Brief pathophysiology
Household exposure may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Toxic effects vary by agent and co-exposure. Ventilation, rate/rhythm, pressure, and temperature are the most useful four observations for recognizing an evolving toxidrome.
Respiratory rate (breaths/min)
May rise or fallVentilation can be depressed or stimulated depending on the agent.
Heart rate (bpm)
Rate / rhythm may changeObtain ECG monitoring when cardiotoxicity is plausible.
Blood pressure (mmHg)
May rise or fallPressure direction depends on agent, dose, and stage.
Temperature (°C)
May rise or fallTemperature disturbance can identify severe stimulant, anticholinergic, sedative, or environmental toxicity.
Front-load in the triage report
- Symptoms depend on the known agent and timing.
- Intentional vs accidental.
- Co-exposures.
Medical illnessImportant alternative presentation
HPI
Clarify agent, amount/concentration, route and exact time; intentional vs accidental; co-exposures.
Signs & symptoms
Infection, glucose disturbance, trauma, and multiple agents can mimic or complicate poisoning.
Focused exam
Assess pupils, skin, bowel sounds, temperature, mental status, respiratory pattern, rhythm, and signs of trauma or concealed co-ingestion; Repeat observations because drug effects may evolve.
Brief pathophysiology
Medical illness can resemble poisoning / toxic exposure through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Toxic effects vary by agent and co-exposure. Ventilation, rate/rhythm, pressure, and temperature are the most useful four observations for recognizing an evolving toxidrome.
Respiratory rate (breaths/min)
May rise or fallVentilation can be depressed or stimulated depending on the agent.
Heart rate (bpm)
Rate / rhythm may changeObtain ECG monitoring when cardiotoxicity is plausible.
Blood pressure (mmHg)
May rise or fallPressure direction depends on agent, dose, and stage.
Temperature (°C)
May rise or fallTemperature disturbance can identify severe stimulant, anticholinergic, sedative, or environmental toxicity.
Front-load in the triage report
- Infection, glucose disturbance, trauma, and multiple agents can mimic or complicate poisoning.
- Agent, amount/concentration, route and exact time.
- Intentional vs accidental.
Mixed ingestionImportant alternative presentation
HPI
Clarify intentional vs accidental; co-exposures; symptoms/toxidrome.
Signs & symptoms
Infection, glucose disturbance, trauma, and multiple agents can mimic or complicate poisoning.
Focused exam
Repeat observations because drug effects may evolve; Use a toxidrome examination and identify container, route, dose, timing, workplace or household exposure, and contamination risk.
Brief pathophysiology
Mixed ingestion can resemble poisoning / toxic exposure through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Toxic effects vary by agent and co-exposure. Ventilation, rate/rhythm, pressure, and temperature are the most useful four observations for recognizing an evolving toxidrome.
Respiratory rate (breaths/min)
May rise or fallVentilation can be depressed or stimulated depending on the agent.
Heart rate (bpm)
Rate / rhythm may changeObtain ECG monitoring when cardiotoxicity is plausible.
Blood pressure (mmHg)
May rise or fallPressure direction depends on agent, dose, and stage.
Temperature (°C)
May rise or fallTemperature disturbance can identify severe stimulant, anticholinergic, sedative, or environmental toxicity.
Front-load in the triage report
- Infection, glucose disturbance, trauma, and multiple agents can mimic or complicate poisoning.
- Intentional vs accidental.
- Co-exposures.
Findings that should escalate concern
- Respiratory depression, corrosive airway symptoms, dysrhythmia, seizure, shock, hyperthermia, or altered LOC requires immediate escalation.
- Cardiotoxic, corrosive, or cellular toxin exposure: ECG change, airway injury, acidosis pattern, shock, or delayed deterioration.
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Guidelines for establishing a poison centreWorld Health Organization
Clinical toxicology context for time-critical poisoning, supportive care, consultation, and poison-centre expertise.
- Management of Acetaminophen Poisoning in the US and Canada: A Consensus StatementJAMA Network Open · 2023
A model for poison-specific history, risk stratification, consultation, testing, and time-sensitive antidotal care.