Poisoning is the leading cause of death due to unintentional injury in the United States. Each year, between 2,000,000 and 4,000,000 US poison exposures occur. Poison control centers (PCCs), health departments, and family physicians work at different levels of the health care system to identify, manage, and prevent poisoning. PCCs provide assistance to the public and to clinicians and health care facilities, with expert consultation in identification, diagnosis, and treatment of poison exposures. They also provide education for clinicians and support primary prevention activities. State, tribal, and local health departments have been established by law to address public health in their jurisdictions. For patients exposed to a poison, family physicians are often the first point of contact with the health care system. Patients who present with undifferentiated symptoms, such as headache, rash, or respiratory symptoms, may have had an unknown exposure. A comprehensive history, including detailed occupational and social histories, and physical examination are often the first steps in identifying an exposure. Family physicians performing an initial assessment of symptoms can call the PCC if they suspect a toxic exposure or are unable to identify a cause.
Case 1. You are working in the emergency department when a family is brought in for exposure to carbon monoxide. The family consists of two parents, a teenager, and two children. Most of the family members were sleeping in the home when the teenager, who was awake working on homework, developed a headache, nausea, and dizziness. She alerted her parents, who checked on the children in their shared bedroom over the garage. They were weak and dizzy. The parents called 911 and all family members were transported to the hospital for evaluation. The first responders noted that a car was running in the garage with its doors closed. They think the car’s remote start was accidentally activated.
Poisoning is defined as exposure to any substance swallowed, inhaled, touched, or injected that can cause injury or death.1 In the United States, poisoning is the leading cause of death due to unintentional injury.2
In 2022, there were 102,958 US deaths due to unintentional poisoning, or a mortality rate of 30.9 deaths per 100,000 individuals. This was more than the combined total of unintentional fall deaths (44,630) and motor vehicle traffic deaths (45,534), which were the second and third US leading causes of death due to unintentional injury.2
Each year in the United States, between 2,000,000 and 4,000,000 poison exposures occur. More than half of these exposures involve children younger than 6 years who are exposed to toxic substances at home.3
Exposure to poisons can occur through ingestion, inhalation, or injection as well as skin or eye contact. Poisonous substances can be inhaled in polluted air, via a sudden or occupational exposure (eg, chemical spill), or in the home from toxic mold or substances in building materials. Poisons can be ingested through a contaminated water supply, pesticides or herbicides used on food crops, or chemicals used in storage or transportation of food.4 Transdermal exposures can occur through direct contact or when people swim in contaminated water. An uncommon but important consideration is intravenous exposure, particularly in health care settings via medical equipment and supplies.5
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