Poisoning: What to Do and How to Provide First Aid

What Is Poisoning and Why Is It Dangerous?

Poisoning is an acute condition that occurs when toxic substances enter the body and disrupt its normal functioning. These substances can be diverse: pesticides, medications, household chemicals, industrial poisons, or even certain food products. The danger of poisoning lies in its ability to cause multi-organ dysfunction, meaning the disruption of several vital organs and systems simultaneously [1].

For example, poisoning with highly toxic aluminum phosphide, a widely used agricultural pesticide, can lead to life-threatening conditions such as cardiovascular collapse, severe metabolic acidosis, and arrhythmias [1]. Even certain therapeutic medications intended for chronic disease management can cause severe side effects mimicking poisoning. For instance, tirzepatide (Mounjaro), used for type 2 diabetes and obesity, can lead to acute gastrointestinal disorders, including nausea, vomiting, constipation, and even acute small bowel obstruction [2]. Immunotherapy drugs used in oncology can also cause immune-mediated toxicities of the upper gastrointestinal tract [5].

In some cases, such as metabolic disorders associated with a ketogenic diet in children, symptoms similar to poisoning may be observed: vomiting, drowsiness, edema, metabolic acidosis, and hypoglycemia [3]. All of this highlights the variety of causes and the severity of the consequences of intoxications, which require immediate and qualified medical assistance.

Signs of Poisoning: What to Look For?

Recognizing the symptoms of poisoning is key to providing timely assistance. Signs may vary depending on the type and dose of the toxic substance, but there are common manifestations that require immediate attention:

• Gastrointestinal symptoms: Nausea, vomiting (sometimes repetitive), severe abdominal pain, abdominal distension, diarrhea [1, 2, 3, 5, 7]. Vomiting and diarrhea are defensive reactions of the body aimed at eliminating toxins.
• Cardiovascular disorders: Decreased blood pressure (hypotension), irregular pulse, arrhythmias (e.g., atrial fibrillation) [1]. These symptoms indicate serious damage to the cardiovascular system.
• Neurological manifestations: Drowsiness, lethargy, fainting (syncope), confusion [2, 3]. In severe cases, altered consciousness up to a coma is possible.
• Metabolic disorders: Severe metabolic acidosis (increased blood acidity), hypoglycemia (decreased blood sugar levels) [1, 3]. These conditions can be extremely life-threatening and require immediate correction.
• Other symptoms: General weakness, dizziness, edema [3], skin discoloration, difficulty breathing.

It is important to remember that some symptoms may develop gradually, while others occur lightning-fast. If any of these signs appear, especially if contact with a toxic substance is suspected, immediate action must be taken.

First Aid for Poisoning: Immediate Actions

Correct actions in the first minutes after poisoning can save a victim's life. Here is what needs to be done:

1. Immediately call an ambulance (103 or 112). This is the most crucial step. Clearly describe the situation to the dispatcher, the victim's age, the suspected substance, and observed symptoms. Follow the dispatcher's instructions.
2. Eliminate contact with the poison.
   • If poisoning occurred via the respiratory tract (e.g., gases), move the victim to fresh air.
   • If poison gets on the skin or in the eyes, thoroughly rinse the affected areas with plenty of running water for 15-20 minutes.
   • If the poison was swallowed, immediately remove any residue from the mouth.
3. Do not attempt to induce vomiting on your own unless recommended by medical professionals. In some cases (e.g., poisoning with caustic substances such as acids or alkalis, or petroleum products), vomiting can cause additional harm by triggering repeated esophageal burns or aspiration of the substance into the respiratory tract.
4. Save samples. If possible, save the packaging of the suspected poison, substance residues, vomit, or other biological fluids. This will help doctors determine the type of poisoning faster and prescribe appropriate treatment.
5. Ensure rest and warmth. Lay the victim down and loosen restrictive clothing. Cover them to prevent hypothermia.
6. If the victim is unconscious but breathing, place them in a stable recovery position (recovery posture) to prevent the tongue from falling back and vomit from entering the respiratory tract.
7. Continuously monitor the victim's condition until medical help arrives, checking breathing and pulse. Be prepared to start cardiopulmonary resuscitation if necessary.

When Every Minute Counts: The Importance of Timely Medical Care

In poisoning, time plays a critically important role. Many studies show that early initiation of treatment significantly improves the patient's prognosis [4, 6]. In emergency medicine, especially in conditions like sepsis (a severe systemic inflammatory response that can develop as a complication of poisoning or infection), every minute matters. For example, in sepsis and septic shock, it is recommended to initiate antibiotic administration within the first three hours [4, 6].

The Emergency Department (ED) is the key place where poisoning patients receive their first qualified care. ED physicians play a decisive role in early diagnosis, resuscitation, and the initiation of treatment [6]. Since specific antidotes do not exist for many toxic substances, the main focus is on supportive care [1]. This may include aggressive intravenous fluid resuscitation to maintain blood pressure, norepinephrine infusion to stabilize circulation, as well as the administration of specific antidotes (e.g., N-acetylcysteine for certain poisonings), sodium bicarbonate to correct metabolic acidosis, and hydrocortisone [1].

Rapid delivery of the victim to a medical facility allows these life-saving measures to begin as soon as possible, minimizing damage to the body and increasing the chances of a full recovery.

What to Expect in the Hospital: Diagnosis and Treatment

Upon admission to the hospital, particularly in the emergency department or intensive care unit, comprehensive medical care will be provided to the poisoning victim. Doctors will perform a thorough examination and take a medical history, including information about the suspected toxic substance, the time and method of its entry into the body [7].

Diagnostic measures may include:

• Laboratory blood and urine tests: to assess general condition, organ function, detect metabolic disorders (e.g., levels of beta-hydroxybutyrate, bicarbonate, glucose in metabolic disorders [3]), and determine the concentration of the toxin if possible.
• Instrumental studies: ECG to assess heart function (e.g., in atrial fibrillation [1]), ultrasound or CT of the abdominal organs if intestinal obstruction [2] or other internal injuries are suspected.
• Vital sign monitoring: continuous tracking of blood pressure, pulse, respiratory rate, and blood oxygen saturation.

Treatment will be aimed at:

• Detoxification: removing the poison from the body (e.g., gastric lavage, administration of activated charcoal, forced diuresis, hemodialysis).
• Supportive therapy: maintaining the stable function of the heart, lungs, kidneys, and other organs. This may include intravenous fluids, vasopressors, and oxygen therapy [1].
• Correction of metabolic disorders: administration of sodium bicarbonate for acidosis, glucose for hypoglycemia [1, 3].
• Antidote administration: if a specific antidote exists for the given poison (e.g., N-acetylcysteine for acetaminophen poisoning) [1].
• Complication management: for instance, antibiotics for infectious complications or sepsis [4, 6, 7], or surgical intervention for intestinal obstruction [2].

In severe cases, patients may be transferred to the intensive care unit for round-the-clock monitoring and specialized treatment [1].

Sources

1. [1] Successful survival after severe aluminum phosphide poisoning complicated by cardiogenic shock, atrial fibrillation and severe metabolic acidosis: a case report. (Journal of medical case reports, 2026) https://pubmed.ncbi.nlm.nih.gov/42387583/
2. [2] Acute Small Bowel Obstruction Induced by Tirzepatide (Mounjaro). (Cureus, 2026) https://pubmed.ncbi.nlm.nih.gov/42438627/
3. [3] Corpus Callosotomy in LIS1 Lissencephaly: Postoperative Ketogenic Diet-Related Metabolic Derangements and Feeding Intolerance. (Cureus, 2026) https://pubmed.ncbi.nlm.nih.gov/42453837/
4. [4] Early Antimicrobial Therapy for Sepsis: Does Each Hour Really Count? (Seminars in respiratory and critical care medicine, 2019) https://pubmed.ncbi.nlm.nih.gov/31585471/
5. [5] Immune-Mediated upper gastrointestinal toxicities reported With immune checkpoint inhibitors: An analysis of the food and drug administration adverse event reporting system (FAERS). (Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners, 2026) https://pubmed.ncbi.nlm.nih.gov/42089770/
6. [6] Management of sepsis and septic shock in the emergency department. (Internal and emergency medicine, 2021) https://pubmed.ncbi.nlm.nih.gov/33890208/
7. [7] Infectious diarrhea. (Emergency medicine clinics of North America, 1985) https://pubmed.ncbi.nlm.nih.gov/3902451/
8. [8] Primary Immunodeficiency and the Gut. (Gastroenterology clinics of North America, 2019) https://pubmed.ncbi.nlm.nih.gov/31046971/

Important Note: The information in this article is for reference purposes only and cannot replace an in-person consultation with a qualified medical specialist. If you notice any signs of poisoning, seek medical help immediately.