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Poisoning (toxicology)

Toxicology

For healthcare professionals. This information does not replace clinical judgement in the individual case; the current summary of product characteristics and the guidelines cited are authoritative.

Medically reviewed: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Poisoning (toxicology): Poison hotline, Initial assessment, Toxidromes, Decontamination, Antidotes – respiratory depression and coma, Antidotes – heart and circulation – concise for emergency, anaesthesia and intensive care teams, with sources and medically reviewed.

What the chapter covers

  1. Poison hotline
  2. Initial assessment
  3. Toxidromes
  4. Decontamination
  5. Antidotes – respiratory depression and coma
  6. Antidotes – heart and circulation
  7. Antidotes – others
  8. Special situations

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Drugs in this chapter

Sources and guidelines

  1. Lott C et al. European Resuscitation Council Guidelines 2025: Special Circumstances in Resuscitation. Resuscitation 2025;215 Suppl 1:110753.
  2. Soar J, Böttiger BW et al. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support. Resuscitation 2025;215 Suppl 1:110769 (Korrigendum 2026).
  3. Lavonas EJ, Akpunonu PD, Arens AM et al. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning. Circulation 2023;148:e149–e184 (u. a. Hochdosis-Insulin bei Betablocker- und Calciumantagonisten-Vergiftung, VA-ECMO bei refraktärem Schock).
  4. Holstege CP, Borek HA. Toxidromes. Crit Care Clin 2012;28:479–498.
  5. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005;352:1112–1120.
  6. Chyka PA, Seger D, Krenzelok EP, Vale JA (AACT/EAPCCT). Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005;43:61–87.
  7. Höjer J, Troutman WG, Hoppu K et al. (AACT/EAPCCT). Position paper update.
  8. Benson BE, Hoppu K, Troutman WG et al. (AACT/EAPCCT). Position paper update.
  9. Thanacoody R, Caravati EM, Troutman B et al. (AACT/EAPCCT). Position paper update.
  10. Tox Info Suisse. Antidot-Monographie Natriumhydrogenkarbonat.
  11. ToxInfo (toxinfo.de). Antidote im Detail.
  12. St-Onge M, Anseeuw K, Cantrell FL et al. Experts consensus recommendations for the management of calcium channel blocker poisoning in adults. Crit Care Med 2017;45(3):e306–e315.
  13. Tox Info Suisse. Antidot-Monographie Glucagon (Schnorf-Huber S, Reichert C, Rauber-Lüthy C), Stand 06/2016: Betablocker- bzw. Calciumantagonisten-Vergiftung Erwachsene 50 µg/kg i.v. (max. 5–10 mg) über 15 min in Glucose 5 %, dann Dauerinfusion 2–5 mg/h; Kinder 50–150 µg/kg, dann 50 µg/kg/h (gleichlautend Antidotliste 2020/21 und 2022/23); Ausfällung in der Infusionslösung möglich.
  14. Neal JM, Neal EJ, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Reg Anesth Pain Med 2021;46:81–82.
  15. Association of Anaesthetists of Great Britain and Ireland (AAGBI). Safety Guideline: Management of Severe Local Anaesthetic Toxicity. London 2010.
  16. Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet 2008;371:597–607 (Atropin-Startbolus 1–3 mg i.v. je nach Schweregrad, Dosisverdopplung ohne Besserung nach 5 min bis zur klinischen Atropinisierung.
  17. Eddleston M, Chowdhury FR. Pharmacological treatment of organophosphorus insecticide poisoning.
  18. Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine.
  19. Deutsche Diabetes Gesellschaft (DDG). S3-Leitlinie Therapie des Typ-1-Diabetes, Version 5, 2023. AWMF-Register-Nr. 057-013.
  20. EXTRIP Workgroup (Extracorporeal Treatments in Poisoning). Systematische Empfehlungen zur extrakorporalen Giftelimination, u. a. Lithium (Clin J Am Soc Nephrol 2015), Salicylate (Ann Emerg Med 2015), Methanol (Crit Care Med 2015), Metformin (Crit Care Med 2015).
  21. Giftinformationszentren in Deutschland.
  22. Tox Info Suisse: Infoblatt N-Acetylcystein.
  23. Queensland Poisons Information Centre: Antidote stocking recommendations.
  24. Tox Info Suisse. Merkblatt Calciumantagonisten und Betablocker, Stand 01/2026: Glucagon (bei Betablockern „falls vorhanden“) Erwachsene und Kinder initial 50 µg/kg i.v. über 15 min in Glucose 5 %, dann 50 µg/kg/h als Dauerinfusion.
  25. Tox Info Suisse. Antidotliste 2026/2027, Eintrag Glucagon: Intoxikation mit Betarezeptorenblockern, Erwachsene initial 5–10 mg i.v. (älteres Schema beibehalten, abweichend vom Merkblatt 01/2026); keine bestimmten Lagermengen mehr, da mit der Insulin/Glucose-Therapie (HIET) im intensivmedizinischen Setting eine bevorzugte Alternative verfügbar ist; Hinweis auf Tachyphylaxie.
  26. Eddleston M, Dawson A, Karalliedde L et al. Early management after self-poisoning with an organophosphorus or carbamate pesticide.
  27. Merck Manual Professional Edition. Organophosphate Poisoning and Carbamate Poisoning.
  28. Life in the Fast Lane (LITFL). Organophosphate toxicity.
  29. Atlantic Canada Poison Centre. Atropine.
  30. Summaries of product characteristics of authorised products – product and section for each dose in the app.