Acute poisoning is one of the commonest medical emergencies. There are specific antidotes available for some poisons and drugs, but the majority of the management is supportive. TOXBASE is the best resource for managing acute poisoning. The most important management available at present is supportive care. Tracheal intubation and airway protection is almost always necessary when a patient tolerates insertion of an oropharyngeal airway. Basic observations, including blood pressure, pulse rate, peripheral perfusion and urine output should be recorded. Continue supportive care with attention paid to fluid balance, correction of electrolytes, initiation of nutritional support and prompt treatment of nosocomial infection. General supportive management is discussed with specific importance to measurement of serum levels of paracetamol. Ninety per cent of paracetamol is conjugated by the liver to nontoxic inactive compounds, which are renally excreted. Toxicity occurs when the hepatic glutathione stores lose their ability to conjugate the toxic metabolite.