Substance identification

The substance taken may be elicited by the patient, but this should be corroborated, especially in serious suicidal attempts. Fellow household members, relatives, neighbours, ambulance personnel, and the police may all be useful as sources of third-party evidence.

Where possible, ascertain:

• time of ingestion
• associated alcohol consumption
• past and current medical history
• symptoms noted since ingestion

Useful clues may be present by examining the:

• eyes:
  • dilated pupils - tricyclics, cocaine, amphetamine
  • pinpoint pupils - opiates - rapidly reversed by naloxone; organophosphates
  • nystagmus - alcohol, benzodiazepines, phenytoin
• breath - bitter almond smell of cyanide; alcohol; organic solvents
• burns around the mouth - corrosive substances such as paraquat, glue sniffers
• hyperventilation - salicylates
• needlemarks - 'recreational' drug abuse