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Arch Hellen Med, 24(2), March-April 2007, 111-120


Recent developments in the clinical management of poisoning

Department of Forensic Medicine and Toxicology, Medical School, University of Athens, Athens, Greece

The clinical management of the poisoned patient has changed radically during the last few years. Guidelines on gastric decontamination, enhanced elimination and new antidotes are reviewed. Classic gastrointestinal decontamination methods such as emesis and gastric lavage have now been abandoned. Although there is no evidence that activated charcoal improves patient outcome it should be still used. The use of cathartics is not indicated since they are ineffective and potentially dangerous. Whole bowel irrigation should be used only for ingestion of significant amounts of iron or lithium, sustained-release, enteric-coated tablets and illicit drug packets. Although many methods are commonly used to enhance poison elimination they have limited usefulness. Urinary alkalinization should be used only in the treatment of serious chlorophenoxy herbicide poisoning. Hemodialysis should be applied only in the treatment of poisoning with lithium, salicylates, theophylline, methanol and ethylene glycol, while hemoperfusion is effective only in serious theophylline overdose and exposure to the mushroom Amanita phalloides and the herbicide paraquat. Multiple dose activated charcoal should only be used in serious poisoning with carbamazepine, dapsone, phenobarbital, quinine and theophylline. The use of two new antidotes, fomepizole in the treatment of ethylene glycol and methanol poisoning and crotalidae polyvalent immune Fab (Ovine) in the treatment of snake envenomation is discussed. Finally, recent developments in the management of two common serious forms of poisoning, paracetamol and tricyclic antidepressants, are outlined.

Key words: Activated charcoal, Antidotes, Clinical management, Emesis, Paracetamol, Poisonings, Tricyclic antidepressants.

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