Azizan Haji Daud, Razak Hj Lajis, Adilah Mohd Ariff, Sa’ed H. Zyoud, Halilol Rahman, Sulastri Samsudin. National Poison Center, University Science of Malaysia Objective: Poisoning involving natural toxin (NT) is one of the national health problems in Malaysia that is often overlooked. The aim of the study is to describe the pattern of NT poisoning reported to the National Poison Center (NPC) in Malaysia over a 4-year period. Methods: We reviewed and analyzed all calls registered by the NPC 24-h information and consultation service for the period between 1 January 2006 and 31 December 2009 focusing on the poisoning cases that involved NT. Age, gender, date of exposure, route of exposure, and type of NT poisoning were evaluated. SPSS version 15 was used for descriptive analysis of the data collected. Results: During the study period, the NPC collected 292 telephone enquiries from the emergency departments in Malaysia regarding NT poisoning. Most calls were made by medical doctors (98.6 %) followed by other health professional (1.0 %) and public (0.3 %). NT poisoning occurred mostly in males (65.4 %). Snake bite accounted for 142 cases (48.63 %), followed by spider/scorpion/centipede poisoning in 41 cases (14.04 %), insects poisoning in 9 cases (3.08 %), jelly fish poisoning in 11 cases (3.77 %), other marine poisoning in 17 cases (5.82 %), plant poisoning in 17 cases (5.82 %), bacteria/fungi/algae poisoning in 48 cases (16.44 %), other NTs in 6 cases (2.05 %), and 1 case (0.34 %) of unknown NT poisoning. The number of poisoning calls from the emergency departments regarding NT poisoning was observed to have increased annually from 45 calls (15.42 %) in 2006 to 107 calls (36.64 %) in 2009 (p < 0.001). Conclusion and Recommendations: There has been an increase in the number of calls received by the NPC involving NT poisoning. Based on the available data from the reported cases, animal toxins constitute 75 %, and other toxins comprise only 25 %. Further study is required to determine more accurately the degree of morbidity and mortality related to poisoning by NT.