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FOUNDATION OVERVIEW

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Clinical toxicology involves the assessment and management of disease caused by exposure to an agent(s) in which adverse effects may develop. All natural and synthetic xenobiotics are capable of causing toxicity in humans. It is paramount to recognize that all substances can be poisonous in a specific situation. As such, some agents are capable of severe consequence at microgram doses (botulinum toxin) while others are typically viewed as harmless, despite being lethal at extreme doses (water intoxication).

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Key Definitions

ABCs = Airway, breathing, and circulation

ABG = Arterial blood gases

ACLS = Advanced cardiac life support

APAP = Acetaminophen

AST = Aspartate aminotransferase

BZD = Benzodiazepine

CNS = Central nervous system

EKG = Electrocardiogram

GABA = Gamma amino butyric acid

NAPQI = N-acetyl-p-benzoquinone imine

NAC = N-acetylcysteine

PC = Poison center(s)

PPPA = Poison Prevention and Packaging Act

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PREVENTION

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Multiple avenues have been developed to reduce the incidents of unintentional poisoning. National Poison Prevention Week is designated by law (1961) as the third week in March and is used to increase public awareness of the incidents and dangers of poisoning. The Poison Prevention and Packaging Act (1970) (PPPA) requires some hazardous household products, as well as oral prescription medications and some over-the-counter medications, to utilize child-resistant containers. Additionally, the PPPA limits the quantity for packaging of some products. The Poison Control Center Enhancement and Awareness Act (2000) established a toll-free number (1-800-222-1222) to allow nationwide 24 hour access to PC consultation in the United States. Table 67-1 provides select tips that should be emphasized to the public to prevent poisoning emergencies.

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Table Graphic Jump Location
TABLE 67-1Poison Prevention Tips
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GENERAL MANAGEMENT

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General Approach to the Poisoned Patient

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In the setting of known or suspected poisoning, patients commonly present with inadequate and unreliable histories. As such, the potential for rapid patient deterioration should be anticipated, and aggressive supportive care should be instituted early, with first consideration given to the “ABCs” (airway, breathing, circulation). In patients with concerning histories or abnormalities, interventions should also include administration of oxygen; establishment of intravenous access; obtaining a 12-lead electrocardiogram (EKG) and continuous cardiac monitoring; and determination of arterial blood gases (ABGs), blood ...

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