Intensive Care pp 324-356 | Cite as

Acute Poisoning

  • Noel Wright

Abstract

Acute poisoning now accounts for over 10% of all medical admissions and over 50% of medical admissions who are aged less than 45. Despite these very high rates the overall hospital mortality from poisoning remains less than 1% and the number of people dying from suicide continues to fall in Britain. The vast majority of cases in the adult population is self-induced and the mean age for the phenomenon is dropping slowly. Women outnumber men by a ratio of 1.5:1. Motivation for taking an overdose is often complex, including reasons such as a ‘ cry for help’, manipulation of relatives, opting out and so forth, but almost all are not suicidal in intent. This is borne out by the difference in mean age of overdose patients admitted to hospital, which is around 25 years, whilst the mean age of subjects actually committing suicide is around the age of 50 years. Despite the absence of clear suicidal intent, all patients admitted to hospital should be assessed by a suitably trained person with a view to helping the patient and preventing repetition1,2. Accidental poisoning occurs commonly in toddlers and experimental self-poisoning in young adolescents. Though the total number of patients is great the majority are trivial from a physical point of view and do not require intensive care. Approximately 15% do require either intensive observation or active treatment and it is the management of this subgroup that forms the subject of this chapter. The contents are based on 3 years of experience in the Regional Poisoning Centre in Edinburgh followed by 6 years as director of this unit.

Keywords

Depression Carbon Monoxide Cyanide Theophylline Carbamate 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kreitman, N. (1977). Parasuicide. ( London: Wiley )Google Scholar
  2. 2.
    Editorial (1979). Policies on self poisoning. Br. Med. J., 2, 1091CrossRefGoogle Scholar
  3. 3.
    Wright, N. (1980). An assessment of the unreliability of the history given by self poisoned patients. Clin. Toxicol., 16, 381PubMedCrossRefGoogle Scholar
  4. 4.
    Wright, N. (1980). Common errors in the management of self poisoning. J. R. Coil. Physicians London.Google Scholar
  5. 5.
    Matthew, H. and Lawson, A.A.L. (1979). Treatment of Common Acute Poisonings. ( Edinburgh: Churchill Livingstone )Google Scholar
  6. 6.
    Kaplan, S.A. and del Carmen, F. T. (1958). Experimental salicylate poisoning: Observations on the effects of carbonic anhydrase inhibitor and bicarbonate. Paediatrics, 21, 762Google Scholar
  7. 7.
    Goulding, R. (1976). Experience with haemoperfusion in drug abuse. Kidney Int., 10, 338Google Scholar
  8. 8.
    Wright, N., Clarkson, A,R., Brown, S.S. and Foster, V. (1971). Effects of poisoning on serum enzyme activities, coagulation and fibrinolysis. Br. Med. J., 3, 347Google Scholar
  9. 9.
    Sutherland, G.R., Park, J. and Proudfoot, A.T. (1977). Ventilation and acidbase changes in deep coma due to barbiturate or tricyclic antidepressant poisoning. Clin. Toxicol., 2, 403CrossRefGoogle Scholar
  10. 10.
    Arndt, K. A., Milne, M. C. and Parrish, J. A. (1973). Bullae, a cutaneous sign of a variety of neurological diseases. J. Invest. Dermatol, 60, 312CrossRefGoogle Scholar
  11. 11.
    Barbour, B.H., Lasette, A.M. and Kome, A. (1976). Fixed bed charcoal haemoperfusion for the treatment of drug overdose. Kidney Int., 10, 5Google Scholar
  12. 12.
    Vale, 1.A., Rees, A.l., Widdop, B. and Goulding, R. (1975). Use of charcoal haemoperfusion in the management of severely poisoned patients. Br. Med. J., 1, 5CrossRefGoogle Scholar
  13. 13.
    Rosenbaum, 1.L., Kramer, M.S., Raja, R., Winsten, S. and Dalal, F. (1976). Haemoperfusion for acute drug intoxication. Kidney Int., 10, 5Google Scholar
  14. 14.
    Lorch, 1. A. and Garella, S. (1979). Haemoperfusion to treat intoxication. Ann. Intern. Med., 91, 301Google Scholar
  15. 15.
    Chazen, 1.A. and Cohen, 1. (1969). Clinical spectrum of glutethimide poisoning. J. Am. Med. Assoc., 208, 837CrossRefGoogle Scholar
  16. 16.
    Wright, N. and Roscoe, P. (1970). Acute glutethimide poisoning. J. Am. Med. Assoc., 214, 1704CrossRefGoogle Scholar
  17. 17.
    Matthew, H., Proudfoot, A.T., Brown, S.S. and Smith, A.C.A. (1968). Mandrax poisoning, conservative management of 116 patients. Br. Med. J., 2, 101PubMedCrossRefGoogle Scholar
  18. 18.
    Bailey, D.N. (1973). Methyprylon overdosage: interpretation of serum drug concentration. Clin. Toxicol., 6, 563PubMedCrossRefGoogle Scholar
  19. 19.
    Gibson, P.F. and Wright, N. (1972). Ethchlorvynol in biological fluids: specificity of methods of assay. J. Pharm. Sci., 61, 169PubMedCrossRefGoogle Scholar
  20. 20.
    Marshall, A.l. (1977). Cardiac arrhythmias caused by chloral hydrate. Br. Med. J., 2, 944CrossRefGoogle Scholar
  21. 21.
    Illingworth, R.N. and Stewart, M.l. (1979). Severe poisoning with chlormethiazole. Br. Med. J., 2, 903CrossRefGoogle Scholar
  22. 22.
    Masters, A. B. (1967). Delayed death in imipramine poisoning. Br. Med. J., 3, 866PubMedCrossRefGoogle Scholar
  23. 23.
    Petit, 1.M., Spiker, D.G., Rutwitch, 1.F., Ziegler, V.E., Weiss, A.N. and Biggs, 1. T. (1977). Tricyclic antidepressant plasma levels and adverse effects after overdose. Clin. Pharm. Ther., 20, 47Google Scholar
  24. 24.
    Slovis, T. L., Oh, 1. E., Teitlebaum, D. T. and Lipscombe, W. (1971). Physostigmine therapy in acute tricyclic antidepressant poisoning. Clin. Toxicol., 4, 451Google Scholar
  25. 25.
    Newton, R. W. (1975). Physostigmine salicylate in the treatment of tricyclic antidepressant overdosage. J. Am. Med. Assoc., 231, 941CrossRefGoogle Scholar
  26. 26.
    Vance, M.A., Ross, S.M., Millington, W.R. and Blumberg, 1.B. (1977). Potentiation of tricyclic antidepressant toxicity by physostigmine in mice. Clin. Toxieo!., 11, 413PubMedCrossRefGoogle Scholar
  27. 27.
    Proudfoot, A. T. and Brown, S. S. (1969). Acidaemia and salicylate poisoning in adults. Br. Med. J., 1, 547CrossRefGoogle Scholar
  28. 28.
    Lawson, A.A.H., Proudfoot, A.T., Brown, S.S., MacDonald, R.H., Fraser, G., Cameron, J.C. and Matthew, H. (1969). Forced diuresis in the treatment of acute salicylate poisoning in adults. Q. J. Med., 38, 31Google Scholar
  29. 29.
    Hormaechea, E., Carlson, R.W., Rogoue, H., Uphold, J., Henning, R.. and Weil, M. H. (1979). Hypovolaemia, pulmonary oedema and protein changes in severe salicylate poisoning. Am. J. Med., 66, 1046PubMedCrossRefGoogle Scholar
  30. 30.
    Davidson, D.G.D. and Eastham, W.N. (1966). Acute liver necrosis following overdose of paracetamol. Br. Med. J., 2, 497PubMedCrossRefGoogle Scholar
  31. 31.
    Prescott, L.F., Wright, N., Roscoe, P. and Brown, S.S. (1971). Plasma-paracetamol half life and hepatic necrosis in patients with paracetamol overdosage. Lancet, 1, 519PubMedCrossRefGoogle Scholar
  32. 32.
    Wright, N. and Prescott, L.F. (1973). Potentiation of previous drug therapy of hepatoxicity following paracetamol overdosage. Scott. Med. J., 18, 56Google Scholar
  33. 33.
    Prescott, L.F., Illingworth, R.N., Critchley, J.A.J.H., Stewart, M.J., Adam, R.D. and Proudfoot, A. T. (1979). Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. Br. Med. J., 2, 1097PubMedCrossRefGoogle Scholar
  34. 34.
    Prescott, L.F., P,ark, J., Sutherland, G.R., Smith, I.J. and Proudfoot, A.T. (1976). Cysteamine, methionine and penicillamine in the treatment of paracetamol poisoning. Lancet, 2, 109PubMedCrossRefGoogle Scholar
  35. 35.
    Hughes, R.D., Gazzard, B.G., Hamid, M.A., Trewby, P.N., Murray-Lyon, I.M., Davis, M., Williams, R. and Bennett, J.R. (1977). Controlled trial of cysteamine and dimercaprol after paracetamol overdose. Br. Med. J., 2, 1395PubMedCrossRefGoogle Scholar
  36. 36.
    Saunders, J.B., Wright, N. and Lewis, K.O. (1980). Predicting the outcome of paracetamol poisoning. Br. Med. J., 1, 279CrossRefGoogle Scholar
  37. 37.
    Carson, D. J. L. and Carson, E.D. (1977). Fatal dextropropoxyphene poisoning in Northern Ireland. Lancet, 1, 894PubMedCrossRefGoogle Scholar
  38. 38.
    Weisdorf, D., Kramer, J., Goldberg, A. and Klawans, H.L. (1978). Physostigmine for cardiac and neurologic manifestations of phenothiazine poisoning. Clin. Pharm. Ther., 24, 663Google Scholar
  39. 39.
    Veltri, J.C. and Temple, A.R. (1975). Fenfluramine poisoning. J. Paediatr., 87, 119CrossRefGoogle Scholar
  40. 40.
    Riley, I., Corson, J., Haiden, J. and Oswald, I. (1969). Fenfluramineoverdosage. Lancet, 2, 1162PubMedCrossRefGoogle Scholar
  41. 41.
    Cowen, P.J. (1979). Toxic psychosis with antihistamines reversed byphysostigmine. Postgrad. Med. J., 55, 556PubMedCrossRefGoogle Scholar
  42. 42.
    Kahn, A. and Muscar-Baron, J.M. (1977). Fatal oxprenolol poisoning. Br. Med. J., 1, 552CrossRefGoogle Scholar
  43. 43.
    Lawyer, C., Aitchison, J., Sutton, J. and Bennett, W. (1978). Treatment of Theophylline neurotoxicity with resin haemoperfusioTl. Ann. Intern. Med., 88, 516PubMedGoogle Scholar
  44. 44.
    Eriksson, F., Johansson, S.V., Mellstedt, H. and Strandberd, O. (1974). Iron intoxication in two adult patients. Acta Med. Scand., 196, 231Google Scholar
  45. 45.
    Genda, A., Gault, H., Churchill, D. and Hollomby, D. (1978). Haemodialysis\ for methanol intoxication. Am. J. Med., 64, 749CrossRefGoogle Scholar
  46. 46.
    McCoy, H., Cipolle, R.J., Ehlers, S.M., Sawchuk, R.J. and Zaske, D.E. (1979). Severe methanol poisoning. Am. J. Med., 67, 804PubMedCrossRefGoogle Scholar
  47. 47.
    Rose, M.S., Smith, L.L. and Wyatt, I. (1974). Active uptake of paraquat by the lung. Nature, (London), 252, 314CrossRefGoogle Scholar
  48. 48.
    Proudfoot, A. T., Stewart, M.S., Levitt, T. and Widdop, B. (1979). Paraquat poisoning: significance of plasma paraquat concentrations. Lancet, 2, 330PubMedCrossRefGoogle Scholar
  49. 49.
    Smith, D.M. (1971). Organophosphorus poisoning from emergency use of a handsprayer. Practitioner, 218, 877Google Scholar
  50. 50.
    Bryson, D. D. (1978). Cyanide poisoning. Lancet, 1, 92CrossRefGoogle Scholar
  51. 51.
    Venables, G.S. (1977). Carbon monoxide: a forgotten poison. Lancet, 2, 461PubMedCrossRefGoogle Scholar

Copyright information

© MTP Press Limited 1982

Authors and Affiliations

  • Noel Wright

There are no affiliations available

Personalised recommendations