Poisoning occurs when a person is exposed to a substance that causes harmful physiological effects. It is a leading cause of emergency department visits, especially among children. Rapid recognition and appropriate first aid — starting with contacting the Poison Control Center — can be lifesaving.

Ambulance responding to a poisoning emergency — Poisoning — from medications, household chemicals, or environmental toxins — requires prompt recognition, decontamination, and antidote administration when available. Source: Unsplash.

CPR training for poisoning emergency response — CPR skills are essential when responding to poisoning emergencies that cause cardiac or respiratory arrest. Source: Unsplash.

Routes of Poisoning Exposure

Ingestion. Most common route. Includes medications (accidental overdose or intentional), household chemicals (bleach, detergents, pesticides), plants, food poisoning, and alcohol.

Inhalation. Breathing in toxic fumes, gases, or vapors: carbon monoxide, smoke, natural gas, chemical fumes, volatile solvents.

Absorption (skin or eye). Contact with toxic substances: pesticides, plant toxins (poison ivy, poison oak), chemical spills.

Injection. Venom from insect stings or snake bites, needle-stick injuries, drug overdose via injection.

Immediate First Aid

Initial Steps

If you suspect poisoning: assess the scene for safety first (do not become a victim yourself). Move the person away from the source of poisoning if safe to do so. Call the Poison Control Center at 1-800-222-1222 (United States) — available 24/7, free, confidential, with expert toxicologists. If the person is unconscious, not breathing, or having a seizure, call 911 immediately.

Have the following information ready for Poison Control: the person’s age, weight, and known medical conditions; the substance involved (read the label); the amount swallowed or exposed to; the time of exposure; any symptoms already present.

What NOT to Do

Do NOT induce vomiting unless specifically instructed by Poison Control or a medical professional.
Do NOT give ipecac syrup — it is no longer recommended for poisoning.
Do NOT give the person anything to eat or drink unless instructed.
Do NOT neutralize the poison with lemon juice, vinegar, or other household products (this can cause chemical reactions that worsen injury).
Do NOT wait for symptoms to appear before calling — many toxins cause significant internal damage before symptoms arise.

ⓘ Information

Inducing vomiting is no longer recommended for most poisonings. Reasons: caustic substances (acids, alkalis) cause additional damage when vomited back up through the esophagus and mouth. Hydrocarbons (gasoline, kerosene, lighter fluid) can be aspirated into the lungs, causing chemical pneumonitis. Sharp objects or pills that have not fully dissolved can cause additional trauma. Ipecac syrup can cause persistent vomiting and complicate treatment. In some specific cases, medical professionals may use gastric lavage (stomach pumping) in a controlled setting — this is not the same as inducing vomiting at home.

Poisoning by Ingestion

Signs and Symptoms

Nausea, vomiting, abdominal pain
Diarrhea
Burns or redness around the mouth and lips
Unusual breath odor (bitter almond smell may indicate cyanide, garlic smell may indicate arsenic or organophosphates)
Drowsiness, confusion, loss of consciousness
Seizures
Slow or rapid breathing
Drooling or difficulty swallowing

First Aid

Call Poison Control. If the person is awake and alert, they may be instructed to drink water or milk (to dilute the poison). Save the container or bottle — bring it to the emergency department. If the person vomits, save a sample for analysis if possible (take a photo of the vomit). Do not force fluids.

Activated Charcoal

Activated charcoal can absorb certain poisons in the gastrointestinal tract, preventing absorption into the bloodstream. It is most effective when given within one hour of ingestion. It is NOT effective for all poisons (does not bind alcohols, heavy metals, iron, lithium, cyanide, or caustics). It should only be administered under the direction of Poison Control or a physician. Activated charcoal causes the stool and vomit to turn black — this is harmless and expected.

Poisoning by Inhalation

Common Inhalation Poisons

Carbon monoxide. Colorless, odorless gas from incomplete combustion (car exhaust, furnaces, generators, wood stoves, charcoal grills). Symptoms: headache, nausea, dizziness, confusion, loss of consciousness. Treatment: immediately move the person to fresh air, call 911, administer 100% oxygen or hyperbaric oxygen therapy.

Smoke inhalation. Fire-related poisoning — a combination of carbon monoxide, cyanide, and thermal injury to the airways. Signs: soot around the mouth or nose, coughing, hoarseness, difficulty breathing, altered mental status. Treatment: remove from smoke environment, call 911, provide oxygen.

Chemical fumes. Chlorine (from pool chemicals or cleaning product mixing), ammonia, cleaning solvents, paint fumes, pesticides. Treatment: move to fresh air, call Poison Control, remove contaminated clothing.

First Aid

Rescue breathing in fresh air only if it is safe (do not enter a toxic environment without proper protective equipment). Open windows and doors to ventilate. Loosen tight clothing. If the person is unconscious but breathing, place in the recovery position (on their side). Administer oxygen if available and trained.

Poisoning by Skin Contact

Signs and Symptoms

Redness, rash, blisters, burns
Itching, swelling, pain
Systemic absorption (symptoms affecting other body systems)

First Aid

Remove contaminated clothing immediately (protect your own hands with gloves). Brush off dry powder before flushing. Flush the affected skin with copious amounts of cool running water for at least 15-20 minutes. For chemical burns, continue flushing until medical help arrives. Do not apply any ointments, butter, or home remedies. Wrap the area loosely in a clean, dry cloth. For organophosphate or pesticide exposure, special decontamination may be needed — follow Poison Control instructions.

Poisoning by Eye Contact

Signs and Symptoms

Redness, burning, pain, tearing
Blurred vision, sensitivity to light
Swelling of eyelids

First Aid

Immediately flush the affected eye with lukewarm water for at least 15-20 minutes. Hold the eyelid open and pour water from the inner corner outward (to avoid contaminating the other eye). Remove contact lenses if present (after flushing begins). Do not rub the eye. Do not apply any eye drops, ointments, or home remedies. After flushing, cover the eye with a clean, loose dressing and seek medical evaluation — chemical eye injuries can cause permanent vision loss.

Opioid Overdose — Naloxone (Narcan)

Recognition of Opioid Overdose

Opioids (heroin, fentanyl, morphine, oxycodone, hydrocodone, methadone) cause respiratory depression. Signs: pinpoint pupils (miosis), unconsciousness, slow or absent breathing, cyanosis (blue lips and fingertips), choking or gurgling sounds (agonal breathing), limp body.

Naloxone Administration

Naloxone is an opioid antagonist that rapidly reverses opioid overdose. It is available as a nasal spray (Narcan) or injectable form. In many states, it is available without a prescription through pharmacies and community distribution programs.

Nasal spray (Narcan). Place the person on their back, support the neck, and tilt the head back (head-tilt/chin-lift). Insert the nozzle into one nostril until your fingers touch the outside of the nostril. Press the plunger firmly to deliver the full dose. Spray into the opposite nostril the same way if available. Repeat every 2-3 minutes if there is no response. Naloxone wears off in 30-90 minutes, while opioids may last longer — multiple doses may be needed. After naloxone administration, begin rescue breathing or CPR if the person is not breathing. Call 911. Naloxone causes immediate withdrawal symptoms in opioid-dependent persons (agitation, vomiting) — this is unpleasant but not life-threatening and preferable to death from overdose.

⚠ Caution

Synthetic opioids like fentanyl and carfentanil are extremely potent (fentanyl is 50-100 times more potent than morphine; carfentanil is 10,000 times more potent). They can cause rapid respiratory arrest. Naloxone is effective against fentanyl but may require higher or more frequent doses. First responders should use universal precautions and avoid direct contact with unknown powders or residues — fentanyl and carfentanil can be absorbed through the skin or mucous membranes. Naloxone auto-injectors and high-dose formulations (4 mg nasal spray vs. 2 mg standard) may be preferred in known or suspected fentanyl overdose.

Poisoning by Snake Bite

In the United States, venomous snakes include rattlesnakes, copperheads, water moccasins (cottonmouths), and coral snakes. Pit vipers (rattlesnakes, copperheads, cottonmouths) leave fang marks and cause immediate pain, swelling, and bruising. Coral snakes have small teeth and cause neurologic symptoms (weakness, difficulty speaking, respiratory failure) with minimal local findings.

First Aid

Call 911 immediately. Keep the person calm and still — movement increases venom spread. Remove jewelry and tight clothing near the bite site (swelling will occur). Keep the bite area below heart level if possible. Clean the wound with soap and water (do not flush vigorously). Cover with a clean, dry dressing. Do NOT: cut the wound and suck out venom, apply a tourniquet, apply ice or heat, give alcohol or caffeine, or use a venom extraction kit — these interventions are harmful and increase complications. Antivenom is the definitive treatment and should be administered in an emergency department.

Poisoning by Food

Food poisoning (foodborne illness) results from consuming food contaminated with bacteria (Salmonella, E. coli, Listeria, Campylobacter), viruses (norovirus, hepatitis A), parasites, or toxins (staphylococcal enterotoxin, botulism toxin). Symptoms include nausea, vomiting, diarrhea, abdominal cramps, and fever, appearing within hours to days after consumption.

First Aid for Food Poisoning

Most cases resolve with supportive care: rest, oral rehydration (small sips of clear fluids, oral rehydration solution), and a bland diet as tolerated. Do not take antidiarrheal medications (loperamide) if you have bloody diarrhea or fever — they can prolong infection. Seek medical attention for: bloody diarrhea, high fever (over 101.5°F / 38.6°C), severe abdominal pain, signs of dehydration (dry mouth, decreased urination, dizziness), symptoms lasting more than 3 days, or if the person is very young, elderly, pregnant, or immunocompromised. Botulism (blurred vision, difficulty swallowing, descending paralysis) is a medical emergency — call 911 immediately.

Summary

For any suspected poisoning: call the Poison Control Center at 1-800-222-1222 (or 911 for emergencies). Do NOT induce vomiting. Provide fresh air for inhalation exposures. Flush skin and eyes thoroughly for contact exposures. Administer naloxone for suspected opioid overdose. Do NOT use harmful first-aid interventions (tourniquets for snake bites, cutting and sucking venom, neutralizing with household products). Prevention through safe storage of medications and chemicals, installation of carbon monoxide detectors, and proper food handling is essential.