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TABLE 102.1
SUBSTANCES MOST OFTEN REPORTED IN HUMAN EXPOSURES
Substance

Percentage of
total exposures

Analgesics (including opioids)
Cleaning substances
Cosmetics/personal care products
Sedatives/hypnotics/antipsychotics
Antidepressants
Antihistamines
Cardiovascular drugs
Foreign bodies/toys
Pesticides
Alcohols

11.1
7.4
6.8
5.7
5
4.3
4.2
3.5
3.3
2.8

From Gummin DD, Mowry JB, Spyker DA, et al. 2017 Annual Report of the American Association of
Poison Control Centers’ National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol

2018;56(12):1213–1415. Adapted by permission of Taylor & Francis Ltd, www.tandfonline.com .

CLINICAL CONSIDERATIONS
Following the analogy between unintentional poisoning and traumatic injury, a
similar model may be used in formulating a management approach. The poisoned
patient often represents an acute-onset emergency with a broad spectrum of
multiorgan system pathophysiology akin to the multiple trauma patient. In
essence, poisoning might be viewed as a multiple chemical trauma. The concept
of a brief window of opportunity to make critical diagnostic and management
decisions is likewise analogous. One may conceptualize a management approach
that attempts to prioritize critical assessment and, at times, simultaneous
management interventions ( Table 102.4 ). The initial phase (or primary survey)
addresses the traditional airway, breathing, and circulation (ABCs) of airway
securement and cardiorespiratory support, with a slight additional emphasis on
emergent toxicologic considerations. The more specific evaluation and
detoxification phase (or secondary survey) is aimed at simultaneously initiating
generic treatment while assessing the actual extent of intoxication (in cases of
known or presumed exposures) and/or identifying the actual toxicants involved
(in unknown but highly suspected intoxications).