Chapter 120. Toxic Ingestions and Exposures

Management of the Intoxicated Patient

Evaluation of the Poisoned Patient

Sing-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 or opioids...."

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