toxicology Pathways

37 pathways

Work through 37 interactive toxicology decision pathways — branching, guideline-grounded workflows that take you from presentation to assessment, risk stratification and management. Each pathway cites its source (NICE, ESC, AHA and specialty guidance), embeds the relevant calculators, and makes escalation and safety-netting explicit. For decision support only — apply clinical judgement and local protocols.

Paracetamol overdose

Risk stratification and N-acetylcysteine treatment for paracetamol (acetaminophen) overdose.

TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014)
TCA overdose

Cardiovascular and CNS management of tricyclic antidepressant overdose, including sodium bicarbonate therapy.

TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
Opioid overdose

Recognition and titrated naloxone reversal of opioid overdose, including delayed-action and long-acting agents.

TOXBASE/NPIS; Resuscitation Council UK
Anticholinergic toxidrome

Recognition and management of anticholinergic poisoning, including supportive care and the role of physostigmine.

TOXBASE/NPIS; AACT/EAPCCT
Benzodiazepine overdose

Supportive management of benzodiazepine overdose; selective use of flumazenil.

TOXBASE/NPIS; AACT/EAPCCT
β-blocker overdose

Bradycardia, hypotension and shock from β-blocker overdose — atropine, glucagon, high-dose insulin and intralipid.

TOXBASE/NPIS; AACT/EAPCCT; ESC
Calcium channel blocker overdose

Calcium, high-dose insulin euglycaemia and intralipid for severe calcium-channel-blocker poisoning.

TOXBASE/NPIS; AACT/EAPCCT; ESC
Serotonin syndrome

Recognition (Hunter criteria) and management of serotonin syndrome from SSRI/SNRI/MAOI/triptan/linezolid combinations.

Hunter criteria (Dunkley 2003); TOXBASE/NPIS
Salicylate (aspirin) overdose

Acid–base management, urinary alkalinisation and indications for haemodialysis in salicylate poisoning.

TOXBASE/NPIS; AACT/EAPCCT; EXTRIP
Iron overdose

Risk-stratification by elemental iron dose, role of whole-bowel irrigation, and desferrioxamine for severe poisoning.

TOXBASE/NPIS; AACT/EAPCCT
Lithium toxicity

Differentiating acute, acute-on-chronic and chronic lithium toxicity; indications for haemodialysis (EXTRIP).

TOXBASE/NPIS; EXTRIP 2015 (Decker); NICE CG185
Digoxin toxicity

Recognition of digoxin toxicity including arrhythmia patterns, hyperkalaemia and digoxin-specific antibody (DigiFab) indications.

TOXBASE/NPIS; ESC; SmPC DigiFab
Methanol / ethylene glycol poisoning

Recognition of toxic alcohol ingestion (osmolar gap, anion gap), fomepizole/ethanol blockade and dialysis.

TOXBASE/NPIS; AACT/EAPCCT; EXTRIP
Organophosphate / carbamate poisoning

Cholinergic crisis from anticholinesterase agents — atropine titration to drying of secretions plus pralidoxime for organophosphates.

TOXBASE/NPIS; WHO; AACT/EAPCCT
Sympathomimetic / cocaine / MDMA toxicity

Hypertension, tachyarrhythmia, hyperthermia and end-organ injury from cocaine, amphetamines and MDMA — benzodiazepines first.

TOXBASE/NPIS; AACT/EAPCCT; AHA scientific statement on cocaine cardiotoxicity
Carbon monoxide poisoning

Recognition, oxygen therapy and indications for hyperbaric oxygen in carbon monoxide poisoning.

TOXBASE/NPIS; UHMS Hyperbaric Oxygen Indications 14th ed
GHB / GBL overdose

Rapid-onset coma and bradycardia from gamma-hydroxybutyrate / gamma-butyrolactone; supportive airway care and recognition of withdrawal.

TOXBASE/NPIS; AACT/EAPCCT
Sulfonylurea / insulin hypoglycaemia

Recurrent hypoglycaemia from sulfonylurea or insulin overdose — glucose, octreotide and prolonged observation.

TOXBASE/NPIS; JBDS guidance on hypoglycaemia in adults
Paraquat poisoning

Restrict supplemental oxygen, urgent decontamination and prognostication for paraquat — a highly lethal herbicide.

TOXBASE/NPIS; AACT/EAPCCT; Proudfoot nomogram
DOAC overdose / reversal

Reversal of life-threatening bleeding from DOACs — idarucizumab for dabigatran, andexanet alfa or PCC for factor Xa inhibitors.

BSH 2018; ESC 2021; TOXBASE/NPIS; SmPC Praxbind/Ondexxya
Button battery ingestion

Time-critical management of button battery ingestion — risk of caustic oesophageal injury within 2 hours.

TOXBASE/NPIS; NPSA Alert; ESPGHAN; AAP
Sodium channel blocker / LAST

Local anaesthetic systemic toxicity (LAST) and other Na⁺-channel blocker overdose — bicarbonate, intralipid and prolonged resuscitation.

AAGBI Safety Guideline 2010 (LAST); TOXBASE/NPIS; ESC
Propofol / ketamine toxicity

Acute sedation, propofol infusion syndrome (PRIS) and ketamine recreational use — including urological complications.

TOXBASE/NPIS; AAGBI; AACT/EAPCCT
Snake bite (UK adder)

Assessment of Vipera berus (UK adder) bite and indications for ViperaTAb antivenom.

TOXBASE/NPIS; National Poisons Information Service ViperaTAb protocol
Jellyfish / marine envenomation

First aid and management of UK and tropical marine envenomation (jellyfish, weever fish, sea urchin).

TOXBASE/NPIS; Marine Conservation Society
Mushroom poisoning

Syndromic approach to mushroom ingestion, with emphasis on amatoxin (Amanita phalloides) hepatotoxicity.

TOXBASE/NPIS; AACT/EAPCCT; EASL
Isoniazid (INH) overdose

Refractory seizures and metabolic acidosis from isoniazid — pyridoxine antidote in gram-for-gram dosing.

TOXBASE/NPIS; AACT/EAPCCT
Isopropanol poisoning

Isopropyl alcohol (rubbing alcohol) ingestion — ketosis without acidosis, supportive care; HD only if severe.

TOXBASE/NPIS; AACT/EAPCCT; EXTRIP
Theophylline / aminophylline overdose

Refractory tachyarrhythmia, seizures and hypokalaemia from theophylline — multi-dose charcoal and haemodialysis.

TOXBASE/NPIS; AACT/EAPCCT; EXTRIP
Cyanide Poisoning

Smoke inhalation / industrial exposure / suicide; lactic acidosis + cardiovascular collapse; hydroxocobalamin first-line antidote.

TOXBASE; UK NPIS
Anticonvulsant Toxicity (Phenytoin / Carbamazepine / Valproate)

Drug-specific toxidromes — phenytoin (cerebellar), carbamazepine (anticholinergic + cardiac), valproate (hyperammonaemia + hepatic).

TOXBASE; NPIS
Caustic / Corrosive Ingestion

Strong acid / alkali ingestion — DO NOT induce vomiting, no neutralisation, urgent endoscopy 12–24h, surgical input for full-thickness injury.

TOXBASE; ESPGHAN
Hydrofluoric Acid Exposure

Severe pain disproportionate to skin signs; calcium gluconate gel topical + intra-arterial / IV; hypocalcaemia + hypomagnesaemia + cardiac arrhythmia.

TOXBASE; NPIS
Lead Poisoning

Identify exposure (occupational, paint, water, traditional remedies); blood lead level; chelation for severe; address source.

TOXBASE; PHE; CDC
Cannabis Hyperemesis Syndrome

Chronic cannabis use + recurrent severe vomiting + relief by hot showers; supportive + cessation curative.

TOXBASE; NPIS
Salbutamol / β-Agonist Toxicity

β2-agonist toxicity — tachycardia, tremor, hypokalaemia, hyperglycaemia, lactic acidosis; supportive + cardiac monitoring.

TOXBASE; NPIS
Novel Psychoactive Substances / Synthetic Cannabinoids

'Spice', synthetic cathinones, NPS — variable presentation, supportive care, avoid haloperidol in stimulant.

TOXBASE; NPIS; SCAN