The Intoxicated Patient

Abstract

Most clinicians care for intoxicated patients only infrequently. While the history is once again key to understanding if and with which agent the patient is intoxicated, it is important to remember that, in most cases, this information must be obtained from other sources than the patient. Knowledge of common toxidromes helps to recognize clinical symptoms typical for specific groups of toxins.

Clinical Practice

Box 1 Checklist Patient History: Intoxication

History taking in intoxicated patients, particularly in those in whom intoxication occurred in a suicidal attempt, is unreliable! Take an indirect history from paramedics, bystanders, family members, friends and carers.

Yes	No	Circumstances?
□	□	Type of substance, medication or drug consumed?
□	□	Empty medication blisters (hand bag, dustbin, apartment) found? If yes, consider (suicidal) medication overdose
□	□	Drugs in same household (parents, grandparents, spouse)? If yes, consider (suicidal) medication overdose
□	□	Suicide letter/goodbye note found? If yes, consider suicide/self-harm
□	□	Drug paraphernalia (e.g. pipes, syringes, spoon, lighter, mirror, razor blade, straws, balloon, bottles) found? If yes, consider drug intoxication
□	□	Circumstance suggestive of body packing/body stuffing (arrested by police, arrested at border crossing or arrested by customs officers or drug agents)? If yes, consider drug intoxication
Yes	No	Past medical history?
□	□	Previous drug abuse? If yes, consider drug intoxication
□	□	Previous suicide attempt or history of self-harm? If yes, consider suicide/self-harm
□	□	Known depression, borderline syndrome or bipolar disorder? If yes, consider suicide/self-harm
□	□	Post-traumatic stress disorder or current stress? If yes, consider suicide/self-harm