Acute poisoning is one of the most common medical emergencies in the UK, accounting for 10-20% of all acute medical admissions. At least 50% involve more than one drug. with alcohol being the most frequent second agent.
Substances involved in poisoning vary widely between different countries (BOX 9.1), In the UK. poisoning wilh paracetamol accounts for 48% of all overdoses, but only 7% of those in Ihe USA, and in Nepal it is very rare. Poisoning with tricyclic antidepressants, selective serotonin (5-hydroxytryprumine, 5-HT) re-uptake inhibilors and drugs of misuse is very common in Ihe UK and USA. Australia has a similar range of ingested toxins to the UK but envenoming wilh snakes. spiders und marine creatures is also very common. In South and South-east Asiua, pesticide ingestion is endemic, and constitutes the most common cause of death by poisoning. The toxicity of available poisons and the paucity of medical facilities in the developing world mean that the mortality rate for self-poisoning is high at 10-20%, compared with 0.5- 1% in most industrialised countries. Reducing deaths from self-harm requires interventions both to lower the incidence of harmful behaviour and to improve the medical management of acute poisoning.