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Poisonings and overdoses in the intensive care unit: General and specific management issues

Zimmerman, Janice L. MD, FCCM

Concise Definitive Review

Objective: To provide current information on general and specific interventions for overdoses likely to require intensive care.

Design: Review of literature relevant to selected interventions for general management of overdoses and specific poisons.

Results: The benefit of interventions to decrease absorption or enhance elimination of toxins is limited to a relatively small number of specific agents. Antidotes and certain interventions may be helpful in preventing or treating toxicity in specific poisonings when used appropriately. Intensive supportive care is also necessary to achieve good outcomes.

Conclusion: Knowledge of the indications and limitations of current interventions for poisonings and overdoses is important for care of the critically ill poisoned patient.

“Poison and medicines are oftentimes the same substance given with different intents.”— Peter Latham

Poisoning may result from intentional or unintentional exposures, recreational drug use, and therapeutic use of drugs or other agents. Although mortality and serious morbidity in poisonings are uncommon, patients requiring hospitalization often require intensive care. The appropriate management of poisoned patients should improve outcome and decrease complications. Evidence-based information is minimal in toxicology because the variety of drugs and doses that patients are exposed to limits the ability to conduct clinical trials of specific interventions. Current recommendations for severely poisoned patients are based on limited data from animal and human studies, case reports, pharmacokinetic information, known pathophysiology, and often consensus opinion. Studies in animal models and human volunteers do not replicate clinical situations commonly encountered in patients. Therapeutic guidelines can be suggested but may not be supported by definitive evidence.

The management of a poisoned patient often involves emergency physicians, primary care physicians, and intensivists. Table 1 summarizes some management issues before intensive care unit (ICU) admission (1–7), and additional material can be consulted for more information (8, 9). This review will focus on interventions likely to be used in the ICU.

From the Department of Medicine, Baylor College of Medicine, Houston, TX.

© 2003 Lippincott Williams & Wilkins, Inc.