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Table 36.3

Urgent Investigation of the Patient with Poisoning

Tests requested should take into account poison(s) taken, physiological status and comorbidities

Blood glucose, sodium, potassium, urea and creatinine

Plasma osmolality*

Paracetamol level if paracetamol poisoning is known or possible

Full blood count

Urinalysis (myoglobinuria due to rhabdomyolysis gives a positive stick test for blood)

Arterial blood gases and pH

Chest X-ray

ECG if there is hypotension, coexistent heart disease or suspected ingestion of cardiotoxic drugs (e.g. anti-arrhythmics, tricyclics)

If the substance ingested is not known, save serum (10 mL) and urine (50 mL) at 4°C in case later analysis is needed

* The normal range of plasma osmolality is 280–300mOsmol/kg. If the measured plasma osmolality (by freezing-point depression method) exceeds calculated osmolality (from the formula [2(Na+K)+urea+glucose]) by 10mOsmol/kg or more, consider poisoning with ethanol, ethylene glycol, isopropyl alcohol or methanol.