Poisoning and toxicity: resources to support clinical decisions

Urgent poisons advice

If a person presents with an overdose, consult TOXBASE (registration required, see below) to find information on the specific poison(s) and manage accordingly.

Telephone the National Poisons Information Service (NPIS) for advice if:

• poisoning is severe or complex (for example, multiple ingestions)
• the person has significant morbidity
• there are uncertainties regarding management after consulting TOXBASE online
• the poison is unknown

TOXBASE

TOXBASE is the clinical toxicological database of the UK NPIS and should be the first port of call for healthcare professionals seeking poisons information in the UK. Access is via mobile app or online and requires registration.

Mobile app

Available for Apple and android devices, full access is free for individuals who register with their NHS email address. Registration for the app takes several minutes:

1. Download and enter the required details (including a username and password, your professional registration number and NHS email address).
2. You will immediately receive a verification email to that address.
3. Click on the link in the email. You can then log in to the app.

Online access

Healthcare professionals can register for free online access using an NHS email address. Previous shared accounts for GP practices and other NHS units have been retired; individual users need to register for their own account and can choose their own username and password.

TOXBASE monographs

Monographs are available for over 21,000 medicines, chemicals, household products, plants and substances of abuse. Each monograph includes:

• an alert box advising which situations require people to be referred for medical assessment
• information on symptoms of toxicity, case reports and pharmacokinetics such as peak plasma concentration
• advice on management with specific step-by-step guidance

Printable versions of monographs are available for the management of individual patients. Printouts should not be kept for future reference as advice may change.

Also useful are these leaflets on potentially serious poisonings and low-risk substances:

• Keep your child safe in the garden
• Keep your child safe in the home
• Low toxicity substances

Non-urgent advice

In addition to TOXBASE, the following resources may be helpful and are free to access.

SPS resources

SPS has some advice on poisoning. Articles include:

• Reversing an adult opioid overdose with naloxone (SPS page)
• Considering fluoride and accidental ingestion of toothpaste (SPS page)
• Investigating suspected tampering with medicines (SPS page)

British National Formulary

The British National Formulary (BNF) and BNF for Children (BNFC) contain a treatment summary of Poisoning, emergency treatment which provides general advice such as:

• toxic effects on different body systems
• poison removal and elimination

They also provide an overview on management of poisoning from around thirty specific medicines, drug classes and other substances including two forms of paracetamol poisoning – acute overdose and therapeutic excess.

For specific management advice, consult TOXBASE.

NICE Clinical Knowledge Summaries

Clinical Knowledge Summaries (CKS) has advice on poisoning, with general advice on diagnosis and management, including a table of signs and symptoms for drugs commonly involved in poisoning or overdose.

Summaries of Product Characteristics

SmPCs are available from electronic Medicines Compendium and MHRA. Useful sections include:

• Posology and method of administration (4.2) to check the usual maximum dose
• Overdose (4.9) for information on symptoms and management of overdose
• Pharmacokinetic properties (5.2) to determine peak plasma concentration and half-life

SPS Medicines Advice

Our Medicines Advice service (SPS page) can support primary care health professionals regarding situations such as:

• accidental ingestion of an additional dose of person’s own medicine
• when to restart medication following accidental overdose
• tablet identification

Training resources

If you would like more information on how to approach answering questions on poisoning or medicines toxicity we recommend:

TOXlearning

UK NPIS provides an e-learning resource, TOXlearning, for doctors, nurses and pharmacists in UK hospitals and general practice, and others including ambulance personnel and NHS111 staff. There are two modules:

• Learn how to use TOXBASE
• Clinical management of poisoned patients (coming soon)

People registered with TOXBASE can access from a link in the footer after logging in. Otherwise, log in or login or register at TOXlearning directly.

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