Clinical Management of Poisoning and Drug Overdose

Here's the latest edition of the most comprehensive reference in clinical toxicology...the ONLY text that features contributions from experts in all disciplines - medicine, emergency medicine, internal medicine, pediatrics, toxicology, nephrology, and primary care. Readers are given a practical, readable, authoritative source of information to help them manage their toxicology patient for the entire hospital stay in the ER and ICU.
Review of the Previous Edition:
"A major work...An excellent resource...Recommend to anyone involved in providing care for poisoned patients."
--JAMA

Contains completely rewritten and reorganized coverage to encompass the background, pharmacology, pathophysiology, diagnosis, and management of each toxin for clinical treatment throughout a patient's hospital stay.

Features a new editor--Michael Shannon, MD--whose experience in pediatric emergency medicine expands the text's coverage of pediatrics...and almost 60 new contributing experts who have made original contributions to their field, with a majority certified by the first approved subspecialty board in toxicology.

Presents 10 new chapters that cover: pediatric resuscitation, antibiotic hypersensitivity and anaphylaxis, MAO inhibitors and the serotonin syndrome, herbal and alternative medicine, and thrombolytic therapy, and more. OUTSTANDING FEATURES:

Uses a clinical approachfor maximum clinical relevance, addressing how toxins affect humans, not animals.

Incorporates the experience of many expert authors from numerous specialties for a Comprehensive review of toxicology and an authoritative overview of each specialty.

Contains colour plates of toxic natural life, including various snakes, mushrooms, plants, and marine life--a feature unique to this book.

In an increasingly technological world, humans are attracted to the outdoors, "organic" foods, and weekend forays for exotic mushrooms. They are thus exposed to snake venom, botulism, and deadly hepatotoxins. As we seek political domination, the weapons of war include nuclear bombs, biologic agents, and evil concoctions such as nerve gas. As pharmaceutical scientists release ever more potent agents to mitigate high blood pressure, arrhythmias, depression, clogged prostates, and everything else that ails us, the pill vials sit in the medicine cabinet waiting for an inquisitive child or a morose adult to gulp a fistful. Middle Americans labor in factories and on farms, inhaling or absorbing heavy metals, noxious fumes, pesticides, and other industrial chemicals. Teenagers don their headphones and imagine rock music as celestial communication, with the assistance of marijuana, LSD, and the designer drug of the month. We smoke cigarettes, abuse narcotics, get stung by bees, bleach our skin, undergo chemotherapy, seek herbal remedies, and succumb to carbon monoxide in igloos. Like it or not, toxins are ubiquitous.

The third edition of Clinical Management of Poisoning and Drug Overdose instructs the clinician about the major considerations related to exposure to natural and artificial toxins, as well as providing a comprehensive approach to clinical management. The subject matter is sufficiently diverse that the editors have wisely chosen to avoid the usual arbitrary uniformity of a chapter format that can inhibit a comprehensive discussion. The essential clinical information is not overwhelmed by the requisite descriptions of chemical formulas and drug kinetics. Certain chapters, such as those on carbon-monoxide poisoning, tricyclic antidepressants, and antipsychotic drugs, are as replete as any in the literature. Many of the contributors are recognized as the best in their fields. The book is logically organized and reads well. Like previous editions, the third edition will be useful to emergency physicians, intensivists, hospitalists, internists, family practitioners, clinical toxicologists, occupational-medicine physicians, and public health practitioners.

My overall impression of the book is that it is good enough to carry the moniker of a "standard," but there are deficiencies. The topics selected cover all the major categories of toxicology, but there are some subjects missing, such as drugs of abuse (performance enhancers) and drug testing in athletes. The entire premodern history of poisons is offered in six brief paragraphs. Many of the color images are of poor quality, essentially blurred or washed out. Why was an unidentified and perhaps nontoxic species of jellyfish ("with no name") chosen for inclusion? Occasional medical tragedy occurs when activated charcoal is forced through a nasogastric tube that has been inadvertently placed in a trachea or bronchus; this complication merits a discussion of treatment and techniques for prevention. There are instances where cross-referencing would have been useful, such as from the discussion regarding mushrooms in the chapter on hepatotoxins to the chapter on mushrooms. There is no mention, for or against, about the use of electric shock to treat a venomous snakebite. (By the way, don't do it.) The index is not comprehensive. A clinician in the emergency department who encounters a cyanotic and comatose victim with a bottle of "Locker Room" (a nitrite) would not find it listed in the index. The drug is mentioned, but not discussed, in the chapter on volatile-substance abuse, from where the reader is referred back to the section on methemoglobinemia in the chapter on the hematologic consequences of poisoning. Therefore, for the purpose of emergency treatment, a computer with Poisondex information becomes essential. Finally, the discussion of herbal medicines is understated and merits expansion.

We live in an era of exposures and growing complexity of consumer awareness and accountability. With improved surveillance and reporting, an outbreak of gastroenteritis induced by Escherichia coli serotype O157:H7 can focus a spotlight in a matter of hours on physicians, who must be clinically decisive and media savvy. In times of easy world travel and political unrest, it falls to the health care system to respond with equal agility to sarin in the subway or scombroid on the airplane meal tray. This book is therefore both an invaluable resource and a key component of the literary armamentarium necessary to provide the clinician with information that would otherwise not be readily available.

Reviewed by Paul S. Auerbach, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.