# General Principles of Poisoning Management

> General principles of poisoning management for NEET-PG Medicine, covering ABC stabilisation, decontamination, charcoal limits and enhanced elimination.

- Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/general-principles-of-poisoning-management
- Exam / course: NEET-PG · Subject: Medicine
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Goldfrank's Toxicologic Emergencies; Modi's Textbook of Medical Jurisprudence and Toxicology
- How to cite: "General Principles of Poisoning Management", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/general-principles-of-poisoning-management

## Direct answer

Poisoning management begins with ABC stabilisation, followed by decontamination, enhanced elimination and specific antidotes where they exist. Activated charcoal adsorbs most drugs when given within about one hour of ingestion, but it does not bind alcohols, iron, lithium or caustics, and it is withheld when the airway is unprotected. The order of these steps stays the same for most poisons, while the antidote and elimination method depend on the agent.

## What you must remember

- **ABC first:** airway protection, breathing support and circulation come before any antidote; empirical dextrose, naloxone and thiamine are given to comatose patients when hypoglycaemia or opioid toxicity is possible.
- **Skin and eye:** irrigate contaminated skin and eyes with water or saline and remove contaminated clothing, which stops ongoing absorption.
- **Activated charcoal:** most useful within about one hour; it is not used for hydrocarbons because of aspiration risk and is contraindicated with an unprotected airway or gut obstruction.
- **Gastric lavage:** not routine; reserved for life-threatening ingestions presenting within about an hour, and ipecac-induced emesis is no longer recommended.
- **Whole-bowel irrigation:** used for large ingestions of sustained-release products, iron and lithium, with the bowel and airway protected.
- **Multiple-dose charcoal:** helps specific drugs such as carbamazepine, phenobarbital and theophylline by interrupting enterohepatic or intestinal recirculation.
- **Dialysis and alkalinisation:** haemodialysis clears lithium, methanol, ethylene glycol and salicylates, while urinary alkalinisation aids salicylate and phenobarbital elimination.
- **Specific antidotes:** naloxone for opioids, atropine with pralidoxime for organophosphates, and flumazenil only with caution, since it can precipitate seizures.

## A stepwise approach from arrival to discharge

Poisoning management follows a fixed order, and each step is taken only once the previous one is safe.

1. **Stabilise first:** secure the airway, support breathing and circulation, check blood glucose and give naloxone or thiamine where indicated.
2. **Identify the agent:** take the history from relatives, containers and pill counts, look for a toxidrome, and call the Poison Centre for advice; the National Poisons Information Centre at AIIMS, New Delhi, is a useful national reference.
3. **Stop further exposure:** remove contaminated clothing and irrigate the skin or eyes, so that the poison is not absorbed further.
4. **Decide on decontamination:** give activated charcoal within about an hour only if the airway is safe and the agent binds to it, and use whole-bowel irrigation for iron and sustained-release products.
5. **Enhance elimination:** use multiple-dose charcoal, urinary alkalinisation or extracorporeal removal when the drug is dialysable or has a low volume of distribution.
6. **Give the antidote early:** naloxone, flumazenil, atropine with pralidoxime, or a specific chelator, once the agent is reasonably identified.
7. **Monitor and support:** repeat levels where they guide therapy, watch for delayed toxicity, and admit when symptoms or levels warrant it.

## Where the exam tries to catch you

Most lost marks come from the order of steps or from giving decontamination that cannot help.

- **Trap:** giving activated charcoal to a drowsy patient with no airway protection — **Correct:** secure the airway first, because charcoal aspiration causes pneumonitis.
- **Trap:** using activated charcoal after an iron or lithium ingestion expecting adsorption — **Correct:** charcoal does not bind these agents, so whole-bowel irrigation or dialysis is used instead.
- **Trap:** performing routine gastric lavage on every ingestion — **Correct:** lavage is rarely indicated and carries aspiration risk, so it is reserved for life-threatening ingestions within about an hour.
- **Trap:** giving flumazenil to a patient with a tricyclic overdose and benzodiazepine co-ingestion — **Correct:** flumazenil can precipitate seizures in mixed overdose and in chronic benzodiazepine users.

## Frequently asked questions

### When is activated charcoal useful in poisoning?

Activated charcoal is most useful in poisoning when it is given within about one hour of ingestion of an agent it adsorbs, provided the airway is protected. It is not useful for alcohols, iron, lithium or caustics, and repeated doses help only specific drugs such as carbamazepine.

### Is gastric lavage recommended routinely in poisoning?

No, gastric lavage is not recommended routinely in poisoning because it carries aspiration risk and rarely changes the outcome. It is reserved for life-threatening ingestions presenting within about an hour, with the airway protected.

### Which poisons are removed by haemodialysis?

Haemodialysis removes small, water-soluble poisons with low protein binding, including lithium, methanol, ethylene glycol and salicylates. Its use depends on the agent's properties, so the Poison Centre should be consulted before dialysis is arranged.

### Why is flumazenil given with caution in poisoning?

Flumazenil can precipitate seizures in patients with tricyclic antidepressant overdose or in those with chronic benzodiazepine dependence. It is therefore given cautiously, and only when benzodiazepine toxicity is clearly the cause of coma and the airway is secure.

### What is the empirical DNT approach in a comatose poisoned patient?

The empirical DNT approach gives intravenous dextrose, naloxone and thiamine to a comatose patient before the poison is known. It covers hypoglycaemia, opioid toxicity and Wernicke risk, and it is given early because the drugs are low-risk when the cause is unclear.