Additional Information
Book Details
Abstract
Toxicology Handbook is a practical evidence-based guide on the care of the poisoned patient.
This concise text is informed by the latest clinical research and takes a rigorous and structured risk assessment-based approach to decision making in the context of clinical toxicology.
It assists the clinician to quickly find information on poisons, toxins, antidotes, envenomings and antivenoms and determine the appropriate treatment for the acutely poisoned patient.
- Guides clinicians through drug administration and treatment
- Includes 'handy tips' and 'pitfalls'
- Incorporates drug dosages and administration are based on current pharmacological regulations
- Content on drug dosage and administration based on the most up-to-date pharmacological regulations
- Geographical locations of envenomings from snakes, spiders and jellyfish are portrayed on illustrated maps
- New subchapters include Newer oral anticoagulants (NOACs) and Paracetamol: Modified release formulations
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Toxicology Handbook | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Foreword | ix | ||
| Preface | x | ||
| Editors | xi | ||
| Contributors | xii | ||
| Reviewers | xiii | ||
| 1 Approach to the Poisoned Patient | 1 | ||
| 1.1 Overview | 2 | ||
| 1.2 Resuscitation | 4 | ||
| Introduction | 4 | ||
| Airway, Breathing and Circulation | 4 | ||
| Detect and Correct Seizures | 5 | ||
| Detect and Correct Hypoglycaemia | 5 | ||
| Detect and Correct Hyper-/Hypothermia | 11 | ||
| Emergency Antidote Administration | 11 | ||
| References | 11 | ||
| 1.3 Risk Assessment | 12 | ||
| Role of the Poisons Information Centre | 13 | ||
| Reference | 14 | ||
| 1.4 Supportive Care and Monitoring | 14 | ||
| 1.5 Investigations | 16 | ||
| References | 19 | ||
| 1.6 Gastrointestinal Decontamination | 19 | ||
| Induced Emesis (Syrup of Ipecac) | 20 | ||
| Technique | 21 | ||
| Contraindications | 21 | ||
| Potential complications | 21 | ||
| Gastric Lavage | 21 | ||
| Technique | 22 | ||
| Contraindications | 22 | ||
| 2 Specific Considerations | 37 | ||
| 2.1 Approach to Snakebite | 38 | ||
| Risk Assessment | 38 | ||
| Pre-Hospital Care | 41 | ||
| First aid | 41 | ||
| Transport | 41 | ||
| Hospital Management | 42 | ||
| Resuscitation | 42 | ||
| Determine whether the patient is envenomed or not | 42 | ||
| Determine the type of monovalent antivenom required | 43 | ||
| Administer antivenom | 44 | ||
| Adjuvant therapy | 44 | ||
| References | 45 | ||
| 2.2 Approach to Mushroom Poisoning | 45 | ||
| Risk Assessment | 46 | ||
| Mushroom Species and Toxins | 46 | ||
| Clinical Features | 50 | ||
| Management | 50 | ||
| Resuscitation | 50 | ||
| Supportive care | 50 | ||
| Decontamination | 50 | ||
| Investigations | 50 | ||
| Enhanced elimination | 51 | ||
| Antidotes | 51 | ||
| Disposition and follow-up | 51 | ||
| References | 52 | ||
| 2.3 Approach to Plant Poisoning | 52 | ||
| Risk Assessment | 52 | ||
| Important Plant Toxins | 53 | ||
| Calcium oxalate | 53 | ||
| Toxins capable of causing severe poisoning | 53 | ||
| Clinical Features | 55 | ||
| Management | 56 | ||
| Resuscitation | 56 | ||
| Supportive care and monitoring | 56 | ||
| Investigations | 56 | ||
| Decontamination | 56 | ||
| Antidotes | 56 | ||
| Enhanced elimination | 57 | ||
| Disposition | 57 | ||
| Dermal, mucosal and ophthalmic plant exposures | 57 | ||
| References | 57 | ||
| 2.4 Coma | 58 | ||
| Management | 58 | ||
| Resuscitation | 58 | ||
| Risk assessment | 60 | ||
| Supportive care, monitoring and disposition | 61 | ||
| Investigations | 61 | ||
| Enhanced elimination techniques and antidote administration | 61 | ||
| References | 62 | ||
| 2.5 Hypotension | 62 | ||
| Reference | 63 | ||
| 2.6 Seizures | 64 | ||
| Management | 65 | ||
| References | 65 | ||
| 2.7 Delirium and Agitation | 65 | ||
| Duty of Care | 66 | ||
| Management | 66 | ||
| Resuscitation | 66 | ||
| Risk assessment | 67 | ||
| Supportive care and monitoring | 68 | ||
| Investigations | 70 | ||
| Enhanced elimination techniques and antidote administration | 70 | ||
| References | 70 | ||
| 2.8 Serotonin Syndrome | 70 | ||
| Clinical Features | 70 | ||
| Diagnosis | 71 | ||
| Differential Diagnosis | 73 | ||
| Management | 73 | ||
| Resuscitation | 73 | ||
| Risk assessment | 73 | ||
| Investigations | 75 | ||
| Supportive care | 75 | ||
| Antidote therapy: Specific serotonin antagonists | 75 | ||
| Disposition | 75 | ||
| References | 76 | ||
| 2.9 Anticholinergic Syndrome | 76 | ||
| Clinical Features | 76 | ||
| Management | 78 | ||
| Resuscitation | 78 | ||
| Risk assessment | 78 | ||
| Supportive care | 78 | ||
| Investigations | 79 | ||
| Decontamination | 79 | ||
| Enhanced elimination | 79 | ||
| Antidotes | 79 | ||
| References | 79 | ||
| 2.10 Cholinergic Syndrome | 80 | ||
| Clinical Features | 80 | ||
| Management | 82 | ||
| Resuscitation | 82 | ||
| Risk assessment | 82 | ||
| Supportive care | 82 | ||
| Investigations | 83 | ||
| Decontamination | 83 | ||
| Enhanced elimination | 83 | ||
| Antidotes | 83 | ||
| References | 83 | ||
| 2.11 Neuroleptic Malignant Syndrome | 83 | ||
| Clinical Features | 84 | ||
| Diagnostic Criteria | 84 | ||
| Differential Diagnosis | 85 | ||
| Complications | 86 | ||
| Management | 86 | ||
| Resuscitation | 86 | ||
| Investigations | 87 | ||
| Supportive care | 87 | ||
| Antidote therapy | 87 | ||
| Disposition and follow-up | 88 | ||
| References | 88 | ||
| 2.12 Alcohol Use Disorder | 89 | ||
| Screening and Brief Intervention Strategies | 90 | ||
| Alcohol Withdrawal | 91 | ||
| Pathophysiology | 91 | ||
| Clinical features | 91 | ||
| Autonomic excitation | 91 | ||
| Neuro-excitation | 94 | ||
| Delirium tremens | 94 | ||
| Co-morbidities | 95 | ||
| Management | 95 | ||
| Management approach to severe alcohol withdrawal in the hospital setting | 96 | ||
| Resuscitation, supportive care and monitoring | 96 | ||
| Investigations as indicated | 96 | ||
| Disposition and follow-up | 96 | ||
| References | 97 | ||
| 2.13 Amphetamine Use Disorder | 98 | ||
| Amphetamine Withdrawal | 98 | ||
| References | 99 | ||
| 2.14 Opioid Use Disorder | 99 | ||
| Opioid Withdrawal | 99 | ||
| Pathophysiology | 99 | ||
| Clinical features | 99 | ||
| Co-morbidities | 100 | ||
| Management | 100 | ||
| Opioid replacement therapy | 101 | ||
| Detoxification | 101 | ||
| Supportive care | 102 | ||
| References | 102 | ||
| 2.15 Sedative-Hypnotic Use Disorder | 103 | ||
| Sedative-Hypnotic Withdrawal | 103 | ||
| Pathophysiology | 103 | ||
| Clinical features | 104 | ||
| Co-morbidities | 104 | ||
| Management | 104 | ||
| Disposition | 105 | ||
| References | 105 | ||
| 2.16 Solvent Abuse | 106 | ||
| Physicochemical Properties | 106 | ||
| Mechanism of Toxicity | 106 | ||
| Modes of Abuse | 107 | ||
| Clinical Features | 108 | ||
| Acute inhalational exposure | 108 | ||
| Chronic inhalational abuse | 108 | ||
| Management | 109 | ||
| Disposition | 109 | ||
| Solvent Withdrawal | 109 | ||
| Solvent Abuse during Pregnancy and Lactation | 109 | ||
| References | 109 | ||
| 2.17 Body Packers and Stuffers | 110 | ||
| Clinical Presentation | 111 | ||
| Management of ‘Body Stuffers’ | 111 | ||
| Management of ‘Body Packers’ | 111 | ||
| Resuscitation, supportive care and monitoring | 111 | ||
| Risk assessment | 111 | ||
| Supportive care and disposition | 112 | ||
| Investigations | 112 | ||
| Decontamination | 112 | ||
| Antidotes | 113 | ||
| References | 113 | ||
| 2.18 Osmolar Gap | 113 | ||
| References | 116 | ||
| 2.19 Acid–Base Disorders | 116 | ||
| References | 121 | ||
| 2.20 The 12-Lead Ecg in Toxicology | 121 | ||
| Electropathophysiology | 121 | ||
| Tricyclic Antidepressants | 125 | ||
| Systematic Analysis of the 12-Lead ECG of a Poisoned Patient | 125 | ||
| References | 126 | ||
| 2.21 Poisoning During Pregnancy and Lactation | 127 | ||
| References | 128 | ||
| 2.22 Poisoning in Children | 128 | ||
| Management | 129 | ||
| Resuscitation | 129 | ||
| Risk assessment | 129 | ||
| Supportive care and disposition | 133 | ||
| Investigations | 133 | ||
| Decontamination | 133 | ||
| Enhanced elimination and antidotes | 133 | ||
| Disposition and Follow-Up | 133 | ||
| References | 134 | ||
| 2.23 Poisoning in the Elderly | 134 | ||
| Reference | 135 | ||
| 3 Specific Toxins | 137 | ||
| 3.1 Alcohol: Ethanol | 140 | ||
| Risk Assessment | 140 | ||
| Toxic mechanism | 140 | ||
| Toxicokinetics | 140 | ||
| Clinical Features | 140 | ||
| Investigations | 141 | ||
| Screening tests in deliberate self-poisoning | 141 | ||
| Specific investigations as indicated | 141 | ||
| Management | 142 | ||
| Resuscitation, supportive care and monitoring | 142 | ||
| Decontamination | 142 | ||
| Enhanced elimination | 142 | ||
| Antidotes | 142 | ||
| Disposition and Follow-Up | 142 | ||
| Handy Tips | 142 | ||
| Pitfalls | 142 | ||
| Presentations | 143 | ||
| References | 143 | ||
| 3.2 Alcohol: Ethylene Glycol | 143 | ||
| Risk Assessment | 143 | ||
| Toxic mechanism | 143 | ||
| Toxicokinetics | 143 | ||
| Clinical Features | 144 | ||
| Investigations | 144 | ||
| Screening tests in deliberate self-poisoning | 144 | ||
| Specific investigations | 144 | ||
| Management | 144 | ||
| Resuscitation, supportive care and monitoring | 144 | ||
| Decontamination | 145 | ||
| Enhanced elimination | 145 | ||
| Antidotes | 145 | ||
| Disposition and Follow-Up | 145 | ||
| Handy Tips | 146 | ||
| Pitfalls | 146 | ||
| Controversy | 146 | ||
| Sources | 146 | ||
| References | 146 | ||
| 3.3 Alcohol: Isopropanol (isopropyl alcohol) | 146 | ||
| Risk Assessment | 147 | ||
| Toxic mechanism | 147 | ||
| Toxicokinetics | 147 | ||
| Clinical Features | 147 | ||
| Investigations | 147 | ||
| Screening tests in deliberate self-poisoning | 147 | ||
| Specific investigations as indicated | 147 | ||
| Management | 148 | ||
| Resuscitation, supportive care and monitoring | 148 | ||
| Decontamination | 148 | ||
| Enhanced elimination | 148 | ||
| Antidotes | 148 | ||
| Disposition and Follow-Up | 148 | ||
| Handy Tip | 148 | ||
| Sources | 148 | ||
| References | 148 | ||
| 3.4 Alcohol: Methanol (methyl alcohol) | 149 | ||
| Risk Assessment | 149 | ||
| Toxic mechanism | 149 | ||
| Toxicokinetics | 149 | ||
| Clinical Features | 149 | ||
| Investigations | 150 | ||
| Screening tests in deliberate self-poisoning | 150 | ||
| Specific investigations | 150 | ||
| Management | 150 | ||
| Resuscitation, supportive care and monitoring | 150 | ||
| Decontamination | 151 | ||
| Enhanced elimination | 151 | ||
| Antidotes | 151 | ||
| Disposition and Follow-Up | 151 | ||
| Handy Tips | 151 | ||
| Pitfalls | 152 | ||
| Controversy | 152 | ||
| Sources | 152 | ||
| References | 152 | ||
| 3.5 Alcohol: Other Toxic Alcohols | 152 | ||
| Risk Assessment | 152 | ||
| Toxic mechanism | 153 | ||
| Toxicokinetics | 153 | ||
| Clinical Features | 153 | ||
| Investigations | 153 | ||
| Screening tests in deliberate self-poisoning | 153 | ||
| Specific investigations | 153 | ||
| Management | 154 | ||
| Resuscitation, supportive care and monitoring | 154 | ||
| Decontamination | 154 | ||
| Enhanced elimination | 154 | ||
| Antidotes | 154 | ||
| Disposition and Follow-Up | 154 | ||
| Handy Tip | 155 | ||
| Pitfalls | 155 | ||
| Controversy | 155 | ||
| Sources | 155 | ||
| References | 155 | ||
| 3.6 Amiodarone | 155 | ||
| Risk Assessment | 155 | ||
| Toxic mechanism | 156 | ||
| Toxicokinetics | 156 | ||
| Clinical Features | 156 | ||
| Investigations | 156 | ||
| Screening tests in deliberate self-poisoning | 156 | ||
| Specific investigations as indicated | 156 | ||
| Management | 156 | ||
| Resuscitation, supportive care and monitoring | 156 | ||
| Decontamination | 156 | ||
| Enhanced elimination | 156 | ||
| Antidotes | 156 | ||
| Disposition and Follow-Up | 156 | ||
| Controversy | 157 | ||
| Presentations | 157 | ||
| Reference | 157 | ||
| 3.7 Amisulpride | 157 | ||
| Risk Assessment | 157 | ||
| Toxic mechanism | 157 | ||
| Toxicokinetics | 157 | ||
| Clinical Features | 158 | ||
| Investigations | 158 | ||
| Screening tests in deliberate self-poisoning | 158 | ||
| Specific investigations as indicated | 158 | ||
| Management | 158 | ||
| Resuscitation, supportive care and monitoring | 158 | ||
| Decontamination | 158 | ||
| Enhanced elimination | 158 | ||
| Antidote | 158 | ||
| Disposition and Follow-Up | 159 | ||
| Handy Tips | 159 | ||
| Pitfall | 159 | ||
| Controversy | 159 | ||
| Presentations | 159 | ||
| References | 159 | ||
| 3.8 Amphetamines and Other Sympathomimetics | 159 | ||
| Risk Assessment | 160 | ||
| Toxic mechanism | 160 | ||
| Toxicokinetics | 160 | ||
| Clinical Features | 160 | ||
| Investigations | 161 | ||
| Screening tests in deliberate self-poisoning | 161 | ||
| Specific investigations as indicated | 161 | ||
| Management | 161 | ||
| Resuscitation, supportive care and monitoring | 161 | ||
| Decontamination | 162 | ||
| Enhanced elimination | 162 | ||
| Antidotes | 162 | ||
| Disposition and Follow-Up | 162 | ||
| Handy Tips | 163 | ||
| Pitfalls | 163 | ||
| Controversy | 163 | ||
| Presentations | 163 | ||
| References | 164 | ||
| 3.9 Angiotensin-Converting Enzyme Inhibitors | 164 | ||
| Risk Assessment | 164 | ||
| Toxic mechanism | 164 | ||
| Toxicokinetics | 165 | ||
| Clinical Features | 165 | ||
| Investigations | 165 | ||
| Screening tests in deliberate self-poisoning | 165 | ||
| Specific investigations as indicated | 165 | ||
| Management | 165 | ||
| Resuscitation, supportive care and monitoring | 165 | ||
| Decontamination | 165 | ||
| Enhanced elimination | 165 | ||
| Antidotes | 165 | ||
| Disposition and Follow-Up | 165 | ||
| Controversy | 165 | ||
| Presentations | 166 | ||
| References | 166 | ||
| 3.10 Anticoagulant Rodenticides | 166 | ||
| Risk Assessment | 166 | ||
| Toxic mechanism | 167 | ||
| Toxicokinetics | 167 | ||
| Clinical Features | 167 | ||
| Investigations | 167 | ||
| Screening tests in deliberate self-poisoning | 167 | ||
| Specific investigations as indicated | 167 | ||
| Management | 167 | ||
| Resuscitation, supportive care and monitoring | 167 | ||
| Decontamination | 168 | ||
| Enhanced elimination | 168 | ||
| Antidotes | 168 | ||
| Disposition and Follow-Up | 168 | ||
| Pitfall | 168 | ||
| Presentations | 168 | ||
| References | 169 | ||
| 3.11 Anticonvulsants: Newer Agents | 169 | ||
| Risk Assessment | 169 | ||
| Toxic mechanism | 169 | ||
| Toxicokinetics | 169 | ||
| Clinical Features | 169 | ||
| Investigations | 170 | ||
| Screening tests in deliberate self-poisoning | 170 | ||
| Specific investigations as indicated | 170 | ||
| Management | 170 | ||
| Resuscitation, supportive care and monitoring | 170 | ||
| Decontamination | 170 | ||
| Enhanced elimination | 171 | ||
| Antidotes | 171 | ||
| Disposition and Follow-Up | 171 | ||
| Handy Tips | 171 | ||
| Presentations | 171 | ||
| References | 171 | ||
| 3.12 Antihistamines (non-sedating) | 172 | ||
| Risk Assessment | 172 | ||
| Toxic mechanism | 172 | ||
| Toxicokinetics | 172 | ||
| Clinical Features | 172 | ||
| Investigations | 172 | ||
| Screening tests in deliberate self-poisoning | 172 | ||
| Specific investigations as indicated | 173 | ||
| Management | 173 | ||
| Resuscitation, supportive care and monitoring | 173 | ||
| Decontamination | 173 | ||
| Enhanced elimination | 173 | ||
| Antidotes | 173 | ||
| Disposition and Follow-Up | 173 | ||
| Handy Tip | 173 | ||
| Pitfall | 173 | ||
| Controversy | 173 | ||
| Presentations | 174 | ||
| References | 174 | ||
| 3.13 Antihistamines (sedating) | 174 | ||
| Risk Assessment | 174 | ||
| Toxic mechanism | 174 | ||
| Toxicokinetics | 174 | ||
| Clinical Features | 175 | ||
| Investigations | 175 | ||
| Screening tests in deliberate self-poisoning | 175 | ||
| Specific investigations as indicated | 175 | ||
| Management | 175 | ||
| Resuscitation, supportive care and monitoring | 175 | ||
| Decontamination | 175 | ||
| Enhanced elimination | 175 | ||
| Antidotes | 175 | ||
| Disposition and Follow-Up | 175 | ||
| Handy Tip | 176 | ||
| Pitfalls | 176 | ||
| Controversy | 176 | ||
| Presentations | 176 | ||
| References | 176 | ||
| 3.14 Arsenic | 177 | ||
| Risk Assessment | 177 | ||
| Toxic mechanism | 177 | ||
| Toxicokinetics | 177 | ||
| Clinical Features | 177 | ||
| Acute toxicity | 177 | ||
| Subacute toxicity | 178 | ||
| Chronic toxicity | 178 | ||
| Investigations | 178 | ||
| Screening tests in deliberate self-poisoning | 178 | ||
| Specific investigations as indicated | 178 | ||
| Management | 178 | ||
| Resuscitation, supportive care and monitoring | 178 | ||
| Decontamination | 179 | ||
| Enhanced elimination | 179 | ||
| Antidotes | 179 | ||
| Disposition and Follow-Up | 179 | ||
| Handy Tips | 179 | ||
| Pitfall | 180 | ||
| Controversies | 180 | ||
| Presentations | 180 | ||
| References | 180 | ||
| 3.15 Baclofen | 180 | ||
| Risk Assessment | 180 | ||
| Toxic mechanism | 180 | ||
| Toxicokinetics | 181 | ||
| Clinical Features | 181 | ||
| Investigations | 181 | ||
| Screening tests in deliberate self-poisoning | 181 | ||
| Management | 181 | ||
| Resuscitation, supportive care and monitoring | 181 | ||
| Decontamination | 181 | ||
| Enhanced elimination | 182 | ||
| Antidotes | 182 | ||
| Disposition and Follow-Up | 182 | ||
| Handy Tips | 182 | ||
| Pitfall | 182 | ||
| Controversy | 182 | ||
| Presentations | 182 | ||
| Reference | 182 | ||
| 3.16 Barbiturates | 183 | ||
| Risk Assessment | 183 | ||
| Toxic mechanism | 183 | ||
| Toxicokinetics | 183 | ||
| Clinical Features | 183 | ||
| Investigations | 184 | ||
| Screening tests in deliberate self-poisoning | 184 | ||
| Specific investigations as indicated | 184 | ||
| Management | 185 | ||
| Resuscitation, supportive care and monitoring | 185 | ||
| Decontamination | 185 | ||
| Enhanced elimination | 185 | ||
| Antidotes | 186 | ||
| Disposition and Follow-Up | 186 | ||
| Handy Tips | 186 | ||
| Pitfalls | 186 | ||
| Controversies | 186 | ||
| Presentations | 187 | ||
| References | 187 | ||
| 3.17 Benzodiazepines | 187 | ||
| Risk Assessment | 187 | ||
| Toxic mechanism | 187 | ||
| Toxicokinetics | 188 | ||
| Clinical Features | 188 | ||
| Investigations | 188 | ||
| Screening tests in deliberate self-poisoning | 188 | ||
| Management | 188 | ||
| Resuscitation, supportive care and monitoring | 188 | ||
| Decontamination | 188 | ||
| Enhanced elimination | 188 | ||
| Antidotes | 188 | ||
| Disposition and Follow-Up | 189 | ||
| Handy Tips | 189 | ||
| Pitfall | 189 | ||
| Presentations | 189 | ||
| References | 189 | ||
| 3.18 Benztropine | 190 | ||
| Risk Assessment | 190 | ||
| Toxicokinetics | 190 | ||
| Toxic mechanism | 190 | ||
| Clinical Features | 190 | ||
| Investigations | 190 | ||
| Screening tests in deliberate self-poisoning | 190 | ||
| Specific investigations as indicated | 190 | ||
| Management | 190 | ||
| Resuscitation, supportive care and monitoring | 190 | ||
| Decontamination | 191 | ||
| Enhanced elimination | 191 | ||
| Antidote | 191 | ||
| Disposition and Follow-Up | 191 | ||
| Handy Tip | 191 | ||
| Pitfall | 191 | ||
| Controversy | 191 | ||
| Presentations | 191 | ||
| 3.19 Beta-Blockers | 191 | ||
| Risk Assessment | 191 | ||
| Toxic mechanism | 192 | ||
| Toxicokinetics | 192 | ||
| Clinical Features | 192 | ||
| Cardiovascular | 192 | ||
| Central nervous system | 192 | ||
| Other | 192 | ||
| Investigations | 192 | ||
| Screening tests in deliberate self-poisoning | 192 | ||
| Specific investigations as indicated | 193 | ||
| Management | 193 | ||
| Resuscitation, supportive care and monitoring | 193 | ||
| Decontamination | 193 | ||
| Enhanced elimination | 193 | ||
| Antidotes | 193 | ||
| Disposition and Follow-Up | 193 | ||
| Handy Tip | 193 | ||
| Controversies | 194 | ||
| Presentations | 194 | ||
| References | 194 | ||
| 3.20 Bupropion | 194 | ||
| Risk Assessment | 195 | ||
| Toxic mechanism | 195 | ||
| Toxicokinetics | 195 | ||
| Clinical Features | 195 | ||
| Investigations | 195 | ||
| Screening tests in deliberate self-poisoning | 195 | ||
| Specific investigations as indicated | 196 | ||
| Management | 196 | ||
| Resuscitation, supportive care and monitoring | 196 | ||
| Decontamination | 196 | ||
| Enhanced elimination | 196 | ||
| Antidotes | 196 | ||
| Disposition and Follow-Up | 196 | ||
| Handy Tip | 197 | ||
| Pitfalls | 197 | ||
| Controversies | 197 | ||
| Presentations | 197 | ||
| References | 197 | ||
| 3.21 Button Batteries | 197 | ||
| Risk Assessment | 197 | ||
| Mechanism of injury | 198 | ||
| Clinical Features | 198 | ||
| Investigations | 198 | ||
| Management | 198 | ||
| Resuscitation and supportive care | 198 | ||
| Decontamination | 199 | ||
| Disposition and Follow-Up | 199 | ||
| Handy Tips | 199 | ||
| Pitfalls | 199 | ||
| Controversies | 199 | ||
| Sources | 200 | ||
| References | 200 | ||
| 3.22 Calcium Channel Blockers | 200 | ||
| Risk Assessment | 200 | ||
| Toxic mechanism | 200 | ||
| Toxicokinetics | 201 | ||
| Clinical Features | 201 | ||
| Investigations | 201 | ||
| Screening tests in deliberate self-poisoning | 201 | ||
| Specific investigations as indicated | 201 | ||
| Management | 201 | ||
| Resuscitation, supportive care and monitoring | 202 | ||
| Decontamination | 202 | ||
| Enhanced elimination | 202 | ||
| Antidotes | 202 | ||
| Disposition and Follow-Up | 203 | ||
| Handy Tip | 203 | ||
| Pitfalls | 203 | ||
| Controversies | 203 | ||
| Presentations | 203 | ||
| References | 204 | ||
| 3.23 Cannabinoids (marijuana) | 205 | ||
| Risk Assessment | 205 | ||
| Toxic mechanism | 205 | ||
| Toxicokinetics | 205 | ||
| Clinical Features | 205 | ||
| Investigations | 206 | ||
| Screening tests in deliberate self-poisoning | 206 | ||
| Specific investigations as indicated | 206 | ||
| Management | 206 | ||
| Resuscitation, supportive care and monitoring | 206 | ||
| Decontamination | 207 | ||
| Enhanced elimination | 207 | ||
| Antidotes | 207 | ||
| Disposition and Follow-Up | 207 | ||
| Handy Tips | 207 | ||
| Pitfall | 207 | ||
| Controversy | 207 | ||
| Presentations | 207 | ||
| References | 207 | ||
| 3.24 Carbamazepine | 208 | ||
| Risk Assessment | 208 | ||
| Toxic mechanism | 208 | ||
| Toxicokinetics | 208 | ||
| Clinical Features | 208 | ||
| Investigations | 209 | ||
| Screening tests in deliberate self-poisoning | 209 | ||
| Specific investigations as indicated | 209 | ||
| Management | 209 | ||
| Resuscitation, supportive care and monitoring | 209 | ||
| Decontamination | 210 | ||
| Enhanced elimination | 210 | ||
| Antidotes | 210 | ||
| Disposition and Follow-Up | 210 | ||
| Handy Tip | 210 | ||
| Pitfalls | 211 | ||
| Controversy | 211 | ||
| Presentations | 211 | ||
| References | 211 | ||
| 3.25 Carbon Monoxide | 211 | ||
| Risk Assessment | 211 | ||
| Toxic mechanism | 212 | ||
| Toxicokinetics | 212 | ||
| Clinical Features | 212 | ||
| Investigations | 212 | ||
| Screening tests in deliberate self-poisoning | 212 | ||
| Specific investigations as indicated | 213 | ||
| Management | 213 | ||
| Resuscitation, supportive care and monitoring | 213 | ||
| Decontamination | 213 | ||
| Enhanced elimination | 214 | ||
| Antidotes | 214 | ||
| Disposition and Follow-Up | 214 | ||
| Handy Tip | 214 | ||
| Pitfalls | 214 | ||
| Controversies | 214 | ||
| Sources | 214 | ||
| References | 215 | ||
| 3.26 Chloroquine and Hydroxychloroquine | 215 | ||
| Risk Assessment | 215 | ||
| Toxic mechanism | 215 | ||
| Toxicokinetics | 215 | ||
| Clinical Features | 215 | ||
| Investigations | 216 | ||
| Screening tests in deliberate self-poisoning | 216 | ||
| Specific investigations as indicated | 216 | ||
| Management | 216 | ||
| Resuscitation, supportive care and monitoring | 216 | ||
| Decontamination | 216 | ||
| Enhanced elimination | 216 | ||
| Antidote | 217 | ||
| Disposition and Follow-Up | 217 | ||
| Handy Tips | 217 | ||
| Controversy | 217 | ||
| Presentations | 217 | ||
| References | 217 | ||
| 3.27 Chloral Hydrate | 217 | ||
| Risk Assessment | 218 | ||
| Toxic mechanism | 218 | ||
| Toxicokinetics | 218 | ||
| Clinical Features | 218 | ||
| Investigations | 218 | ||
| Screening tests in deliberate self-poisoning | 218 | ||
| Specific investigations as indicated | 218 | ||
| Management | 219 | ||
| Resuscitation, supportive care and monitoring | 219 | ||
| Decontamination | 219 | ||
| Enhanced elimination | 219 | ||
| Antidotes | 219 | ||
| Disposition and Follow-Up | 219 | ||
| Handy Tips | 220 | ||
| Pitfalls | 220 | ||
| Controversies | 220 | ||
| Presentations | 220 | ||
| References | 220 | ||
| 3.28 Clonidine | 220 | ||
| Risk Assessment | 220 | ||
| Toxic mechanism | 221 | ||
| Toxicokinetics | 221 | ||
| Clinical Features | 221 | ||
| Investigations | 221 | ||
| Screening tests in deliberate self-poisoning | 221 | ||
| Specific investigations as indicated | 221 | ||
| Management | 221 | ||
| Resuscitation, supportive care and monitoring | 221 | ||
| Decontamination | 222 | ||
| Enhanced elimination | 222 | ||
| Antidotes | 222 | ||
| Disposition and Follow-Up | 222 | ||
| Handy Tips | 222 | ||
| Pitfalls | 222 | ||
| Controversy | 222 | ||
| Presentations | 223 | ||
| References | 223 | ||
| 3.29 Clozapine | 223 | ||
| Risk Assessment | 223 | ||
| Toxic mechanism | 223 | ||
| Toxicokinetics | 223 | ||
| Clinical Features | 223 | ||
| Investigations | 224 | ||
| Screening tests in deliberate self-poisoning | 224 | ||
| Specific investigations as required | 224 | ||
| Management | 224 | ||
| Resuscitation, supportive care and monitoring | 224 | ||
| Decontamination | 224 | ||
| Enhanced elimination | 224 | ||
| Antidotes | 224 | ||
| Disposition and Follow-Up | 224 | ||
| Handy Tips | 225 | ||
| Pitfall | 225 | ||
| Presentations | 225 | ||
| References | 225 | ||
| 3.30 Cocaine | 225 | ||
| Risk Assessment | 225 | ||
| Toxic mechanism | 226 | ||
| Toxicokinetics | 226 | ||
| Clinical Features | 226 | ||
| Investigations | 227 | ||
| Screening tests in deliberate self-poisoning | 227 | ||
| Specific investigations as indicated | 227 | ||
| Management | 227 | ||
| Resuscitation, supportive care and monitoring | 227 | ||
| Decontamination | 228 | ||
| Enhanced elimination | 228 | ||
| Antidotes | 228 | ||
| Disposition and Follow-Up | 228 | ||
| Handy Tips | 229 | ||
| Pitfalls | 229 | ||
| Controversies | 229 | ||
| Presentations | 229 | ||
| References | 229 | ||
| 3.31 Colchicine | 229 | ||
| Risk Assessment | 230 | ||
| Toxic mechanism | 230 | ||
| Toxicokinetics | 230 | ||
| Clinical Features | 230 | ||
| Investigations | 230 | ||
| Screening tests in deliberate self-poisoning | 230 | ||
| Specific investigations as indicated | 230 | ||
| Management | 231 | ||
| Resuscitation, supportive care and monitoring | 231 | ||
| Decontamination | 231 | ||
| Enhanced elimination | 231 | ||
| Antidotes | 231 | ||
| Disposition and Follow-Up | 231 | ||
| Handy Tip | 232 | ||
| Pitfalls | 232 | ||
| Controversy | 232 | ||
| Presentations | 232 | ||
| References | 232 | ||
| 3.32 Corrosives | 232 | ||
| Risk Assessment | 232 | ||
| Toxic mechanism | 233 | ||
| Clinical Features | 233 | ||
| Investigations | 233 | ||
| Screening tests in deliberate self-poisoning | 233 | ||
| Specific investigations as indicated | 233 | ||
| Management | 234 | ||
| Resuscitation, supportive care and monitoring | 234 | ||
| Decontamination | 234 | ||
| Enhanced elimination | 234 | ||
| Antidotes | 234 | ||
| Disposition and Follow-Up | 234 | ||
| Handy Tips | 235 | ||
| Pitfall | 235 | ||
| Controversies | 235 | ||
| Sources | 235 | ||
| References | 235 | ||
| 3.33 Cyanide | 236 | ||
| Risk Assessment | 236 | ||
| Toxic mechanism | 236 | ||
| Toxicokinetics | 236 | ||
| Clinical Features | 236 | ||
| Investigations | 237 | ||
| Screening tests in deliberate self-poisoning | 237 | ||
| Specific investigations as indicated | 237 | ||
| Management | 237 | ||
| Resuscitation, supportive care and monitoring | 237 | ||
| Decontamination | 237 | ||
| Enhanced elimination | 238 | ||
| Antidotes | 238 | ||
| Disposition and Follow-Up | 238 | ||
| Handy Tips | 238 | ||
| Pitfalls | 238 | ||
| Controversy | 238 | ||
| Sources | 238 | ||
| References | 239 | ||
| 3.34 Digoxin: Acute Overdose | 239 | ||
| Risk Assessment | 239 | ||
| Toxic mechanism | 239 | ||
| Toxicokinetics | 239 | ||
| Clinical Features | 240 | ||
| Investigations | 240 | ||
| Screening tests in deliberate self-poisoning | 240 | ||
| Specific investigations | 240 | ||
| Management | 240 | ||
| Resuscitation, supportive care and monitoring | 240 | ||
| Decontamination | 241 | ||
| Enhanced elimination | 241 | ||
| Antidote | 241 | ||
| Disposition and Follow-Up | 241 | ||
| Handy Tips | 242 | ||
| Pitfall | 242 | ||
| Controversies | 242 | ||
| Presentations | 242 | ||
| References | 242 | ||
| 3.35 Digoxin: Chronic Poisoning | 243 | ||
| Risk Assessment | 243 | ||
| Toxic mechanism | 243 | ||
| Toxicokinetics | 244 | ||
| Clinical Features | 244 | ||
| Investigations | 244 | ||
| Screening tests in deliberate self-poisoning | 244 | ||
| Specific investigations as indicated | 244 | ||
| Management | 245 | ||
| Resuscitation, supportive care and monitoring | 245 | ||
| Decontamination | 245 | ||
| Enhanced elimination | 245 | ||
| Antidotes | 245 | ||
| Disposition and Follow-Up | 245 | ||
| Handy Tips | 246 | ||
| Pitfalls | 246 | ||
| Controversy | 246 | ||
| Presentations | 246 | ||
| References | 246 | ||
| 3.36 Diphenoxylate–Atropine | 247 | ||
| Risk Assessment | 247 | ||
| Toxic mechanism | 247 | ||
| Toxicokinetics | 247 | ||
| Clinical Features | 247 | ||
| Investigations | 248 | ||
| Screening tests in deliberate self-poisoning | 248 | ||
| Specific investigations as indicated | 248 | ||
| Management | 248 | ||
| Resuscitation, supportive care and monitoring | 248 | ||
| Decontamination | 248 | ||
| Enhanced elimination | 248 | ||
| Antidotes | 248 | ||
| Disposition and Follow-Up | 248 | ||
| Pitfall | 248 | ||
| Presentations | 248 | ||
| References | 249 | ||
| 3.37 Gamma-Hydroxybutyrate (GHB) | 249 | ||
| Risk Assessment | 249 | ||
| Toxic mechanism | 249 | ||
| Toxicokinetics | 249 | ||
| Clinical Features | 250 | ||
| Investigations | 250 | ||
| Screening tests in deliberate self-poisoning | 250 | ||
| Specific investigations | 250 | ||
| Management | 251 | ||
| Resuscitation, supportive care and monitoring | 251 | ||
| Decontamination | 251 | ||
| Enhanced elimination | 251 | ||
| Antidotes | 251 | ||
| Disposition and Follow-Up | 251 | ||
| Handy Tips | 251 | ||
| Pitfall | 252 | ||
| Controversy | 252 | ||
| Presentation and Sources | 252 | ||
| References | 252 | ||
| 3.38 Glyphosate | 252 | ||
| Risk Assessment | 252 | ||
| Toxic mechanism | 253 | ||
| Toxicokinetics | 253 | ||
| Clinical Features | 253 | ||
| Investigations | 254 | ||
| Screening tests in deliberate self-poisoning | 254 | ||
| Specific investigations as indicated | 254 | ||
| Management | 254 | ||
| Resuscitation, supportive care and monitoring | 254 | ||
| Decontamination | 254 | ||
| Enhanced elimination | 254 | ||
| Antidotes | 254 | ||
| Disposition and Follow-Up | 254 | ||
| Handy Tip | 255 | ||
| Pitfalls | 255 | ||
| Controversy | 255 | ||
| Presentation and Sources | 255 | ||
| References | 255 | ||
| 3.39 Hydrocarbons | 255 | ||
| Risk Assessment | 256 | ||
| Toxic mechanism | 256 | ||
| Toxicokinetics | 256 | ||
| Clinical Features | 256 | ||
| Investigations | 257 | ||
| Screening tests in deliberate self-poisoning | 257 | ||
| Specific investigations as indicated | 257 | ||
| Management | 257 | ||
| Resuscitation, supportive care and monitoring | 257 | ||
| Decontamination | 257 | ||
| Enhanced elimination | 258 | ||
| Antidotes | 258 | ||
| Disposition and Follow-Up | 258 | ||
| Handy Tip | 258 | ||
| Pitfall | 258 | ||
| Controversies | 258 | ||
| Sources | 258 | ||
| References | 258 | ||
| 3.40 Hydrofluoric Acid | 258 | ||
| Risk Assessment | 259 | ||
| Toxic mechanism | 259 | ||
| Toxicokinetics | 259 | ||
| Clinical Features | 259 | ||
| Investigations | 260 | ||
| Screening tests in deliberate self-poisoning | 260 | ||
| Specific investigations as indicated | 260 | ||
| Management | 260 | ||
| Resuscitation, supportive care and monitoring | 260 | ||
| Decontamination | 260 | ||
| Enhanced elimination | 260 | ||
| Antidotes | 261 | ||
| Disposition and Follow-Up | 261 | ||
| Handy Tips | 261 | ||
| Pitfalls | 261 | ||
| Controversy | 262 | ||
| Presentations | 262 | ||
| References | 262 | ||
| 3.41 Hydrogen Peroxide | 262 | ||
| Risk Assessment | 262 | ||
| Toxic mechanism | 262 | ||
| Toxicokinetics | 263 | ||
| Clinical Features | 263 | ||
| Investigations | 263 | ||
| Screening tests in deliberate self-poisoning | 263 | ||
| Specific investigations as indicated | 263 | ||
| Management | 264 | ||
| Resuscitation, supportive care and monitoring | 264 | ||
| Decontamination | 264 | ||
| Enhanced elimination | 264 | ||
| Antidotes | 264 | ||
| Disposition and Follow-Up | 264 | ||
| Pitfall | 265 | ||
| Controversies | 265 | ||
| Presentations | 265 | ||
| References | 265 | ||
| 3.42 Insulin | 265 | ||
| Risk Assessment | 265 | ||
| Toxic mechanism | 265 | ||
| Toxicokinetics | 266 | ||
| Clinical Features | 266 | ||
| Investigations | 266 | ||
| Screening tests in deliberate self-poisoning | 266 | ||
| Specific investigations as indicated | 266 | ||
| Management | 266 | ||
| Resuscitation, supportive care and monitoring | 266 | ||
| Decontamination | 267 | ||
| Enhanced elimination | 267 | ||
| Antidotes | 267 | ||
| Disposition and Follow-Up | 267 | ||
| Handy Tips | 267 | ||
| Pitfalls | 268 | ||
| Controversy | 268 | ||
| Presentations | 268 | ||
| References | 269 | ||
| 3.43 Iron | 269 | ||
| Risk Assessment | 269 | ||
| Toxic mechanism | 270 | ||
| Local | 270 | ||
| Systemic | 270 | ||
| Toxicokinetics | 270 | ||
| Clinical Features | 270 | ||
| Investigations | 271 | ||
| Screening tests in deliberate self-poisoning | 271 | ||
| Specific investigations as indicated | 271 | ||
| Management | 271 | ||
| Resuscitation, supportive care and monitoring | 271 | ||
| Decontamination | 271 | ||
| Enhanced elimination | 271 | ||
| Antidotes | 271 | ||
| Disposition and Follow-Up | 271 | ||
| Handy Tips | 272 | ||
| Pitfalls | 272 | ||
| Controversies | 272 | ||
| Presentations | 272 | ||
| References | 272 | ||
| 3.44 Isoniazid | 273 | ||
| Risk Assessment | 273 | ||
| Toxic mechanism | 273 | ||
| Toxicokinetics | 273 | ||
| Clinical Features | 273 | ||
| Investigations | 274 | ||
| Screening tests in deliberate self-poisoning | 274 | ||
| Specific investigations as indicated | 274 | ||
| Management | 274 | ||
| Resuscitation, supportive care and monitoring | 274 | ||
| Decontamination | 274 | ||
| Enhanced elimination | 274 | ||
| Antidotes | 274 | ||
| Disposition and Follow-Up | 274 | ||
| Handy Tips | 275 | ||
| Pitfall | 275 | ||
| Controversies | 275 | ||
| Presentations | 275 | ||
| Reference | 275 | ||
| 3.45 Lead | 275 | ||
| Risk Assessment | 275 | ||
| Toxic mechanism | 276 | ||
| Toxicokinetics | 276 | ||
| Clinical Features | 276 | ||
| Investigations | 277 | ||
| Screening tests in deliberate self-poisoning | 277 | ||
| Specific investigations as indicated | 277 | ||
| Management | 277 | ||
| Resuscitation, supportive care and monitoring | 277 | ||
| Decontamination | 277 | ||
| Enhanced elimination | 278 | ||
| Antidotes | 278 | ||
| Handy Tips | 278 | ||
| Pitfalls | 278 | ||
| Controversies | 278 | ||
| Sources | 278 | ||
| References | 279 | ||
| 3.46 Lithium: Acute Overdose | 279 | ||
| Risk Assessment | 279 | ||
| Toxic mechanism | 280 | ||
| Toxicokinetics | 280 | ||
| Clinical Features | 280 | ||
| Investigations | 280 | ||
| Screening tests in deliberate self-poisoning | 280 | ||
| Specific investigations as indicated: | 280 | ||
| Management | 280 | ||
| Resuscitation, supportive care and monitoring | 280 | ||
| Decontamination | 281 | ||
| Enhanced elimination | 281 | ||
| Antidotes | 281 | ||
| Disposition and Follow-Up | 281 | ||
| Handy Tips | 281 | ||
| Pitfall | 281 | ||
| Controversy | 281 | ||
| Presentations | 281 | ||
| References | 281 | ||
| 3.47 Lithium: Chronic Poisoning | 282 | ||
| Risk Assessment | 282 | ||
| Toxic mechanism | 282 | ||
| Toxicokinetics | 282 | ||
| Clinical Features | 282 | ||
| Investigations | 283 | ||
| Specific investigations as indicated | 283 | ||
| Management | 283 | ||
| Resuscitation, supportive care and monitoring | 283 | ||
| Decontamination | 283 | ||
| Enhanced elimination | 283 | ||
| Antidotes | 283 | ||
| Disposition and Follow-Up | 283 | ||
| Handy Tips | 283 | ||
| Pitfall | 283 | ||
| Controversies | 284 | ||
| Presentations | 284 | ||
| References | 284 | ||
| 3.48 Local Anaesthetic Agents | 284 | ||
| Risk Assessment | 284 | ||
| Toxic mechanism | 285 | ||
| Toxicokinetics | 285 | ||
| Clinical Features | 285 | ||
| Investigations | 286 | ||
| Specific investigations as indicated | 286 | ||
| Management | 286 | ||
| Resuscitation, supportive care and monitoring | 286 | ||
| Decontamination | 286 | ||
| Enhanced elimination | 286 | ||
| Antidotes | 286 | ||
| Disposition and Follow-Up | 286 | ||
| Handy Tip | 286 | ||
| Controversy | 287 | ||
| Presentations | 287 | ||
| References | 287 | ||
| 3.49 Mercury | 288 | ||
| Risk Assessment | 288 | ||
| Toxic mechanism | 288 | ||
| Toxicokinetics | 288 | ||
| Clinical Features | 289 | ||
| Investigations | 290 | ||
| Screening tests in deliberate self-poisoning | 290 | ||
| Specific investigations as indicated | 290 | ||
| Management | 290 | ||
| Resuscitation, supportive care and monitoring | 290 | ||
| Decontamination | 290 | ||
| Enhanced elimination | 291 | ||
| Antidotes | 291 | ||
| Disposition and Follow-Up | 291 | ||
| Handy Tip | 291 | ||
| Pitfall | 291 | ||
| Controversies | 291 | ||
| Sources | 292 | ||
| References | 292 | ||
| 3.50 Metformin | 292 | ||
| Risk Assessment | 292 | ||
| Toxic mechanism | 292 | ||
| Toxicokinetics | 293 | ||
| Clinical Features | 293 | ||
| Investigations | 293 | ||
| Screening tests in deliberate self-poisoning | 293 | ||
| Specific investigations as indicated | 293 | ||
| Management | 293 | ||
| Resuscitation, supportive care and monitoring | 293 | ||
| Decontamination | 293 | ||
| Enhanced elimination | 293 | ||
| Antidotes | 294 | ||
| Disposition and Follow-Up | 294 | ||
| Handy Tip | 294 | ||
| Pitfalls | 294 | ||
| Controversies | 294 | ||
| Presentations | 294 | ||
| References | 294 | ||
| 3.51 Methotrexate | 295 | ||
| Risk Assessment | 295 | ||
| Toxic mechanism | 296 | ||
| Toxicokinetics | 296 | ||
| Clinical Features | 296 | ||
| Investigations | 296 | ||
| Screening tests in deliberate self-poisoning | 296 | ||
| Specific investigations as indicated | 296 | ||
| Management | 296 | ||
| Resuscitation, supportive care and monitoring | 296 | ||
| In patients presenting with established methotrexate toxicity | 296 | ||
| In patients presenting following acute overdose | 297 | ||
| Decontamination | 297 | ||
| Enhanced elimination | 297 | ||
| Antidotes | 297 | ||
| Disposition and Follow-Up | 297 | ||
| Handy Tip | 298 | ||
| Pitfalls | 298 | ||
| Controversies | 298 | ||
| Presentations | 298 | ||
| References | 298 | ||
| 3.52 Mirtazapine | 298 | ||
| Risk Assessment | 299 | ||
| Toxic mechanism | 299 | ||
| Toxicokinetics | 299 | ||
| Clinical Features | 299 | ||
| Investigations | 299 | ||
| Screening tests in deliberate self-poisoning | 299 | ||
| Management | 299 | ||
| Resuscitation, supportive care and monitoring | 299 | ||
| Decontamination | 299 | ||
| Enhanced elimination | 299 | ||
| Antidotes | 299 | ||
| Disposition and Follow-Up | 299 | ||
| Handy Tip | 300 | ||
| Presentations | 300 | ||
| Reference | 300 | ||
| 3.53 Monoamine Oxidase Inhibitors (MAOIs) | 300 | ||
| Risk Assessment | 300 | ||
| Toxic mechanism | 301 | ||
| Toxicokinetics | 301 | ||
| Clinical Features | 301 | ||
| Investigations | 302 | ||
| Screening tests in deliberate self-poisoning | 302 | ||
| Specific investigations as indicated | 302 | ||
| Management | 302 | ||
| Resuscitation, supportive care and monitoring | 302 | ||
| Decontamination | 302 | ||
| Enhanced elimination | 303 | ||
| Antidotes | 303 | ||
| Disposition and Follow-Up | 303 | ||
| Handy Tip | 303 | ||
| Pitfalls | 303 | ||
| Controversy | 303 | ||
| Presentations | 303 | ||
| References | 303 | ||
| 3.54 New Oral Anticoagulants | 304 | ||
| Risk Assessment | 304 | ||
| Toxic mechanism | 304 | ||
| Toxicokinetics | 304 | ||
| Clinical Features | 304 | ||
| Investigations | 305 | ||
| Screening tests in deliberate self-poisoning | 305 | ||
| Specific investigations as indicated | 305 | ||
| Management | 305 | ||
| Resuscitation, supportive care and monitoring | 305 | ||
| Decontamination | 305 | ||
| Enhanced elimination | 305 | ||
| Antidotes | 305 | ||
| Disposition and Follow-Up | 306 | ||
| Handy Tips | 307 | ||
| Pitfalls | 307 | ||
| Controversies | 307 | ||
| Presentations | 307 | ||
| References | 307 | ||
| 3.55 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) | 308 | ||
| Risk Assessment | 308 | ||
| Toxic mechanism | 308 | ||
| Toxicokinetics | 309 | ||
| Clinical Features | 309 | ||
| Investigations | 309 | ||
| Screening tests in deliberate self-poisoning | 309 | ||
| Specific investigations as indicated | 309 | ||
| Management | 309 | ||
| Resuscitation, supportive care and monitoring | 309 | ||
| Decontamination | 309 | ||
| Enhanced elimination | 309 | ||
| Antidotes | 309 | ||
| Disposition and Follow-Up | 310 | ||
| Handy Tip | 310 | ||
| Pitfall | 310 | ||
| Preparations | 310 | ||
| References | 311 | ||
| 3.56 Olanzapine | 311 | ||
| Risk Assessment | 311 | ||
| Toxic mechanism | 312 | ||
| Toxicokinetics | 312 | ||
| Clinical Features | 312 | ||
| Investigations | 312 | ||
| Screening tests in deliberate self-poisoning | 312 | ||
| Specific investigations as indicated | 312 | ||
| Management | 312 | ||
| Resuscitation, supportive care and monitoring | 312 | ||
| Decontamination | 313 | ||
| Enhanced elimination | 313 | ||
| Antidotes | 313 | ||
| Disposition and Follow-Up | 313 | ||
| Handy Tip | 313 | ||
| Pitfall | 313 | ||
| Controversies | 313 | ||
| Presentations | 313 | ||
| References | 314 | ||
| 3.57 Opioids | 314 | ||
| Risk Assessment | 314 | ||
| Toxic mechanism | 315 | ||
| Toxicokinetics | 315 | ||
| Clinical Features | 315 | ||
| Investigations | 315 | ||
| Screening tests in deliberate self-poisoning | 315 | ||
| Specific investigations as indicated: | 315 | ||
| Management | 315 | ||
| Resuscitation, supportive care and monitoring | 315 | ||
| Decontamination | 316 | ||
| Enhanced elimination | 316 | ||
| Antidotes | 316 | ||
| Disposition and Follow-Up | 316 | ||
| Handy Tips | 316 | ||
| Pitfalls | 317 | ||
| Presentations | 317 | ||
| Reference | 319 | ||
| 3.58 Organochlorines | 319 | ||
| Risk Assessment | 319 | ||
| Toxic mechanism | 320 | ||
| Toxicokinetics | 320 | ||
| Clinical Features | 320 | ||
| Investigations | 320 | ||
| Screening tests in deliberate self-poisoning | 320 | ||
| Specific investigations as indicated | 320 | ||
| Management | 321 | ||
| Resuscitation, supportive care and monitoring | 321 | ||
| Decontamination | 321 | ||
| Enhanced elimination | 321 | ||
| Antidotes | 321 | ||
| Disposition and Follow-Up | 321 | ||
| Handy Tips | 321 | ||
| Pitfall | 322 | ||
| Controversy | 322 | ||
| Presentations | 322 | ||
| References | 322 | ||
| 3.59 Organophosphorus Agents (organophosphates and carbamates) | 322 | ||
| Risk Assessment | 322 | ||
| Toxic mechanism | 323 | ||
| Toxicokinetics | 323 | ||
| Clinical Features | 323 | ||
| Acute intoxication | 323 | ||
| Intermediate syndrome | 324 | ||
| Delayed neurotoxicity | 324 | ||
| Chronic organophosphate-induced neuropsychiatric disorder | 324 | ||
| Investigations | 324 | ||
| Screening tests in deliberate self-poisoning | 324 | ||
| Specific investigations as indicated | 324 | ||
| Management | 325 | ||
| Resuscitation, supportive care and monitoring | 325 | ||
| Decontamination | 325 | ||
| Enhanced elimination | 325 | ||
| Antidotes | 325 | ||
| Disposition and Follow-Up | 326 | ||
| Pitfalls | 326 | ||
| Controversies | 326 | ||
| Presentations | 327 | ||
| References | 327 | ||
| 3.60 Paracetamol: Acute Overdose | 327 | ||
| Risk Assessment | 327 | ||
| Toxic mechanism | 329 | ||
| Toxicokinetics | 329 | ||
| Clinical Features | 329 | ||
| Investigations | 330 | ||
| Screening tests in deliberate self-poisoning | 330 | ||
| Specific investigations as indicated | 330 | ||
| Management | 331 | ||
| Resuscitation, supportive care and monitoring | 331 | ||
| Decontamination | 331 | ||
| Enhanced elimination | 332 | ||
| Antidotes | 332 | ||
| Disposition and Follow-Up | 332 | ||
| Handy Tips | 334 | ||
| Pitfalls | 334 | ||
| Controversies | 334 | ||
| Presentations | 335 | ||
| References | 336 | ||
| 3.61 Paracetamol: Modified-Release Formulations | 336 | ||
| Risk Assessment | 337 | ||
| Toxic mechanism | 337 | ||
| Toxicokinetics | 337 | ||
| Clinical Features | 337 | ||
| Investigations | 337 | ||
| Screening tests in deliberate self-poisoning | 337 | ||
| Specific investigations as indicated | 337 | ||
| Management | 338 | ||
| Resuscitation, supportive care and monitoring | 338 | ||
| Decontamination | 338 | ||
| Enhanced elimination | 338 | ||
| Antidotes | 338 | ||
| Disposition and Follow-Up | 339 | ||
| Handy Tip | 339 | ||
| Pitfalls | 339 | ||
| Controversy | 339 | ||
| Presentations | 339 | ||
| References | 339 | ||
| 3.62 Paracetamol: Repeated Supratherapeutic Ingestion | 340 | ||
| Risk Assessment | 340 | ||
| Toxic mechanism | 341 | ||
| Toxicokinetics | 341 | ||
| Clinical Features | 341 | ||
| Investigations | 341 | ||
| Management | 341 | ||
| Resuscitation, supportive care and monitoring | 341 | ||
| Decontamination | 341 | ||
| Enhanced elimination | 341 | ||
| Antidotes | 341 | ||
| Disposition and Follow-Up | 343 | ||
| Handy Tips | 343 | ||
| Pitfall | 343 | ||
| Controversy | 343 | ||
| Presentations | 343 | ||
| References | 343 | ||
| 3.63 Paraquat | 343 | ||
| Risk Assessment | 344 | ||
| Toxic mechanism | 344 | ||
| Toxicokinetics | 345 | ||
| Clinical Features | 345 | ||
| Investigations | 345 | ||
| Screening tests in deliberate self-poisoning | 345 | ||
| Specific investigations as indicated | 345 | ||
| Management | 347 | ||
| Resuscitation, supportive care and monitoring | 347 | ||
| Decontamination | 347 | ||
| Enhanced elimination | 347 | ||
| Antidotes | 347 | ||
| Disposition and Follow-Up | 348 | ||
| Handy Tip | 348 | ||
| Pitfall | 348 | ||
| Controversies | 348 | ||
| Presentations | 348 | ||
| References | 348 | ||
| 3.64 Phenothiazines and Butyrophenones (antipsychotic agents) | 349 | ||
| Risk Assessment | 349 | ||
| Toxic mechanism | 349 | ||
| Toxicokinetics | 349 | ||
| Clinical Features | 349 | ||
| Investigations | 350 | ||
| Screening tests in deliberate self-poisoning | 350 | ||
| Specific investigations as indicated | 350 | ||
| Management | 350 | ||
| Resuscitation, supportive care and monitoring | 350 | ||
| Decontamination | 350 | ||
| Enhanced elimination | 350 | ||
| Antidotes | 350 | ||
| Disposition and Follow-Up | 350 | ||
| Handy Tips | 350 | ||
| Presentations | 351 | ||
| References | 351 | ||
| 3.65 Phenytoin | 351 | ||
| Risk Assessment | 351 | ||
| Toxic mechanism | 352 | ||
| Toxicokinetics | 352 | ||
| Clinical Features | 352 | ||
| Investigations | 352 | ||
| Screening tests in deliberate self-poisoning | 352 | ||
| Specific investigations as indicated | 352 | ||
| Management | 353 | ||
| Resuscitation, supportive care and monitoring | 353 | ||
| Decontamination | 353 | ||
| Enhanced elimination | 353 | ||
| Antidotes | 353 | ||
| Disposition and Follow-Up | 353 | ||
| Handy Tips | 353 | ||
| Pitfalls | 354 | ||
| Controversy | 354 | ||
| Presentations | 354 | ||
| References | 354 | ||
| 3.66 Potassium Chloride | 354 | ||
| Risk Assessment | 354 | ||
| Toxic mechanism | 355 | ||
| Toxicokinetics | 355 | ||
| Clinical Features | 355 | ||
| Investigations | 355 | ||
| Screening tests in deliberate self-poisoning | 355 | ||
| Specific investigations as indicated | 355 | ||
| Management | 355 | ||
| Resuscitation, supportive care and monitoring | 355 | ||
| Decontamination | 356 | ||
| Enhanced elimination | 356 | ||
| Antidotes | 356 | ||
| Disposition and Follow-Up | 356 | ||
| Handy Tips | 357 | ||
| Controversy | 357 | ||
| Presentations | 357 | ||
| Reference | 357 | ||
| 3.67 Quetiapine | 357 | ||
| Risk Assessment | 357 | ||
| Toxic mechanism | 358 | ||
| Toxicokinetics | 358 | ||
| Clinical Features | 358 | ||
| Investigations | 358 | ||
| Screening tests in deliberate self-poisoning | 358 | ||
| Specific investigations as indicated | 358 | ||
| Management | 358 | ||
| Resuscitation, supportive care and monitoring | 358 | ||
| Decontamination | 359 | ||
| Enhanced elimination | 359 | ||
| Antidotes | 359 | ||
| Disposition and Follow-Up | 359 | ||
| Handy Tips | 359 | ||
| Controversy | 359 | ||
| Presentations | 359 | ||
| References | 359 | ||
| 3.68 Quinine | 360 | ||
| Risk Assessment | 360 | ||
| Toxic mechanism | 360 | ||
| Toxicokinetics | 360 | ||
| Clinical Features | 360 | ||
| Investigations | 361 | ||
| Screening tests in deliberate self-poisoning | 361 | ||
| Specific investigations as indicated | 361 | ||
| Management | 361 | ||
| Resuscitation, supportive care and monitoring | 361 | ||
| Decontamination | 362 | ||
| Enhanced elimination | 362 | ||
| Antidotes | 362 | ||
| Disposition and Follow-Up | 362 | ||
| Handy Tips | 362 | ||
| Pitfall | 362 | ||
| Controversy | 363 | ||
| Presentations | 363 | ||
| References | 363 | ||
| 3.69 Risperidone | 363 | ||
| Risk Assessment | 363 | ||
| Toxic mechanism | 363 | ||
| Toxicokinetics | 363 | ||
| Clinical Features | 364 | ||
| Investigations | 364 | ||
| Screening tests in deliberate self-poisoning | 364 | ||
| Specific investigations as indicated | 364 | ||
| Management | 364 | ||
| Resuscitation, supportive care and monitoring | 364 | ||
| Decontamination | 364 | ||
| Enhanced elimination | 364 | ||
| Antidotes | 364 | ||
| Disposition and Follow-Up | 364 | ||
| Handy Tip | 365 | ||
| Pitfall | 365 | ||
| Presentations | 365 | ||
| References | 365 | ||
| 3.70 Salicylates | 365 | ||
| Risk Assessment | 366 | ||
| Toxic mechanism | 366 | ||
| Toxicokinetics | 366 | ||
| Clinical Features | 367 | ||
| Acute salicylate intoxication | 367 | ||
| Chronic salicylate intoxication | 367 | ||
| Investigations | 367 | ||
| Screening tests in deliberate self-poisoning | 367 | ||
| Specific investigations as indicated | 367 | ||
| Management | 367 | ||
| Resuscitation, supportive care and monitoring | 367 | ||
| Decontamination | 368 | ||
| Enhanced elimination | 368 | ||
| Antidotes | 368 | ||
| Disposition and Follow-Up | 368 | ||
| Handy Tips | 368 | ||
| Pitfalls | 369 | ||
| Presentations | 369 | ||
| References | 369 | ||
| 3.71 Selective Serotonin Reuptake Inhibitors (SSRIs) | 369 | ||
| Risk Assessment | 369 | ||
| Toxic mechanism | 370 | ||
| Toxicokinetics | 370 | ||
| Clinical Features | 370 | ||
| Investigations | 370 | ||
| Screening tests in deliberate self-poisoning | 370 | ||
| Specific investigations as indicated | 370 | ||
| Management | 371 | ||
| Resuscitation, supportive care and monitoring | 371 | ||
| Decontamination | 371 | ||
| Enhanced elimination | 371 | ||
| Antidotes | 371 | ||
| Disposition and Follow-Up | 371 | ||
| Handy Tips | 372 | ||
| Pitfall | 372 | ||
| Controversy | 372 | ||
| Presentations | 372 | ||
| References | 372 | ||
| 3.72 Strychnine | 373 | ||
| Risk Assessment | 373 | ||
| Toxic mechanism | 373 | ||
| Toxicokinetics | 373 | ||
| Clinical Features | 373 | ||
| Investigations | 374 | ||
| Screening tests in deliberate self-poisoning | 374 | ||
| Specific investigations as indicated | 374 | ||
| Management | 374 | ||
| Resuscitation, supportive care and monitoring | 374 | ||
| Decontamination | 374 | ||
| Enhanced elimination | 374 | ||
| Antidotes | 374 | ||
| Disposition and Follow-Up | 374 | ||
| Handy Tips | 375 | ||
| Pitfalls | 375 | ||
| Controversy | 375 | ||
| Presentations | 375 | ||
| References | 375 | ||
| 3.73 Sulfonylureas | 375 | ||
| Risk Assessment | 375 | ||
| Toxic mechanism | 376 | ||
| Toxicokinetics | 376 | ||
| Clinical Features | 376 | ||
| Investigations | 376 | ||
| Screening tests in deliberate self-poisoning | 376 | ||
| Specific investigations as indicated | 376 | ||
| Management | 376 | ||
| Resuscitation, supportive care and monitoring | 376 | ||
| Decontamination | 377 | ||
| Enhanced elimination | 377 | ||
| Antidote | 377 | ||
| Disposition and Follow-Up | 377 | ||
| Handy Tips | 377 | ||
| Pitfalls | 378 | ||
| Controversies | 378 | ||
| Presentations | 378 | ||
| References | 378 | ||
| 3.74 Theophylline | 378 | ||
| Risk Assessment | 378 | ||
| Toxic mechanism | 379 | ||
| Toxicokinetics | 379 | ||
| Clinical Features | 379 | ||
| Investigations | 380 | ||
| Screening tests in deliberate self-poisoning | 380 | ||
| Specific investigations as indicated | 380 | ||
| Management | 380 | ||
| Resuscitation, supportive care and monitoring | 380 | ||
| Decontamination | 381 | ||
| Enhanced elimination | 381 | ||
| Antidotes | 381 | ||
| Disposition and Follow-Up | 382 | ||
| Handy Tips | 382 | ||
| Pitfalls | 382 | ||
| Controversies | 382 | ||
| Presentations | 382 | ||
| References | 382 | ||
| 3.75 Thyroxine | 383 | ||
| Risk Assessment | 383 | ||
| Toxic mechanism | 383 | ||
| Toxicokinetics | 383 | ||
| Clinical Features | 383 | ||
| Investigations | 383 | ||
| Screening tests in deliberate self-poisoning | 383 | ||
| Specific investigations as indicated | 384 | ||
| Management | 384 | ||
| Resuscitation, supportive care and monitoring | 384 | ||
| Decontamination | 384 | ||
| Enhanced elimination | 384 | ||
| Antidotes | 384 | ||
| Disposition and Follow-Up | 384 | ||
| Handy Tip | 384 | ||
| Pitfalls | 384 | ||
| Presentations | 385 | ||
| References | 385 | ||
| 3.76 Tramadol | 385 | ||
| Risk Assessment | 385 | ||
| Toxic mechanism | 385 | ||
| Toxicokinetics | 385 | ||
| Clinical Features | 385 | ||
| Investigations | 386 | ||
| Screening tests in deliberate self-poisoning | 386 | ||
| Specific investigations as indicated | 386 | ||
| Management | 386 | ||
| Resuscitation, supportive care and monitoring | 386 | ||
| Decontamination | 386 | ||
| Enhanced elimination | 386 | ||
| Antidotes | 386 | ||
| Disposition and Follow-Up | 387 | ||
| Handy Tip | 387 | ||
| Pitfalls | 387 | ||
| Presentations | 387 | ||
| References | 387 | ||
| 3.77 Tricyclic Antidepressants (TCAs) | 387 | ||
| Risk Assessment | 388 | ||
| Toxic mechanism | 388 | ||
| Toxicokinetics | 388 | ||
| Clinical Features | 388 | ||
| Investigations | 389 | ||
| Screening tests in deliberate self-poisoning | 389 | ||
| Specific investigations as indicated | 389 | ||
| Management | 389 | ||
| Resuscitation, supportive care and monitoring | 389 | ||
| Decontamination | 390 | ||
| Enhanced elimination | 390 | ||
| Antidotes | 390 | ||
| Disposition and Follow-Up | 390 | ||
| Handy Tips | 390 | ||
| Pitfall | 391 | ||
| Controversies | 391 | ||
| Presentations | 391 | ||
| References | 391 | ||
| 3.78 Valproic Acid (sodium valproate) | 391 | ||
| Risk Assessment | 392 | ||
| Toxic mechanism | 392 | ||
| Toxicokinetics | 392 | ||
| Clinical Features | 392 | ||
| Investigations | 393 | ||
| Screening tests in deliberate self-poisoning | 393 | ||
| Specific investigations as indicated | 393 | ||
| Management | 393 | ||
| Resuscitation, supportive care and monitoring | 393 | ||
| Decontamination | 394 | ||
| Enhanced elimination | 394 | ||
| Antidotes | 394 | ||
| Disposition and Follow-Up | 394 | ||
| Handy Tips | 394 | ||
| Pitfall | 395 | ||
| Controversies | 395 | ||
| Presentations | 395 | ||
| References | 395 | ||
| 3.79 Venlafaxine and Desvenlafaxine | 395 | ||
| Risk Assessment | 396 | ||
| Toxic mechanism | 396 | ||
| Toxicokinetics | 396 | ||
| Clinical Features | 397 | ||
| Investigations | 397 | ||
| Screening tests in deliberate self-poisoning | 397 | ||
| Specific investigations as indicated | 397 | ||
| Management | 397 | ||
| Resuscitation, supportive care and monitoring | 397 | ||
| Decontamination | 398 | ||
| Enhanced elimination | 398 | ||
| Antidotes | 398 | ||
| Disposition and Follow-Up | 398 | ||
| Handy Tips | 398 | ||
| Pitfalls | 398 | ||
| Controversies | 398 | ||
| Presentations | 399 | ||
| References | 399 | ||
| 3.80 Warfarin | 399 | ||
| Risk Assessment | 399 | ||
| Toxic mechanism | 399 | ||
| Toxicokinetics | 400 | ||
| Clinical Features | 400 | ||
| Investigations | 400 | ||
| Screening tests in deliberate self-poisoning | 400 | ||
| Specific investigations as indicated | 400 | ||
| Management | 400 | ||
| Resuscitation, supportive care and monitoring | 400 | ||
| Decontamination | 400 | ||
| Enhanced elimination | 401 | ||
| Antidotes | 401 | ||
| Disposition and Follow-Up | 401 | ||
| Handy Tip | 401 | ||
| Pitfall | 401 | ||
| Presentations | 401 | ||
| References | 401 | ||
| 4 Antidotes | 403 | ||
| 4.1 Atropine | 404 | ||
| Presentations | 404 | ||
| Toxicological Indications | 404 | ||
| Contraindications | 404 | ||
| Mechanism of action | 404 | ||
| Pharmacokinetics | 404 | ||
| Administration | 404 | ||
| Organophosphate and carbamate poisoning | 404 | ||
| Bradycardia caused by drug-induced AV conduction blockade | 404 | ||
| Therapeutic End Points | 405 | ||
| Adverse Drug Reactions and Their Management | 405 | ||
| Specific Considerations | 405 | ||
| Handy Tip | 405 | ||
| Pitfalls | 405 | ||
| References | 405 | ||
| 4.2 Calcium | 405 | ||
| Presentations | 405 | ||
| Toxicological Indications | 406 | ||
| Contraindications | 406 | ||
| Mechanism of action | 406 | ||
| Pharmacokinetics | 406 | ||
| Administration | 406 | ||
| Hypocalcaemia/hyperkalaemia/hypermagnesaemia | 406 | ||
| Calcium channel blocker poisoning | 406 | ||
| Hydrofluoric acid skin exposure | 406 | ||
| Hydrofluoric acid inhalation injury | 407 | ||
| Therapeutic End Points | 407 | ||
| Adverse Drug Reactions and Their Management | 407 | ||
| Specific Considerations | 407 | ||
| Handy Tips | 407 | ||
| Controversies | 408 | ||
| References | 408 | ||
| 4.3 Cyproheptadine | 408 | ||
| Presentations | 408 | ||
| Toxicological Indication | 408 | ||
| Contraindications | 408 | ||
| Mechanism of action | 408 | ||
| Pharmacokinetics | 408 | ||
| Administration | 409 | ||
| Therapeutic End Points | 409 | ||
| Adverse Drug Reactions and Their Management | 409 | ||
| Specific Considerations | 409 | ||
| Handy Tips | 409 | ||
| Pitfalls | 409 | ||
| Reference | 409 | ||
| 4.4 Desferrioxamine | 409 | ||
| Presentations | 409 | ||
| Toxicological Indications | 410 | ||
| Contraindications | 410 | ||
| Mechanism of action | 410 | ||
| Pharmacokinetics | 410 | ||
| Administration | 410 | ||
| Therapeutic End Points | 410 | ||
| Adverse Drug Reactions and Their Management | 410 | ||
| Specific Considerations | 411 | ||
| Handy Tips | 411 | ||
| Pitfalls | 411 | ||
| Controversies | 411 | ||
| References | 411 | ||
| 4.5 Dicobalt Edetate | 411 | ||
| Presentations | 411 | ||
| Toxicological Indications | 411 | ||
| Contraindications | 411 | ||
| Pharmacodynamics | 412 | ||
| Pharmacokinetics | 412 | ||
| Administration | 412 | ||
| Therapeutic End Points | 412 | ||
| Adverse Drug Reactions | 412 | ||
| Specific Considerations | 412 | ||
| Handy Tips | 412 | ||
| Pitfalls | 412 | ||
| Controversy | 413 | ||
| References | 413 | ||
| 4.6 Digoxin Immune Fab | 413 | ||
| Presentations | 413 | ||
| Toxicological Indications | 413 | ||
| Contraindications | 413 | ||
| Mechanism of action | 413 | ||
| Pharmacokinetics | 414 | ||
| Administration | 414 | ||
| Calculation of Dose | 414 | ||
| Duration of Treatment | 414 | ||
| Therapeutic End Points | 414 | ||
| Adverse Drug Reactions and Their Management | 415 | ||
| Specific Considerations | 415 | ||
| Handy Tips | 415 | ||
| Pitfalls | 415 | ||
| Controversies | 415 | ||
| References | 415 | ||
| 4.7 Dimercaprol | 416 | ||
| Presentations | 416 | ||
| Toxicological Indications | 416 | ||
| Contraindications | 416 | ||
| Pharmacodynamics | 416 | ||
| Pharmacokinetics | 416 | ||
| Administration | 416 | ||
| Severe inorganic arsenic or mercury poisoning | 417 | ||
| Lead encephalopathy | 417 | ||
| Adverse Drug Reactions and Their Management | 417 | ||
| Specific Considerations | 417 | ||
| Handy Tips | 417 | ||
| Pitfall | 417 | ||
| Controversy | 418 | ||
| References | 418 | ||
| 4.8 Ethanol | 418 | ||
| Presentations | 418 | ||
| Toxicological Indications | 418 | ||
| Contraindications | 418 | ||
| Mechanism of action | 418 | ||
| Pharmacokinetics | 418 | ||
| Administration | 418 | ||
| Oral or nasogastric administration | 419 | ||
| Intravenous administration | 419 | ||
| Adverse Drug Reactions and Their Management | 419 | ||
| Specific Considerations | 419 | ||
| Handy Tips | 419 | ||
| Pitfalls | 419 | ||
| Controversies | 419 | ||
| References | 420 | ||
| 4.9 Flumazenil | 420 | ||
| Presentations | 420 | ||
| Toxicological Indications | 420 | ||
| Contraindications | 420 | ||
| Mechanism of action | 420 | ||
| Pharmacokinetics | 420 | ||
| Administration | 420 | ||
| Adverse Drug Reactions and Their Management | 421 | ||
| Benzodiazepine withdrawal syndrome | 421 | ||
| Seizures | 421 | ||
| Specific Considerations | 421 | ||
| Handy Tip | 421 | ||
| Pitfalls | 421 | ||
| Controversy | 421 | ||
| References | 421 | ||
| 4.10 Folinic Acid | 422 | ||
| Presentations | 422 | ||
| Toxicological Indications | 422 | ||
| Contraindications | 422 | ||
| Mechanism of action | 422 | ||
| Pharmacokinetics | 423 | ||
| Administration | 423 | ||
| Methotrexate overdose | 423 | ||
| Methanol poisoning | 423 | ||
| Adverse Drug Reactions | 423 | ||
| Specific Considerations | 423 | ||
| Handy Tip | 423 | ||
| Pitfall | 423 | ||
| Controversies | 423 | ||
| 4.11 Fomepizole | 424 | ||
| Presentations | 424 | ||
| Toxicological Indications | 424 | ||
| Contraindications | 424 | ||
| Mechanism of action | 424 | ||
| Pharmacokinetics | 424 | ||
| Administration | 424 | ||
| Therapeutic End Points | 424 | ||
| Adverse Drug Reactions and Their Management | 424 | ||
| Specific Considerations | 425 | ||
| Controversies | 425 | ||
| References | 425 | ||
| 4.12 Glucose | 425 | ||
| Presentations | 425 | ||
| Toxicological Indications | 426 | ||
| Contraindications | 426 | ||
| Mechanism of action | 426 | ||
| Pharmacokinetics | 426 | ||
| Administration | 426 | ||
| Therapeutic End Points | 427 | ||
| Adverse Drug Reactions and Their Management | 427 | ||
| Specific Considerations | 427 | ||
| Handy Tips | 427 | ||
| Pitfalls | 427 | ||
| 4.13 Hydroxocobalamin | 427 | ||
| Presentations | 427 | ||
| Toxicological Indications | 428 | ||
| Contraindications | 428 | ||
| Mechanism of action | 428 | ||
| Pharmacokinetics | 428 | ||
| Administration | 428 | ||
| Therapeutic End Points | 428 | ||
| Adverse Drug Reactions and Their Management | 428 | ||
| Specific Considerations | 429 | ||
| Handy Tips | 429 | ||
| Pitfalls | 429 | ||
| Controversies | 429 | ||
| References | 429 | ||
| 4.14 Insulin (high-dose) | 430 | ||
| Toxicological Indications | 430 | ||
| Contraindications | 430 | ||
| Mechanism of action | 430 | ||
| Administration | 430 | ||
| Therapeutic End Points | 430 | ||
| Adverse Drug Reactions and Their Management | 430 | ||
| Specific Considerations | 431 | ||
| Handy Tips | 431 | ||
| Pitfall | 431 | ||
| Controversies | 431 | ||
| References | 431 | ||
| 4.15 Intravenous Lipid Emulsion | 432 | ||
| Presentations | 432 | ||
| Toxicological Indications | 432 | ||
| Contraindications | 432 | ||
| Mechanism of action | 432 | ||
| Administration | 432 | ||
| Therapeutic End Points | 432 | ||
| Adverse Drug Reactions and Their Management | 432 | ||
| Specific Considerations | 433 | ||
| Handy Tip | 433 | ||
| Controversies | 433 | ||
| References | 433 | ||
| 4.16 Methylene Blue | 433 | ||
| Presentations | 433 | ||
| Toxicological Indications | 433 | ||
| Contraindications | 434 | ||
| Mechanism of action | 434 | ||
| Pharmacokinetics | 434 | ||
| Administration | 434 | ||
| Therapeutic End Points | 434 | ||
| Adverse Drug Reactions and Their Management | 434 | ||
| Specific Considerations | 435 | ||
| Handy Tips | 435 | ||
| Controversies | 435 | ||
| References | 435 | ||
| 4.17 N-Acetylcysteine | 435 | ||
| Presentations | 436 | ||
| Toxicological Indications | 436 | ||
| Contraindications | 436 | ||
| Mechanism of action | 436 | ||
| Pharmacokinetics | 436 | ||
| Administration | 436 | ||
| Therapeutic End Points | 437 | ||
| Adverse Drug Reactions and Their Management | 437 | ||
| Specific Considerations | 437 | ||
| Handy Tip | 437 | ||
| Pitfalls | 438 | ||
| Controversies | 438 | ||
| References | 438 | ||
| 4.18 Naloxone | 438 | ||
| Presentations | 438 | ||
| Toxicological Indications | 438 | ||
| Contraindications | 439 | ||
| Mechanism of action | 439 | ||
| Pharmacokinetics | 439 | ||
| Administration | 439 | ||
| Therapeutic End Points | 439 | ||
| Adverse Drug Reactions and Their Management | 440 | ||
| Specific Considerations | 440 | ||
| Handy Tips | 440 | ||
| Pitfalls | 440 | ||
| Controversies | 440 | ||
| References | 441 | ||
| 4.19 Octreotide | 441 | ||
| Presentations | 441 | ||
| Toxicological Indications | 441 | ||
| Contraindications | 441 | ||
| Mechanism of action | 441 | ||
| Pharmacokinetics | 441 | ||
| Administration | 441 | ||
| Therapeutic End Points | 442 | ||
| Adverse Drug Reactions and Their Management | 442 | ||
| Specific Considerations | 442 | ||
| Handy Tips | 442 | ||
| Pitfall | 442 | ||
| Controversies | 442 | ||
| References | 442 | ||
| 4.20 Penicillamine | 442 | ||
| Presentations | 443 | ||
| Toxicological Indications | 443 | ||
| Contraindications | 443 | ||
| Mechanism of action | 443 | ||
| Pharmacokinetics | 443 | ||
| Administration | 443 | ||
| Therapeutic End Points | 443 | ||
| Adverse Drug Reactions and Their Management | 443 | ||
| Specific Considerations | 444 | ||
| Handy Tip | 444 | ||
| Controversy | 444 | ||
| References | 444 | ||
| 4.21 Physostigmine | 444 | ||
| Presentations | 444 | ||
| Toxicological Indications | 444 | ||
| Contraindications | 444 | ||
| Mechanism of action | 444 | ||
| Pharmacokinetics | 444 | ||
| Administration | 444 | ||
| Therapeutic End Points | 445 | ||
| Adverse Drug Reactions and Their Management | 445 | ||
| Specific Considerations | 445 | ||
| Handy Tips | 445 | ||
| Pitfall | 445 | ||
| Controversies | 445 | ||
| References | 446 | ||
| 4.22 Pralidoxime | 446 | ||
| Presentation | 446 | ||
| Toxicological Indications | 446 | ||
| Contraindications | 446 | ||
| Mechanism of action | 446 | ||
| Pharmacokinetics | 446 | ||
| Administration | 446 | ||
| Adverse Drug Reactions | 447 | ||
| Specific Considerations | 447 | ||
| Handy Tips | 447 | ||
| Pitfalls | 447 | ||
| Controversies | 447 | ||
| References | 448 | ||
| 4.23 Pyridoxine | 448 | ||
| Presentations | 448 | ||
| Toxicological Indications | 448 | ||
| Contraindications | 448 | ||
| Mechanism of action | 448 | ||
| Pharmacokinetics | 448 | ||
| Administration | 448 | ||
| Therapeutic End Points | 449 | ||
| Adverse Drug Reactions and Their Management | 449 | ||
| Specific Considerations | 449 | ||
| Handy Tips | 449 | ||
| Pitfall | 449 | ||
| Controversies | 449 | ||
| Reference | 449 | ||
| 4.24 Sodium Bicarbonate | 450 | ||
| Presentations | 450 | ||
| Toxicological Indications | 450 | ||
| Contraindications | 450 | ||
| Mechanism of action | 450 | ||
| Elevation of serum pH | 451 | ||
| Alkalinisation of urine | 451 | ||
| Pharmacokinetics | 451 | ||
| Administration | 451 | ||
| Cardiotoxicity secondary to fast sodium channel blockade | 451 | ||
| Prevention of redistribution of salicylate to CNS | 452 | ||
| Urinary alkalinisation | 452 | ||
| Adverse Drug Reactions | 452 | ||
| Specific Considerations | 452 | ||
| Handy Tips | 452 | ||
| Pitfalls | 453 | ||
| Controversies | 453 | ||
| References | 453 | ||
| 4.25 Sodium Calcium Edetate | 453 | ||
| Presentations | 453 | ||
| Toxicological Indications | 453 | ||
| Contraindications | 453 | ||
| Mechanism of action | 454 | ||
| Pharmacokinetics | 454 | ||
| Administration | 454 | ||
| Adverse Drug Reactions and Their Management | 454 | ||
| Specific Considerations | 455 | ||
| Handy Tip | 455 | ||
| Pitfall | 455 | ||
| Controversies | 455 | ||
| References | 455 | ||
| 4.26 Sodium Thiosulfate | 455 | ||
| Presentations | 455 | ||
| Toxicological Indications | 455 | ||
| Contraindications | 456 | ||
| Mechanism of action | 456 | ||
| Pharmacokinetics | 456 | ||
| Administration | 456 | ||
| Therapeutic End Points | 456 | ||
| Adverse Drug Reactions | 456 | ||
| Specific Considerations | 456 | ||
| Handy Tips | 456 | ||
| Controversy | 457 | ||
| References | 457 | ||
| 4.27 Succimer | 457 | ||
| Presentations | 457 | ||
| Toxicological Indications | 457 | ||
| Contraindications | 457 | ||
| Mechanism of action | 457 | ||
| Pharmacokinetics | 457 | ||
| Administration | 458 | ||
| Adverse Drug Reactions and Their Management | 458 | ||
| Specific Considerations | 458 | ||
| Handy Tips | 458 | ||
| Pitfall | 458 | ||
| Controversy | 458 | ||
| References | 459 | ||
| 4.28 Vitamin K | 459 | ||
| Presentations | 459 | ||
| Toxicological Indications | 459 | ||
| Contraindications | 459 | ||
| Mechanism of action | 459 | ||
| Pharmacokinetics | 459 | ||
| Administration | 459 | ||
| Therapeutic over-warfarinisation | 459 | ||
| Warfarin overdose | 459 | ||
| Ingestion of long-acting anticoagulant rodenticide | 460 | ||
| Adverse Drug Reactions and Their Management | 460 | ||
| Specific Considerations | 460 | ||
| Handy Tips | 460 | ||
| Pitfalls | 460 | ||
| Controversies | 461 | ||
| References | 461 | ||
| 5 Envenomings | 463 | ||
| 5.1 Black Snake | 464 | ||
| Toxins | 464 | ||
| Clinical Presentation and Course | 464 | ||
| Mulga snake, Collett’s snake, Butler’s snake and Papuan black snake | 464 | ||
| Red-bellied and blue-bellied black snakes | 465 | ||
| Management | 465 | ||
| Pre-hospital | 465 | ||
| Hospital | 465 | ||
| Investigations | 466 | ||
| Differential Diagnosis | 466 | ||
| Disposition and Follow-Up | 466 | ||
| Handy Tips | 467 | ||
| Pitfalls | 467 | ||
| Controversies | 467 | ||
| References | 467 | ||
| 5.2 Brown Snake | 468 | ||
| Toxins | 468 | ||
| Clinical Presentation and Course | 468 | ||
| Management | 468 | ||
| Pre-hospital | 468 | ||
| Hospital | 469 | ||
| Investigations | 469 | ||
| Differential Diagnosis | 469 | ||
| Disposition and Follow-Up | 470 | ||
| Handy Tips | 470 | ||
| Pitfalls | 470 | ||
| Controversies | 470 | ||
| References | 471 | ||
| 5.3 Death Adder | 471 | ||
| TOXIN | 471 | ||
| Clinical Presentation and Course | 471 | ||
| Management | 472 | ||
| Pre-hospital | 472 | ||
| Hospital | 472 | ||
| Investigations | 472 | ||
| Differential Diagnosis | 473 | ||
| Disposition and Follow-Up | 473 | ||
| Handy Tips | 473 | ||
| Pitfalls | 473 | ||
| Controversies | 473 | ||
| References | 473 | ||
| 5.4 Tiger Snake Group | 474 | ||
| Toxins | 474 | ||
| Clinical Presentation and Course | 474 | ||
| Management | 475 | ||
| Pre-hospital | 475 | ||
| Hospital | 475 | ||
| Investigations | 476 | ||
| Differential Diagnosis | 476 | ||
| Disposition and Follow-Up | 476 | ||
| Handy Tips | 477 | ||
| Pitfalls | 477 | ||
| Controversies | 477 | ||
| References | 477 | ||
| 5.5 Taipan | 478 | ||
| Toxins | 478 | ||
| Clinical Presentation and Course | 478 | ||
| Management | 478 | ||
| Pre-hospital | 479 | ||
| Hospital | 479 | ||
| Investigations | 479 | ||
| Differential Diagnosis | 480 | ||
| Disposition and Follow-Up | 480 | ||
| Handy Tips | 480 | ||
| Pitfalls | 480 | ||
| Controversies | 480 | ||
| References | 481 | ||
| 5.6 Sea Snake | 481 | ||
| Toxins | 481 | ||
| Clinical Presentation and Course | 481 | ||
| Management | 481 | ||
| Pre-hospital | 482 | ||
| Hospital | 482 | ||
| Investigations | 482 | ||
| Differential Diagnosis | 482 | ||
| Disposition and Follow-Up | 483 | ||
| Handy Tip | 483 | ||
| Pitfalls | 483 | ||
| Controversies | 483 | ||
| Reference | 483 | ||
| 5.7 Australian Scorpions | 483 | ||
| Toxins | 484 | ||
| Clinical Presentation and Course | 484 | ||
| Management | 484 | ||
| Pre-hospital | 484 | ||
| Hospital | 484 | ||
| Investigations | 484 | ||
| Differential Diagnosis | 484 | ||
| Disposition and Follow-Up | 485 | ||
| Handy Tip | 485 | ||
| Reference | 485 | ||
| 5.8 Bluebottle Jellyfish (Physalia species) | 485 | ||
| Toxins | 485 | ||
| Clinical Presentation and Course | 485 | ||
| Management | 485 | ||
| Investigations | 485 | ||
| Differential Diagnosis | 486 | ||
| Disposition and Follow-Up | 486 | ||
| Handy Tip | 486 | ||
| References | 486 | ||
| 5.9 Stonefish | 486 | ||
| Toxins | 486 | ||
| Clinical Presentation and Course | 486 | ||
| Management | 487 | ||
| Pre-hospital | 487 | ||
| Hospital | 487 | ||
| Investigations | 487 | ||
| Differential Diagnosis | 487 | ||
| Disposition and Follow-Up | 487 | ||
| Handy Tips | 487 | ||
| Pitfall | 487 | ||
| Controversies | 488 | ||
| References | 488 | ||
| 5.10 Box Jellyfish | 488 | ||
| Toxins | 488 | ||
| Clinical Presentation and Course | 488 | ||
| Management | 489 | ||
| Pre-hospital | 489 | ||
| Hospital | 489 | ||
| Investigations | 489 | ||
| Differential Diagnosis | 490 | ||
| Disposition and Follow-Up | 490 | ||
| Handy Tips | 490 | ||
| Pitfalls | 490 | ||
| Controversies | 490 | ||
| References | 490 | ||
| 5.11 Irukandji Syndrome | 491 | ||
| Toxins | 491 | ||
| Clinical Presentation and Course | 491 | ||
| Management | 491 | ||
| Pre-hospital | 491 | ||
| Hospital | 492 | ||
| Investigations | 492 | ||
| Differential Diagnosis | 492 | ||
| Disposition and Follow-Up | 493 | ||
| Handy Tips | 493 | ||
| Pitfalls | 493 | ||
| Controversies | 493 | ||
| References | 493 | ||
| 5.12 Blue-Ringed Octopus | 494 | ||
| Toxins | 494 | ||
| Clinical Presentation and Course | 494 | ||
| Management | 494 | ||
| Pre-hospital | 494 | ||
| Hospital | 494 | ||
| Investigations | 495 | ||
| Differential Diagnosis | 495 | ||
| Disposition and Follow-Up | 495 | ||
| Handy Tip | 495 | ||
| Pitfalls | 495 | ||
| References | 495 | ||
| 5.13 Redback Spider | 496 | ||
| Toxins | 496 | ||
| Clinical Presentation and Course | 496 | ||
| Management | 496 | ||
| Pre-hospital | 496 | ||
| Hospital | 497 | ||
| Investigations | 497 | ||
| Differential Diagnosis | 497 | ||
| Disposition and Follow-Up | 497 | ||
| Handy Tips | 497 | ||
| Pitfall | 497 | ||
| Controversy | 498 | ||
| References | 498 | ||
| 5.14 Funnel-Web (Big Black) Spider | 498 | ||
| Toxins | 498 | ||
| Clinical Presentation and Course | 499 | ||
| Management | 499 | ||
| Pre-hospital | 499 | ||
| Hospital | 499 | ||
| Investigations | 500 | ||
| Differential Diagnosis | 500 | ||
| Disposition and Follow-Up | 500 | ||
| Handy Tips | 500 | ||
| Pitfalls | 500 | ||
| References | 500 | ||
| 5.15 White-Tailed Spider | 501 | ||
| Toxins | 501 | ||
| Clinical Presentation and Course | 501 | ||
| Management | 501 | ||
| Investigations | 501 | ||
| Differential Diagnosis | 501 | ||
| Disposition and Follow-Up | 502 | ||
| Pitfall | 502 | ||
| References | 502 | ||
| 5.16 Ticks | 502 | ||
| Toxins | 502 | ||
| Clinical Presentation and Course | 502 | ||
| Management | 503 | ||
| Pre-hospital | 503 | ||
| Hospital | 503 | ||
| Investigations | 503 | ||
| Differential Diagnosis | 504 | ||
| Disposition and Follow-Up | 504 | ||
| Handy Tips | 504 | ||
| Pitfall | 504 | ||
| Controversy | 504 | ||
| References | 504 | ||
| 6 Antivenoms | 505 | ||
| 6.1 CSL Black Snake Antivenom | 506 | ||
| Presentation | 506 | ||
| Indications | 506 | ||
| Contraindications | 506 | ||
| Administration | 506 | ||
| Therapeutic End Points | 506 | ||
| Adverse Drug Reactions and Management | 506 | ||
| Acute allergic or anaphylactic reaction | 506 | ||
| Serum sickness | 507 | ||
| Specific Considerations | 507 | ||
| Handy Tip | 507 | ||
| Pitfalls | 507 | ||
| Controversies | 507 | ||
| References | 507 | ||
| 6.2 CSL Brown Snake Antivenom | 507 | ||
| Presentation | 508 | ||
| Indications | 508 | ||
| Contraindications | 508 | ||
| Administration | 508 | ||
| Therapeutic End Points | 508 | ||
| Adverse Drug Reactions and Management | 508 | ||
| Acute allergic or anaphylactic reaction | 508 | ||
| Serum sickness | 508 | ||
| Specific Considerations | 509 | ||
| Pitfalls | 509 | ||
| Controversies | 509 | ||
| References | 509 | ||
| 6.3 CSL Death Adder Antivenom | 509 | ||
| Presentation | 509 | ||
| Indications | 510 | ||
| Contraindications | 510 | ||
| Administration | 510 | ||
| Therapeutic End Points | 510 | ||
| Adverse Drug Reactions and Management | 510 | ||
| Acute allergic or anaphylactic reaction | 510 | ||
| Serum sickness | 510 | ||
| Specific Considerations | 510 | ||
| Handy Tips | 511 | ||
| Pitfalls | 511 | ||
| Controversy | 511 | ||
| References | 511 | ||
| 6.4 CSL Tiger Snake Antivenom | 511 | ||
| Presentation | 511 | ||
| Indications | 511 | ||
| Contraindications | 512 | ||
| Administration | 512 | ||
| Therapeutic End Points | 512 | ||
| Adverse Drug Reactions and Management | 512 | ||
| Acute allergic or anaphylactic reaction | 512 | ||
| Serum sickness | 512 | ||
| Specific Considerations | 512 | ||
| Handy Tip | 512 | ||
| Pitfalls | 513 | ||
| Controversies | 513 | ||
| References | 513 | ||
| 6.5 CSL Taipan Antivenom | 513 | ||
| Presentation | 513 | ||
| Indications | 514 | ||
| Contraindications | 514 | ||
| Administration | 514 | ||
| Therapeutic End Points | 514 | ||
| Adverse Drug Reactions and Management | 514 | ||
| Acute allergic or anaphylactic reaction | 514 | ||
| Serum sickness | 514 | ||
| Specific Considerations | 514 | ||
| Handy Tips | 515 | ||
| Pitfalls | 515 | ||
| Controversies | 515 | ||
| References | 515 | ||
| 6.6 CSL Sea Snake Antivenom | 515 | ||
| Presentation | 515 | ||
| Indications | 516 | ||
| Contraindications | 516 | ||
| Administration | 516 | ||
| Therapeutic End Points | 516 | ||
| Adverse Drug Reactions and Management | 516 | ||
| Acute allergic or anaphylactic reaction | 516 | ||
| Serum sickness | 516 | ||
| Specific Considerations | 517 | ||
| Pitfalls | 517 | ||
| Controversy | 517 | ||
| Reference | 517 | ||
| 6.7 CSL Polyvalent Snake Antivenom | 517 | ||
| Presentations | 517 | ||
| Indications | 517 | ||
| Contraindications | 517 | ||
| Administration | 518 | ||
| Therapeutic End Points | 518 | ||
| Adverse Drug Reactions and Management | 518 | ||
| Acute allergic or anaphylactic reaction | 518 | ||
| Serum sickness | 518 | ||
| Specific Considerations | 518 | ||
| Handy Tip | 518 | ||
| Pitfalls | 518 | ||
| References | 519 | ||
| 6.8 CSL Stonefish Antivenom | 519 | ||
| Presentation | 519 | ||
| Indications | 519 | ||
| Contraindications | 519 | ||
| Administration | 519 | ||
| Therapeutic End Points | 519 | ||
| Adverse Drug Reactions and Management | 519 | ||
| Acute allergic or anaphylactic reaction | 519 | ||
| Serum sickness | 520 | ||
| Specific Considerations | 520 | ||
| Pitfalls | 520 | ||
| Controversy | 520 | ||
| References | 520 | ||
| 6.9 CSL Box Jellyfish Antivenom | 520 | ||
| Presentation | 520 | ||
| Indications | 520 | ||
| Contraindications | 521 | ||
| Administration | 521 | ||
| Therapeutic End Points | 521 | ||
| Adverse Drug Reactions and Management | 521 | ||
| Acute allergic or anaphylactic reaction | 521 | ||
| Serum sickness | 521 | ||
| Specific Considerations | 521 | ||
| Handy Tips | 522 | ||
| Pitfall | 522 | ||
| Controversies | 522 | ||
| References | 522 | ||
| 6.10 CSL Redback Spider Antivenom | 522 | ||
| Presentation | 522 | ||
| Indications | 522 | ||
| Contraindications | 522 | ||
| Administration | 523 | ||
| Therapeutic End Points | 523 | ||
| Adverse Drug Reactions and Management | 523 | ||
| Acute allergic or anaphylactic reaction | 523 | ||
| Serum sickness | 523 | ||
| Specific Considerations | 523 | ||
| Handy Tip | 523 | ||
| Pitfalls | 523 | ||
| Controversy | 524 | ||
| References | 524 | ||
| 6.11 CSL Funnel-Web Spider Antivenom | 524 | ||
| Presentation | 524 | ||
| Indications | 524 | ||
| Contraindications | 524 | ||
| Administration | 524 | ||
| Therapeutic End Points | 525 | ||
| Adverse Drug Reactions and Management | 525 | ||
| Acute allergic or anaphylactic reaction | 525 | ||
| Serum sickness | 525 | ||
| Specific Considerations | 525 | ||
| Pitfalls | 525 | ||
| Reference | 525 | ||
| Appendices | 527 | ||
| Appendix 1: Poisons Information Telephone Numbers | 528 | ||
| Appendix 2: Example ECGs | 529 | ||
| Appendix 2A TCA Cardiotoxicity | 529 | ||
| Appendix 2B TCA Cardiotoxicity (Post-alkalinisation) | 530 | ||
| Appendix 2C Acute Digoxin Overdose | 531 | ||
| Appendix 2D QT Prolongation and Torsades De Pointes | 532 | ||
| Appendix 3: Conversion Factors and Therapeutic Ranges for Important Toxins | 533 | ||
| Appendix 4: Alcohol Pathways | 534 | ||
| Appendix 5: Therapeutic Over-Warfarinisation | 535 | ||
| 5A Management of Adult Patients on Warfarin Therapy with Bleeding* | 535 | ||
| 5B Management of Adult Patients on Warfarin Therapy with High INR and No Bleeding | 536 | ||
| 5C Grades of Guideline Recommendations | 537 | ||
| Appendix 6: Management of Allergic Reactions to Antivenoms | 538 | ||
| 1 Management Of Acute Severe Allergic Reaction OR Anaphylaxis | 538 | ||
| Initial management | 538 | ||
| Inadequate response or further deterioration | 538 | ||
| 2 Management Of Serum Sickness | 538 | ||
| Index | 539 | ||
| A | 540 | ||
| B | 543 | ||
| C | 545 | ||
| D | 549 | ||
| E | 552 | ||
| F | 554 | ||
| G | 555 | ||
| H | 557 | ||
| I | 558 | ||
| J | 559 | ||
| K | 559 | ||
| L | 559 | ||
| M | 560 | ||
| N | 562 | ||
| O | 563 | ||
| P | 564 | ||
| Q | 567 | ||
| R | 567 | ||
| S | 569 | ||
| T | 572 | ||
| U | 574 | ||
| V | 574 | ||
| W | 574 | ||
| X | 575 | ||
| Y | 575 | ||
| Z | 575 |