Skip to main content
SpringerLink
Log in

The Diagnostic Process in Medical Toxicology

  • Reference work entry
  • First Online:
Critical Care Toxicology

Abstract

A medical toxicologist must pay great attention to detail. Unlike other specialties, the toxicologist rarely has a gold-standard diagnostic test to confirm a poisoning or withdrawal condition. Instead, the medical toxicology evaluation requires a thorough history and physical examination and strategically ordered diagnostic testing. Then once all available information is gathered, the medical toxicologist must astutely interpret the findings within the appropriate clinical context. Therefore, the toxicologist can be nothing short of an astute diagnostician.

This chapter is an update of the chapter on this topic written by Alex T. Proudfoot and J. Ward Donovan in the first edition of this text.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 338.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Investigators PCESS. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683–93.

    Article  Google Scholar 

  2. Henry JA, Jerreys KJ, Dawling S. Toxicity and deaths from 3,4-methylenedioxymethamphetamine (‘ecstasy’). Lancet. 1992;340:384–7.

    Article  CAS  PubMed  Google Scholar 

  3. Carlson VR. Individual pupillary reactions to certain centrally acting drugs in man. J Pharmacol Exp Ther. 1957;121(4):501–6.

    CAS  PubMed  Google Scholar 

  4. Mofenson HC, Greensher J. The unknown poison. Pediatrics. 1974;54(3):336–42.

    CAS  PubMed  Google Scholar 

  5. Phillips T, Abesamis M, Pizon A. Concomitant clonidine overdose attenuates bupropion-induced sympathomimetic toxicity. Clin Toxicol. 2015;53:708–9. [abstract].

    Google Scholar 

  6. Lakshminarayan S, Sahn SA, Hudson LD, Weil JV. Effect of diazepam on ventilator responses. Clin Pharmacol Ther. 1976;20:178–83.

    Article  CAS  PubMed  Google Scholar 

  7. Estelle F, Simons R. H1-receptor antagonists: safety issues. Ann Allergy Asthma Immunol. 1999;83:481–8.

    Article  CAS  PubMed  Google Scholar 

  8. Vakkalanka JP, Hardison Jr LS, Holstege CP. Epidemiological trends in electronic cigarette exposures reported to U.S. Poison Centers. Clin Toxicol. 2014;52:542–8.

    Article  CAS  Google Scholar 

  9. Hsieh BH, Deng JF, Ger J, et al. Acetylcholinesterase inhibition and the extrapyramidal syndrome: a review of the neurotoxicity of organophosphate. Neurotoxicology. 2001;22:423–7.

    Article  CAS  PubMed  Google Scholar 

  10. Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol. 2009;49:57–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Jaehne EJ, Salem A, Irvine RJ. Pharmacological and behavioral determinants of cocaine, methamphetamine, 3,4-methylenedioxymethamphetamine, and para-methoxyamphetamine-induced hyperthermia. Psychopharmacology (Berl). 2007;194:41–52.

    Article  CAS  Google Scholar 

  12. Isbister GK, Buckley NA, Whyte IM. Serotonin toxicity: a practical approach to diagnosis and treatment. Med J Aust. 2007;187:361–5.

    PubMed  Google Scholar 

  13. Boehnert MT, Lovejoy FH. Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants. N Engl J Med. 1985;313:474–9.

    Article  CAS  PubMed  Google Scholar 

  14. Ryu HH, Jeung KW, Lee BK, et al. Caustic injury: can CT grading system enable prediction of esophageal stricture? Clin Toxicol. 2010;48(2):137–42.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Pittsburgh Medical Center, Division of Medical Toxicology, Department of Emergency Medicine, Pittsburgh, PA, USA

    Anthony F. Pizon, Joseph H. Yanta & Greg S. Swartzentruber

Authors
  1. Anthony F. Pizon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph H. Yanta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Greg S. Swartzentruber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony F. Pizon .

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.

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Pizon, A.F., Yanta, J.H., Swartzentruber, G.S. (2017). The Diagnostic Process in Medical Toxicology. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_43

Download citation

Publish with us

Policies and ethics

Search

Navigation