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The management of patients suspected, but not confirmed, as being poisoned is challenging. The Royal College of Emergency Medicine and National Poisons Information Service have produced this guidance to provide a generalised clinical approach to any poisoned patient in the emergency department. This guideline provides a clinical approach to support the initial assessment of a patient, identification of potential toxic agents and emergency management. A toxidromic approach is used, with emphasis on consideration of the toxicokinetics of potential poisons and how the patient’s clinical condition may change. It does not replace poison-specific guidance available from TOXBASE and the NPIS or a locally appropriate poisons centre.