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FOUNDATION OVERVIEW

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).

PREVENTION

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 73-1 provides select tips that should be emphasized to the public to prevent poisoning emergencies.

TABLE 73-1Poison Prevention Tips

GENERAL MANAGEMENT

General Approach to the Poisoned Patient

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 glucose, and electrolyte values. Additionally, empiric administration of an intravenous “Coma Cocktail” consisting of 100 mg of thiamine, 25 to 50 g of dextrose, and 0.04 to 2 mg of naloxone should be considered early in the management of patients with altered mental status. Seizure and dysrhythmia potential should be considered, and potential need ...

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