Category Archives: Adverse drug reactions and poisoning

Poison Information Services

Information on poisoning can be obtained from the poisons information services at the following numbers: Poisons Information Service Laboratory analysis may help in the diagnosis and management of some cases. Information on the available services can be obtained from the Poisons Information Service in London or the local services in each country.

Drug abuse

Solvents Solvent abuse has become a common problem, particularly in teenagers who inhale volatile organic solvents such as toluene in glues (‘glue sniffing’). Many other solvents, such as aerosols (hair lacquer), antifreeze and petrol, can also be misused. Solvents are applied to a piece of cloth or put into a plastic bag and inhaled, often until consciousness is lost. The patient presents either

Mushrooms

There are many poisonous mushrooms that can be confused with edible fungi and be eaten by mistake. Nevertheless, apart from transient nausea, vomiting and diarrhoea, which can occur with many species, very severe reactions are rare. Fatal mushroom poisoning is almost invariably due to Amanita phalloides (the death-cap mushroom). This fungus contains phallotoxins and amatoxins, both of which interfere with ce

Plants

Many plants are known to be poisonous, but in practice it is unusual for severe poisoning to occur. Children are the usual victims. Only two people are known to have died from plant poisoning in the UK since the early 1970s. The commonest effects of nettles and poison ivy are dermatitis followed by vomiting. Poisonous plants commonly ingested include hemlock, laburnum, deadly nightshade and green potatoes. D

Venomous animals

Snakes The adder (Vipera berus) is the only poisonous snake native to the UK. However, a number of dangerous snakes are kept as pets, and worldwide venomous snakes still cause significant mortality. There are three types of venomous snake: 1 Viperidae have long erectile fangs. They are subdivided into two types: (a) Viperinae (true vipers, e.g. Russell’s viper [dabora], European adder), which are found

Household and industrial poisons

Virtually all substances found in the home have been ingested either by adults because of poorly labelled bottles or accidentally by children. Occasionally household agents are deliberately taken. Many kitchen products contain bleaches (sodium hypochlorite or hydrogen peroxide), acids or alkalis and the main problem after poisoning with them is their corrosive action on the gut. There is an immediate burning

PSYCHOTROPIC DRUGS

Benzodiazepines Benzodiazepines are commonly taken in cases of selfpoisoning, accounting for 40% of all drug overdosages in the UK. On their own they are remarkably safe but they potentiate the CNS-depressant effects of other drugs taken with them, such as barbiturates or ethanol. Benzodiazepines produce drowsiness, ataxia, dysarthria, nystagmus and sometimes coma. Mild hypotension and respiratory depression

Specific Drug Problems

In this section only specific treatment regimens will be discussed. The general principles of management of selfpoisoning will always be required. ANALGESICS Analgesic poisoning is common in some areas, accounting for one-third of all cases of self-poisoning admitted to hospital. Salicylate poisoning has decreased over the past decade, while paracetamol poisoning has increased. Combinations of aspirin or para

SPECIFIC MANAGEMENT

Many techniques have been developed to decrease drug absorption and increase drug elimination, but most of these manoeuvres are only helpful with a few drugs. These, as well as antidotes to specific drugs, are described below. Decreasing drug absorption Vigorous attempts to empty the gastrointestinal tract are indicated when drugs that cause potentially fatal complications other than coma or respiratory depre

Principles of management

Most patients with self-poisoning require only general care and support of the vital systems. However, for a few drugs additional therapy is required. Blood and urine samples should always be taken on admission for the determination of drug levels, as these are invaluable for the management of certain poisons and are helpful in legal problems. Drug screens of blood and urine are occasionally indicated in the