Scottish Intensive Care Society

ICM Induction programme ©

Table 1: Poisoning and ICU admission

2. Considerations and indications for ICU admission following poisoning

Commonly used severity of illness models such as the Acute Physiology and Chronic Health

Evaluation (APACHE) scoring system are not validated for poisoned patients. Caution should

therefore be exercised when thinking about applying them to predict who may require ICU

admission following poisoning.

Several factors must be considered when thinking about an ICU admission for poisoning.

These include:

i) Poison-induced end-organ toxicity

ii) Poison characteristics (pharmacodynamics)

iii) Patient characteristics (pharmacokinetics)

iv) What an ICU can offer the poisoned patient over other departments

These are discussed in more detail through the links in table 1. Before considering any of

the above though, the initial assessment of the patient with possible poisoning should

always assume the traditional ABCDE approach (see the assessment of the critically

ill patient module).

Above all, when you are assessing a critically ill patient with poisoning and you are

wondering whether they would benefit from intensive care nothing is more useful than both

experience (your seniors!) and good clinical judgement.

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