Abstract
More than 1.9 million poison exposures were reported to United States poison centers in 1994,1 at least 74% of which were by intentional or accidental ingestion. This chapter is intended to provide primary care clinicians with sufficient information to diagnose and comprehensively manage common oral poisonings associated with significant morbidity and mortality. They include ingestions of acetaminophen, tricyclic antidepressants, aspirin / salicylates, and benzodiazepines.
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References
Litovitz TL, Felberg L, Soloway RA, Abat MF, Geller R. 1994 Annual report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med 1995;13:551–91.
Rumack BH. Acetaminophen overdose in children and adolescents. Pediatr Clin North Am 1986;33:691–701.
Letter to physicians. McNeil Consumer Products Company, January 23, 1995.
Lewis RK, Paloucek FP. Assessment and treatment of acetaminophen overdose. Clin Pharm 1991;10:765–73.
Peterson RG, Rumack BH. Pharmacokinetics of acetaminophen in children. Pediatrics 1978;62 Supp1:877–9.
Rumack BH, Peterson RC, Koch GC, Amara IA. Acetaminophen overdose. Arch Intern Med 1981;141:380–5.
Zarro VJ. Acetaminophen overdose. Am Fam Physician 1987; 35:235–7.
Smilkstein MJ, Knapp GL, Kulig KW, Rumack BH. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. N Engl J Med 1988;319:1557–62.
Flanagan RJ, Meredith TJ. Use of N-acetylcysteine in clinical toxicology. Am J Med 1991;91 Suppl 3C:131S-9S.
Anker AL, Smilkstein MJ. Acetaminophen: concepts and controversies. Emerg Med Clin North Am 1994;12:335–49.
Harrison PM, Keays R, Bray GP, Alexander GJ, Williams R. Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of acetylcysteine. Lancet 1990;335:1572–3.
Keays RT, Gove C, Forbes A, Alexander GJ, Williams R. Use of late N-acetylcysteine in severe paracetamol overdose [abstract]. Gut 1989;30:A1512.
Pollock BG, Perel JM. Tricyclic antidepressants: contemporary issues for therapeutic practice. Can J Psychiatry 1989; 34:609–17.
Frommer DA, Kulig KW, Marx JA, Rumack B. Tricyclic antidepressant overdose—a review. JAMA 1987;257:521–6.
Braden NJ, Jackson JE, Walson PD. Tricyclic antidepressant overdose. Pediatr Clin North Am 1986;33:287–97.
Hollister LE. Tricyclic antidepressants [first of two parts]. N Engl J Med 1978;299:1106–9.
Groleau G, Jotte R, Barish R. The electrocardiographic manifestations of cyclic antidepressant therapy and overdose: a review. J Emerg Med 1990;8:597–605.
Preskorn SH, Irwin HA. Toxicity of tricyclic antidepressants; kinetics, mechanism, intervention: a review. J Clin Psychiatry 1982;43:151–6.
Biggs JT, Spiker DG, Petit JM, Ziegler VE. Tricyclic antidepressant overdose—incidence of symptoms. JAMA 1977; 238:135–8.
Boehnert MT, Lovejoy FH. Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose in tricyclic antidepressants. N Engl J Med 1985;313:474–9.
Niemann JT, Bessen HA, Rothstein RJ, et al. Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity. Am J Cardiol 1986;57:1154–9.
Liebelt EL, Francis PD, Woolf AD. ECG lead AVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med 1995; 26:195–201.
Buchman AL, Dauer J, Geiderman J. The use of vasoactive agents in the treatment of refractory hypotension seen in tricyclic antidepressant overdose. J Clin Psychopharmacol 1990;10:409–13.
Newton EH, Shih RD, Hoffman RS. Cyclic antidepressant overdose: a review of current management strategies. Am J Emerg Med 1994;12:376–9.
Marshall JB, Forker AD. Cardiovascular effects of tricyclic antidepressant drugs: therapeutic usage, overdose, and management of complications. Am Heart J 1982;103:401–14.
Needs CJ, Brooks PM. Clinical pharmacokinetics of the salicylates. Clin Pharm 1985;10:164–77.
Riggs BS, Kulig K, Rumack BH. Current status of aspirin and acetaminophen intoxication. Pediatr Ann 1987;16: 886–98.
Paulus HE, Siegel M, Morgan E, et al. Variations in serum concentrations and half-life of salicylate in patients with rheumatoid arthritis. Arthritis Rheum 1971;14:527–32.
Temple AR. Acute and chronic effects of aspirin toxicity and their treatment. Arch Intern Med 1981;141:364–9.
Thurston JH, Pollock PG, Warren SK, Jones EM. Reduced brain glucose with normal plasma glucose in salicylate poisoning. J Clin Invest 1970;11:2139–45.
Durnas C, Cusack BJ. Salicylate intoxication in the elderly—recognition and recommendations on how to prevent it. Drugs Aging 1992;2:20–34.
Woolley RJ. Salicylate-induced pulmonary edema: a complication of chronic aspirin therapy. J Am Board Fam Pract 1993;6:399–401.
Leatherman JW, Schmitz PG. Fever, hyperdynamic shock, and multiple-system organ failure: a pseudo-sepsis syndrome associated with chronic salicylate intoxication. Chest 1991;100:1391–6.
Yip L, Dart RC, Gabow PA. Concepts and controversies in salicylate toxicity. Emerg Med Clin North Am 1994;12: 351–64.
Snodgrass WR. Salicylate toxicity. Pediatr Clin North Am 1986;33:381–91.
Gaudreault P, Guay J, Thivierge RL, Verdy I. Benzodiazepine poisoning—clinical and pharmacological considerations and treatment. Drug Saf 1991;6:247–65.
Sellers EM. Clinical pharmacology and therapeutics of benzodiazepines. Can Med Assoc J 1978;118:1533–8.
Hansten PD, Horn JR, editors. Substrates and inhibitors for selected cytochrome P450 isoenzymes. In: Drug interactions and updates. Spokane, WA: Applied Therapeutics, 1996:905–6.
Slaughter RL, Edwards DJ. Recent advances: the cytochrome P450 enzymes. Ann Pharmacother 1995;29:619–24.
Votey SR, Bosse GM, Bayer MJ. Flumazenil: a new benzodiazepine antagonist. Ann Emerg Med 1991;20:181–8.
Ghoneim MM, Mewaldt SP. Benzodiazepines and human memory: a review. Anesthesiology 1990;72:926–38.
Hojer J, Baehrendtz S, Gustafsson L. Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14 year period. J Intern Med 1989;226:117–22.
Jatlow P, Dobular K, Bailey D. Serum diazepam concentrations in overdose—their significance. Am J Clin Pathol 1979; 72:571–7.
Divoll M, Greenblatt DJ, Lacasse Y, Shader RI. Benzodiazepine overdosage: plasma concentrations and clinical outcome. Psychopharmacology 1981;73:381–3.
Bayer MJ, Danzl D, Gay GR, et al. Treatment of benzodiazepine overdose with flumazenil—the flumazenil in benzodiazepine intoxication multicenter study group. Clin Ther 1992;14:978–95.
Hoffman RS, Goldfrank LR. The poisoned patient with altered consciousness—controversies in the use of a “coma cocktail.” JAMA 1995;274:562–9.
Spivey WH, Roberts JR, Derlet RW. A clinical trial of escalating doses of flumazenil for reversal of suspected benzodiazepine overdose in the emergency department. Ann Emerg Med 1993;22:1813–21.
Prischl F, Donner A, Grimm G, Smetana R, Hruby K. Value of flumazenil in benzodiazepine self-poisoning. Med Toxicol 1988;3:334–9.
Sugarman JM, Paul RI. Flumazenil: a review. Pediatr Emerg Care 1994;10:37–43.
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Larsen, L.C., Fuller, S.H. (1998). Poisoning. In: Taylor, R.B., David, A.K., Johnson, T.A., Phillips, D.M., Scherger, J.E. (eds) Family Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-2947-4_48
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DOI: https://doi.org/10.1007/978-1-4757-2947-4_48
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