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The Assessment and Management of Hypotension and Shock in the Poisoned Patient

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Critical Care Toxicology

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Abstract

While several large-scaled multicenter studies have changed the approach to the diagnosis and treatment of hypotension and shock in septic patients in recent years, the evidence base for the appropriate management of circulatory failure in poisoned patients is much more precarious. Toxicological research is often limited to case reports, small case series, or animal studies and most clinical recommendations or treatment guidelines are based on expert consensus or even personal experience rather than on criteria of evidence-based medicine [1]. Additionally, there may be a significant reporting bias from positive cases responding to different treatments, including extraordinary resuscitation measures. However, given the infrequency of many of these poisoning events, the likelihood of confirmatory randomized controlled trials to prove effectiveness will be low [2].

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Authors and Affiliations

  1. Department of Clinical Toxicology, Klinikum rechts der Isar – Technical University of Munich, Munich, Germany

    Florian Eyer

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  1. Florian Eyer
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Correspondence to Florian Eyer .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado, USA

    Jeffrey Brent

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland, USA

    Paul Dargan

  4. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Benjamin Hatten

  5. Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Eyer, F. (2017). The Assessment and Management of Hypotension and Shock in the Poisoned Patient. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_55

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