Background Acute poisoning remains a significant paramount clinical emergency globally. The type of poison to which an individual is exposed to varies all over the world and may even vary in different regions of the same country depending on the socioeconomic factors and cultural diversity. It is of a crucial importance to investigate and analyze the pattern and severity of poisoning in order to manage poisoning cases. Accordingly, prompt initiation of appropriate emergency care and supportive measures could be life-saving and could possibly reduce morbidity and mortality. Aim To characterize acute poisoning, marine envenomation, venomous animal bites/stings, identify the outcome of poisonings and analyze the pattern of management of acute poisoning cases presenting to the emergency medical department in Sultan Qaboos University hospital (SQUH) in the Emergency Medical Department (EMD). Objectives  To analyze reported acute poisoning cases by EMD at SQUH for demographical information and etiological patterns and to identify the nature of agents involved in acute poisoning.  To determine risk factors of prolonged hospital stay for acute poisoning cases.  To assess the adherence to the National Management Guidelines of Poisoning by Ministry of Health (MOH). Methods This was a retrospective study done in the EMD of SQUH (a tertiary care hospital). The Study included a total of 350 cases, out of which 336 patients of acute poisoning, 10 cases of marine envenomation and 4 cases of venomous animal bites/stings. Data regarding demographics, type, and mode of poisoning, comorbid illness, complications, system involvement, first aid outside SQUH, initial treatment at the hospital, requirement of antidote, duration of hospitalization, and outcome were obtained. vi Scoring system: Ministry of health of Oman (MOH) poisoning scoring system, that was adapted from "Poisoning Severity Score" (PSS). It is a standardized scale for grading the severity of poisoning to facilitate qualitative evaluation of morbidity due to poisoning, better identification of real risks and comparability of data. As per MOH poisoning scoring system, severity grading is classified to minor, moderate, and severe/fatal. Results Among the 350 patients included, females accounted for the majority of cases (56,3% versus 43.7%). Intentional exposures were seen more frequent (186, 53.1%). Most of the reported poisoning cases were due to medicinal drugs exposures (247, 71%). Among medicinal drug poisonings, multiple drugs intake was prominent (56, 16%), while among non-pharmaceutical exposures, household products were common (57, 16.4%). It was found that (67 ,19.1%) were treated conservatively without receiving any medical intervention. Length of hospitalization was the highest in patients who were admitted to psychiatry medicine and/ or Intensive care unit (ICU), those who developed multiple system manifestations and among those who received antidotes. There was one death (case fatality rate of 0.3), primarily from organophosphate pesticide ingestion Conclusion Poisoning in the age group of ≤ 12 years is mainly unintentional and commonly due to pharmaceutical agents while poisoning in older age groups is mainly intentional (self-harm). Opioids were detected to cause high rates of delayed recoveries, whereas hydrocarbons, mainly toluene was the most frequent non-pharmaceutical agent causing delayed recovery. Drugs detected at high rates in poisonings, such as paracetamol should be used more cautiously.