The Role of the Nephrologist in Management of Poisoning and Intoxication: Core Curriculum 2022

Am J Kidney Dis. 2022 Jun;79(6):877-889. doi: 10.1053/j.ajkd.2021.06.030. Epub 2021 Dec 9.


Poisoning is a common problem in the United States. Acid-base disturbances, electrolyte derangements, or acute kidney injury result from severe poisoning from toxic alcohols, salicylates, metformin, and acetaminophen. Lithium is highly sensitive to small changes in kidney function. These poisonings and drug overdoses often require the nephrologist's expertise in diagnosis and treatment, which may require correction of acidosis, administration of selective enzyme inhibitors, or timely hemodialysis. The clinical and laboratory abnormalities associated with the poisonings and drug overdoses can develop rapidly and lead to severe cellular dysfunction and death. Understanding the pathophysiology of the disturbances and their clinical and laboratory findings is essential for the nephrologist to rapidly recognize the poisonings and establish an effective treatment plan. This installment of AJKD's Core Curriculum in Nephrology presents illustrative cases of individual poisonings and drug overdoses and summarizes up to date information on their prevalence, clinical and laboratory findings, pathophysiology, diagnosis, and treatment.

Keywords: Acetaminophen; acute kidney injury (AKI); extracorporeal toxin removal (ECTR); hemodialysis; lithium; metformin-associated lactic acidosis; osmolal gap; paracetamol; poisoning; review; salicylate intoxication; toxic alcohol.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acidosis*
  • Curriculum
  • Drug Overdose* / diagnosis
  • Drug Overdose* / therapy
  • Humans
  • Metformin*
  • Nephrologists
  • Poisoning* / diagnosis
  • Poisoning* / epidemiology
  • Poisoning* / therapy


  • Metformin