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Objective This study aimed to determine the characteristics of acute poisoning patients.Design This was a prospective cohort study.Setting The study was conducted for 1 year (1 July 2023 to 30 June 2024) at a tertiary care hospital in Sindh, Pakistan.Participants From the patients who arrived at the emergency department due to poisoning, 1404 were registered and included in the study.Outcome measures The data were collected on demographics (gender, age, residential area, education, employment) and poisoning characteristics, prehospital care, treatment, and services at the hospital, and treatment outcomes (survived and died). A χ 2 test was used to find the association between independent variables and treatment outcomes. A multivariate logistic regression model was used to determine the predictors of death at a 95% CI.Results The majority of patients were male (57.1%) and aged ≤30 years (77.6%). The poisoning was primarily intentional (67.5%), and pesticides (56.1%) were commonly involved in the poisoning. The patients were managed mainly by symptomatic treatment (98.1%) and gastric lavage (65.1%). Multivariate logistic regression indicated that delayed reporting (adjusted OR (AOR)=2.00; 95% CI 1.20 to 3.36; p=0.008) and non-existence of antidote (AOR=1.81; 95% CI 1.08 to 3.03; p=0.025) increased the odds of death while unintentional poisoning (AOR=0.27; 95% CI 0.14 to 0.51; p<0.001) and prolonged stay at hospital had a protective effect (AOR=0.19; 95% CI 0.10 to 0.38; p<0.001).Conclusion The study found that the intentional pesticide poisoning within uneducated, young populations in rural areas was significantly prevalent, and early identification and management of severe cases and extended hospital stays influenced survival.