Opioid overdose has its own section in the collapse chapter, because it presents as an unresponsive person. This is everything else — and the common thread is that the dangerous poisonings are the ones where the person looks fine.
Four rules that cover most of it. Call for advice early
— 999 if they are unwell or drowsy, 111 otherwise, and do not wait to see what happens.
Keep the packaging, or photograph the label, including how much was in it.
Do not induce vomiting, ever — it does not empty the stomach usefully and it
causes harm on the way back up. And do not give anything to drink beyond small sips of
water unless told to.
1. Paracetamol — the one that matters most and looks least urgent
It is the commonest serious overdose in the UK, and its defining feature is that it is silent early. Someone who has taken a dangerous amount typically feels normal, or mildly nauseated, for the first day. By the time they feel genuinely unwell, liver injury is established and the window in which treatment works well has largely closed.
- Treatment is highly effective when started early and progressively less so with delay. That is the entire reason for presenting immediately rather than waiting.
- Go, or call, regardless of how much was taken or how well they feel. Working out whether it was "enough to matter" is a laboratory question, not a kitchen one — the assessment needs a blood level timed from ingestion.
- Staggered overdoses count, and are assessed differently. Repeated doses over hours, taken to relieve pain or distress, cause real toxicity and are easy to dismiss.
- Feeling better later is not reassurance. There is a well-described quiet period between the first day and the onset of liver failure.
2. Button batteries — a genuine two-hour emergency
If a child may have swallowed a button battery, go to an emergency department now
- Not the GP, not 111, not waiting to see if it passes. A lodged battery generates an alkali that burns through the wall of the oesophagus, and damage can begin within two hours. Guidelines aim to remove one from the oesophagus inside that window.
- Even if the child is entirely well. Over half of fatalities involve a delayed diagnosis, because the early presentation is vague or absent — and symptoms can be as unremarkable as a cough, drooling, refusing food or a hoarse voice.
- Honey on the way, for children over 12 months, where the ingestion is known or suspected within the last 12 hours: two teaspoons — about 10 ml — every ten minutes. It coats the battery and slows the burn. Not under 12 months because of infant botulism risk, not if perforation is suspected, and ordinary shop honey rather than anything specialist.
- Nothing else by mouth, and do not try to make them vomit.
- Take the packaging or an identical battery if you can find one. Size and type change the risk.
- The risk falls sharply once it is past the stomach, which is why the x-ray matters — but that is a hospital decision, not one to make at home.
- Bleeding can occur weeks later, even after a battery has been removed or passed. Any later vomiting of blood or black stools in a child with this history is an emergency.
Swallowed magnets are the other one people underestimate. A single magnet is usually harmless. Two or more, or one with any other metal object, can attract across loops of bowel and cut through the wall between them. Same answer: emergency department, straight away.
Babies and children under 12 months — where the advice changes
Honey is not given under 12 months, and the reason is not caution. Infant
botulism: honey can carry Clostridium botulinum spores, which an adult gut handles and an
infant gut does not. So for a baby under one year the protocol above is 999 or straight to an
emergency department, and nothing by mouth at all — no honey, no milk, no water, no
attempt to make them sick. There is no home mitigation for this age group and looking for one costs
time.
What makes a swallowed coin cell different from a swallowed coin
- It is not a choking or obstruction problem, it is a chemical burn. A lodged battery does not need to leak. Current passing through wet tissue splits water and generates hydroxide at the negative pole, and that alkali dissolves the oesophageal wall from the inside.
- Tissue injury begins within about 15 minutes, and serious damage can be done within 2 hours — with perforation following later, sometimes days afterwards, from a burn that was established in those first hours. The clock that matters therefore starts at swallowing, not at diagnosis, and it is not stopped by the child seeming well.
- The dangerous ones are the big flat ones. A 20 mm lithium coin cell — the CR2032 in car keys, scales, thermometers, remote controls, flameless candles, musical greetings cards, hearing aid packs, LED tea lights and children's shoes — is wide enough to wedge in a small child's oesophagus. A "dead" battery is still dangerous, because a voltage too low to run a device is easily enough to burn.
- A swallowed coin is usually a nuisance; a swallowed coin cell is a two-hour emergency. They look similar on the floor and identical to a toddler, and a parent who is unsure which it was should assume battery.
- Past the stomach, the risk falls a great deal — the problem is one that lodges in the oesophagus. But that is an X-ray finding, not something to judge at home.
The things that get missed
- Nobody has to have seen it happen. Most serious cases are found late because the swallowing was unwitnessed. New drooling, refusing food, pain on swallowing, a hoarse or altered cry, noisy breathing, chest or throat pain, vomiting, or blood in vomit or saliva — in a child with access to batteries — is a reason to say so out loud at the front desk.
- Batteries go in noses and ears too, and do the same thing to the septum or the ear canal. Same urgency.
- Bleeding can happen days later, catastrophically, if the burn erodes into a blood vessel. Any bleeding from the mouth after a battery ingestion, even after apparent recovery and even after removal, is a 999 call.
- Take the device and the packaging with you. The battery code on the packet tells the hospital the diameter and chemistry, which changes the urgency.
- Do not make them vomit and do not give anything to “wash it down” beyond the honey protocol above, in the age group it applies to.
And the part that prevents all of it. Coin cells belong in a locked or high cupboard in their packaging, and the compartments in remote controls, scales and flameless candles should have a screw in them. The commonest source is not a battery packet — it is a device whose cover has come off. Check the ones in the house you have never thought about: the bathroom scales, the tea lights, the singing card in the drawer.
3. Household and garden
| Type | What to do differently |
|---|---|
| Corrosives — drain cleaner, oven cleaner, dishwasher tablets, descaler | Never induce vomiting — a second pass burns the oesophagus again. Small sips of water or milk to dilute if they are alert and swallowing normally, and 999. Liquid dishwasher capsules are a common one in toddlers and cause real airway swelling |
| Petrol, white spirit, lamp oil, paraffin | The danger is inhalation into the lungs rather than the stomach. Absolutely no vomiting, nothing to drink, and 999 for any coughing or breathlessness |
| Antifreeze and screenwash | Sweet-tasting, drunk in quantity, and there is an antidote — so it is time-critical and looks harmless for hours. 999 |
| Plants, berries and mushrooms | Most are minor. Photograph the plant and take a sample. Foraged mushrooms are the exception and can be lethal with a delayed onset |
| Alcohol in a child | Far more dangerous than in an adult, because children become hypoglycaemic. A drowsy child who has drunk alcohol needs 999, not a bed |
| Recreational drugs | Say what was taken. Nobody is in trouble at that point and paramedics are not police. Concealing the substance is what turns a survivable overdose into a fatal one |
| Carbon monoxide | Headache, nausea and confusion in several people, or in a household, or that improves when they go outside. Get everyone out, do not go back in, 999. A pulse oximeter reads falsely normal — see oximetry |
4. What to tell the ambulance or 111
- What — the exact product or medicine name, from the packaging.
- How much, or the largest amount that could possibly have gone missing. Over-estimate rather than under.
- When, as precisely as you can. Timing determines the treatment for several poisonings and is the single most useful thing you can give.
- Whether anything else was taken, including alcohol. Mixed overdoses are the norm rather than the exception.
- Weight, roughly, for a child.
And if it was deliberate. Treat the poisoning first and the reason second
— but do treat the reason. Anyone who has taken a deliberate overdose needs a mental health
assessment as part of their care rather than instead of it, and they should not be left alone while
waiting. This site does not attempt that subject, and the routes that help are short: 999
if there is immediate danger, 111 and then the mental health option for urgent
support at any hour and any age, Samaritans on 116 123, or text
SHOUT to 85258. In a school, the designated safeguarding lead, the same day.