Toxicology Handbook

CHAPTER 1 APPROACH TO THE POISONED PATIENT

1.1 Overview

1.2 Resuscitation

1.3 Risk assessment

1.4 Supportive care and monitoring

1.5 Investigations

1.6 Gastrointestinal decontamination

1.7 Enhanced elimination

1.8 Antidotes

1.9 Disposition

CHAPTER 2 SPECIFIC CONSIDERATIONS

2.1 Approach to snakebite

2.2 Approach to mushroom poisoning

2.3 Approach to plant poisoning

2.4 Coma

2.5 Hypotension

2.6 Seizures

2.7 Delirium and agitation

2.8 Serotonin syndrome

2.9 Anticholinergic syndrome

2.10 Cholinergic syndrome

2.11 Neuroleptic malignant syndrome

2.12 Alcohol use disorder

2.13 Amphetamine use disorder

2.14 Opioid use disorder

2.15 Sedative-hypnotic use disorder

2.16 Solvent abuse

2.17 Body packers and stuffers

2.18 Osmolality and the osmolar gap

2.19 Acid – base disorders

2.20 The 12-lead ECG in toxicology

2.21 Poisoning during pregnancy and lactation

2.22 Poisoning in children

2.23 Poisoning in the elderly

CHAPTER 3 SPECIFIC TOXINS

3.1 Alcohol: Ethanol

3.2 Alcohol: Ethylene glycol

3.3 Alcohol: Isopropanol (isopropyl alcohol)

3.4 Alcohol: Methanol (methyl alcohol)

3.5 Alcohol: Other toxic alcohols

3.6 Amiodarone

3.7 Amisulpride

3.8 Amphetamines

3.9 Angiotensin converting enzyme inhibitors

3.10 Anticoagulant rodenticides

3.11 Anticonvulsants: Newer agents

3.12 Antihistamines (non-sedating)

3.13 Antihistamines (sedating)

3.14 Arsenic

3.15 Baclofen

3.16 Barbiturates

3.17 Benzodiazepines

3.18 Benztropine

3.19 Beta-blockers

3.20 Bupropion

3.21 Button batteries

3.22 Calcium channel blockers

3.23 Cannabinoids (marijuana)

3.24 Carbamazepine

3.25 Carbon monoxide

3.26 Chloroquine and hydroxychloroquine

3.27 Chloral hydrate

3.28 Clonidine

3.29 Clozapine

3.30 Cocaine

3.31 Colchicine

3.32 Corrosives

3.33 Cyanide

3.34 Digoxin: Acute overdose

3.35 Digoxin: Chronic poisoning

3.36 Diphenoxylate-atropine

3.37 Gamma-hydroxybutyrate (GHB)

3.38 Glyphosate

3.39 Hydrocarbons

3.40 Hydrofluoric acid

3.41 Hydrogen peroxide

3.42 Insulin

3.43 Iron

3.44 Isoniazid

3.45 Lead

3.46 Lithium: Acute overdose

3.47 Lithium: Chronic poisoning

3.48 Local anaesthetic agents

3.49 Mercury

3.50 Metformin

3.51 Methotrexate

3.52 Mirtazapine

3.53 Monoamine oxidase inhibitors (MAOIs)

3.54 Newer oral anticoagulants (NOACs)

3.55 Non-steroidal anti-inflammatory drugs (NSAIDs)

3.56 Olanzapine

3.57 Opioids

3.58 Organochlorines

3.59 Organophosphorus agents (organophosphates and carbamates)

3.60 Paracetamol: Acute overdose

3.61 Paracetamol: Modified-release formulations

3.62 Paracetamol: Repeated supratherapeutic ingestion

3.63 Paraquat

3.64 Phenothiazines and butyrophenones (antipsychotic agents)

3.65 Phenytoin

3.66 Potassium chloride

3.67 Quetiapine

3.68 Quinine

3.69 Risperidone

3.70 Salicylates

3.71 Selective serotonin reuptake inhibitors (SSRIs)

3.72 Strychnine

3.73 Sylfonyureas

3.74 Theophylline

3.75 Thyroxine

3.76 Tramadol

3.77 Tricyclic antidepressants (TCAs)

3.78 Valproic acid (sodium valproate)

3.79 Venlafaxine and desvenlafaxine

3.80 Warfarin

CHAPTER 4 ANTIDOTES

4.1 Atropine

4.2 Calcium

4.3 Cyproheptadine

4.4 Desferrioxamine

4.5 Dicobalt edetate

4.6 Digoxin immune Fab

4.7 Dimercaprol

4.8 Ethanol

4.9 Flumazenil

4.10 Folinic acid

4.11 Fomepizole

4.12 Glucose

4.13 Hydroxocobalamin

4.14 Insulin (high dose)

4.15 Intravenous lipid emulsion

4.16 Methylene blue

4.17 N-acetylcysteine

4.18 Naloxone

4.19 Octreotide

4.20 Penicillamine

4.21 Physostigmine

4.22 Pralidoxime

4.23 Pyridoxine

4.24 Sodium bicarbonate

4.25 Sodium calcium edetate

4.26 Sodium thiosulfate

4.27 Succimer

4.28 Vitamin K

CHAPTER 5 ENVENOMINGS

5.1 Black snake

5.2 Brown snake

5.3 Death adder

5.4 Tiger snake group

5.5 Taipan

5.6 Sea snake

5.7 Australian scorpions

5.8 Bluebottle jellyfish (Physalia species)

5.9 Stonefish

5.10 Box jellyfish (Chironex fleckeri)

5.11 Irukandji syndrome

5.12 Blue-ringed octopus

5.13 Redback spider

5.14 Funnel-web (big black) spider

5.15 White-tailed spider

5.16 Ticks

CHAPTER 6 ANTIVENOMS

6.1 CSL Black Snake Antivenom

6.2 CSL Brown Snake Antivenom

6.3 CSL Death Adder Antivenom

6.4 CSL Tiger Snake Antivenom

6.5 CSL Taipan Antivenom

6.6 CSL Sea Snake Antivenom

6.7 CSL Polyvalent Snake Antivenom

6.8 CSL Stonefish Antivenom

6.9 CSL Box Jellyfish Antivenom

6.10 CSL Redback Spider Antivenom

6.11 CSL Funnel-web Spider Antivenom

APPENDICES
Appendix 1 Poison Information Telephone Numbers
Appendix 2 Example ECGs
Appendix 3 Conversion factors and therapeutic ranges for important toxins
Appendix 4 Alcohol pathways
Appendix 5 Therapeutic over-warfarinisation
Appendix 6 Management of allergic reactions to antivenoms