Autointoxications are among the most common medical emergencies. Patterns of toxicosyndromes show regional variation, and they change over time. Intoxications are usually multiple. Although autointoxication is often selflimiting and a fatal outcome is unusual, suicide attempts may kill. Toxicity screening, emergency room first aid, decision rules for admission to the Ward or the ICU, or prolonged observation in the Emergency Department, and measures to prevent gastrointestinal substance resorption are based on expert opinion rather than scientific evidence. Toxicity screening needs regular adjustment and should be individually tailored, based on local patterns as well as on clinical syndromes. A team approach and efforts to study safe management strategies should turn caregiver frustration into a more enthusiastic and inquisitive attitude towards the challenges to meet the medical needs of these patients.