Coma induced by intoxication

Clinicians in the emergency department are often confronted with coma Patie nts due to poisoning. A systematic general approach involving early consult ation with a neurologist is of paramount importance. A high index of suspic ion, a systematic first assessment already in the prehospital phase and ear ly stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktai l". The opiate antagonist naloxone should be used only when clinically indi cated and in a titrated way. Flumazenil should only be used with caution an d in restricted cases. Clinical neurological evaluation and technical inves tigations like CT-scan and laboratory rests should make part of a careful d iagnostic plan. Toxicological tests deserve their place in the diagnostic w ork up of a coma patient with suspected poisoning. Knowledge of the possibi lities of the toxicology lab and optimal communication with the clinical to xicologist is important for optimal patient care.