A poison may affect the body in many ways. It may inhibit or alter normal cellular function, change normal organ function, or may change the normal uptake or transport of substances into or within the organism. The toxin may also exclude essential substrates in the environment from being efficiently utilized by the organism. This chapter discusses the general management of poisoned patients. The following chapters discuss specific approaches to patients exposed to individual classes of drugs.
In 1996, there were 2,155,952 toxic exposures reported to poison centers in the United States: 1,137,295 (52.6 percent) involved children younger than 18 years of age. Some authors currently list poisoning as the third leading cause of death in the United States and, between 1985 and 1995, the incidence of toxin-related deaths is said to have increased approximately 300 percent. Although many of these exposures were referred to as "accidents," most were preventable or avoidable by modalities such as increased awareness and education, increased parental control over children, instituted checks and balances in hospitals and pharmacies, computer networking and recognition of potential drug interactions, better hospital protocols to ensure patient identification, detailed procedures to check proper dosing, better warning labels and packaging on products with potential toxicity, and better access to mental health care by the underinsured. The public must be made aware of the potential tragedy when nonfood (potentially harmful) items are stored in food areas behind insufficiently secured barricades accessible to children, as well as the potential health threat when toxins are stored in empty food containers.
Poison centers should be an integral part of the management of exposed patients. These centers are typically staffed with specialists who are trained in the management of poisoned patients, have extensive reference material at their disposal, and have rapid access to medical toxicologists if more extensive evaluation is required. Routine consultation in cases where toxic exposure is suspected can help focus diagnosis and treatment and reduce cost and unnecessary hospitalizations.
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