Section 8. The Acutely Ill Infant and Child >
Part 3. Injuries and Untoward Events >
Chapter 120. Toxic Ingestions and Exposures
Management of the Intoxicated Patient
Evaluation of the Poisoned PatientSing-Yi Feng, Collin S. Goto, and M. Douglas Baker
Topics Discussed: acute illness; anticholinergic syndrome ; anticholinergic toxicity; metabolic acidosis, increased anion gap; opioid intoxication; opioid withdrawal; poisoning; poisoning by sympathomimetic drug; sedative withdrawal delirium; toxic ingestion; toxidrome.
Sections: Decontamination, Enhanced Elimination, Disposition, Pharmaceutical Agents, Acetaminophen, Anticoagulants, Anticonvulsants, Antipsychotics, Beta-Blockers and Calcium Channel Blockers, Clonidine, Cyclic Antidepressants, Digoxin and Cardiac Glycosides, Iron, Isoniazid, Opioids, Salicylates, Sulfonylureas, Environmental and Household Toxins, Caustics, Hydrocarbons, Methanol and Ethylene Glycol, Methemoglobinemia, Organophosphorus and Carbamate Insecticides, References.
Excerpt:"Determining the type of toxin involved guides therapy. The presumptive
diagnosis can often be made using information from the history, vital
signs, and physical examination before extensive laboratory results
are available.Toxidromes or "toxic syndromes" are characteristic
vital signs and physical findings that indicate the presence of
a specific category of toxins (Table 120-2).
Toxidromes are especially helpful when the patient
has been exposed to a single toxin. Exposure to multiple substances can
obscure the clinical diagnosis, whereas other disease processes
may mimic the toxidromes. Stimulation or inhibition of specific
receptors in the autonomic and somatic nervous systems results in
the classic toxidromes (eFig. 120.1).
The opioid toxidrome results from stimulation of opiate receptors
in the central nervous system. Withdrawal syndromes are associated
with sudden abstinence after chronic use of sedative-hypnotic drugs
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