Table of Contents
Information Regarding Toxicity
Accurate identification of the actual poison involved can be difficult for:
- Industrial exposures
- Chemical exposures
- Patients from whom a history is not available (see differential diagnosis)
Once the toxin has been identified, information on the potential effects and management can be obtained from a large number of sources. The product information is generally NOT a good source for this information - the overdose sections are almost never updated and can be very misleading on both the degree of toxicity and management.
This list is in no way definitive but the texts we most frequently use (going from most comprehensive to least) include the following.
ToxiNZ is an Internet database containing information regarding toxic compounds and the management of poisoned patients. Under construction to meet Australasian requirements the database contains some 60,000 listed chemical products, pharmaceuticals, plants and hazardous creatures; and is rapidly expanding to accommodate more.
This system is designed to enable standardised, seamless management of the poisoned patient from home to hospital by providing three distinct formats:
- TOXINZ First-aid
- TOXINZ Primary Management
- TOXINZ Full Management
pThe information, while comprehensive, is succinct, easily navigated, and contains clear recommendations on patient management.
Advice, supported with images and nomograms, is fully referenced and reviewed by an international editorial board which includes all three main authors of HyperTox. Updates are made weekly.
PoisIndex is a US-based CD text also available on the web, which covers in detail a wide range of poisonings. It is updated quarterly and has a huge number of people involved in developing and writing protocols on poisoning. This leads to some problems with its format, which is cumbersome and repetitive. As a general rule it does not pass judgment on or interpret the literature and is non-prescriptive. This means recommendations regarding management are taken from published recommendations (often from many years previously) and may be poorly justified and often directly conflicting. On the other hand, its tremendous scope and comprehensiveness make it particularly useful as it provides at least some information on very unusual poisonings.
The first edition of Medical Toxicology by Ellenhorn & Barceloux was an excellent textbook for all audiences, a very clear guide to what a couple of experienced and well-read clinicians considered was appropriate management for poisoning. The second edition, while still perhaps the best general textbook around, sits on the fence about many controversial issues in toxicology (perhaps reflecting the much larger number of people involved in it's production). A third edition is in preparation.
Our favourite pocket-sized toxicology handbook is the Lange publication edited by Kent Olson and others.
Toxicology of the eye
For ophthalmological toxicity it is hard to go past Grant & Schuman.
The Clinical Toxinology Resources Website is a web-based site for information on venomous animals and poisonous animals, plants and mushrooms. It covers the whole World, with both general information and information about particular organisms, located through a searchable database, that allows users to look for an animal, plant or mushroom, based on a common name, a scientific name or family, a country or region. It is constantly in development and has little or no information in some areas but is very strong in Australian animals.
POISON INFORMATION CENTRES
In Australia, further information can be obtained through the Poisons Information Centres (telephone 131126). There is a clinical toxicologist and a clinical toxinologist (for envenomations) on call 24 hours/day for the Poisons Information Centre network.
Klasco RK (Ed): POISINDEX® System. MICROMEDEX, Greenwood Village, Colorado
Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. Williams & Wilkens, Baltimore, 1997.
Olson KR (ed). Poisoning & Drug Overdose. Appleton & Lange, Norwalk, 3rd edition, 1999
Grant WM & Schuman JS. Toxicology of the eye. Charles C Thomas, Illinois, 5th edition, 1997.