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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. Paracelsus, the father of modern toxicology, identified this principle in stating that "solely the dose determines that a thing is not a poison.“1 As such, some agents are capable of severe consequence at microgram dose (botulinum toxin) while others are typically viewed as harmless, but at extremes can be lethal (water intoxication).2

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Poisoning affects all ages, is associated with varying cause (ie. unintentional, environmental, therapeutic error, suicide attempt, malicious), can occur by numerous routes (ie, ingestion, dermal, inhalation, parenteral), and can be due to acute, acute-on-chronic, or chronic exposure. Unintentional and intentional poisoning is a significant source of morbidity and mortality in the United States. In 2007 over 2.4 million exposure calls were made to US poison centers (PCs). More than half of calls involved children less than age 6. The reason for exposure was unintentional in 83.2% and the route of exposure was ingestion in 78.4% of these cases.3 In the most recent report detailing injury mortality, poisoning was the second leading cause of injury death in the United States. Fatalities due to poisoning were found to be more likely unintentional (72%), drug related (91%), and involving patients age 20 to 54 (80%).4 It is estimated there were over 1.7 million patient visits to emergency departments due to drug-related issues in 2006.5

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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 66-1 provides select tips that should be emphasized to the public to prevent poisoning emergencies.

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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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TABLE 66-1 Poison Prevention Tips2,40

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