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Toxicology Rounds

In an Age of Exploding Information, Toxicology Web Sites Aid in Treatment

Greenberg, Michael I. MD, MPH

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    We all know that we are living in an extraordinary age of exploding information. Emergency medicine and its subspecialty, medical toxicology, are not exempt from the need to access vast amounts of useful information on the web. Many toxicology-related web sites house important and useful information for emergency physicians and medical toxicologists alike.

    The American Association of Poison Control Centers ( contains a treasure trove of interesting data including the most recent Toxic Exposure Surveillance System (TESS) data. TESS is the only comprehensive poisoning surveillance database in the United States. It is a valuable resource for product safety managers, medical directors, regulatory affairs directors, and other important decision-makers within industry.

    Developed in 1983, TESS contains detailed toxicological information on more than 24 million poison exposures reported to U.S. poison centers. That includes more than two million reports to poison centers for 2000 alone, an estimated 96 percent of all poison exposures reported to poison centers in the U.S.

    The American College of Medical Toxicology (ACMT) web site ( provides information about the organization as well as the specialty of medical toxicology. The site provides linked access to a very interesting and useful resource, the Internet Journal of Medical Toxicology (IJMT). The scope of IJMT includes the scientific, medical, social, and political aspects of acute or chronic toxicity due to chemicals, drugs, biologicals, or environmental agents.

    IJMT's purpose is to provide an interactive forum for topics in medical toxicology. IJMT solicits materials with the intent of covering important, timely, or controversial topics in medical toxicology, and is sent to subscribers via email. The specific purpose of this format is to elicit readers' comments or replies to published materials. IJMT is peer-reviewed, and invites original scientific contributions, case reports and case series, reviews, editorials, and letters to the editor. Take a look at this e-journal next time you are surfing the net.

    HazMat Info

    The web site for the Toxikon Multimedia Project can be found at This site contains some excellent educational materials, including a review of toxic syndromes, discussions of various antidotes to common poisons, virtual toxicology cases, and a new feature called virtual toxicology lectures. The virtual toxicology lectures present emergency medicine discussions of various toxicological issues in case format. It's useful, entertaining, and educational.

    The next time you encounter a patient in the emergency department who may have ingested a plant or plant product, you may want to pay a visit to the Cornell University Poisonous Plants Informational Database at This site includes a searchable database that accepts the name of the plant or its species as well as the primary poisons it contains. Entering any combination of this information will call up a very clear image of the plant as well as useful information and data about that plant species.

    For those with a special interest in drugs of abuse, I would highly recommend a visit to the site for the Drug Enforcement Agency (DEA) at This site provides an enormous amount of information about drugs of abuse, including statistics regarding current drug production and use. The site also gives a preview of the relatively unknown DEA museum that is maintained by the DEA and is open to the public. This museum contains perhaps the most comprehensive visual history of drug use in this country, and if you are ever in Washington, D.C., a visit to this museum would be well worth the effort.

    For multiple excellent images of drugs of abuse, don't miss the web site at The site chronicles a large number of drugs of abuse, and a click on the link for that drug will bring up a photo of the drug as well as detailed information about the drug. Emergency physicians will find this site useful to identify the drugs currently in vogue.

    Street Drugs

    No discussion about street drugs and drugs of abuse is complete without a referral to This site is actually an underground site whose stated purpose is: “ is an online library of information about psychoactive plants and chemicals and related topics. The information on the site is a compilation of the experiences, words, and efforts of hundreds of individuals, including users, parents, health professionals, doctors, the rapists, chemists, researchers, teachers, and lawyers.

    “Erowid acts as a publisher of new information as well as a library for the collection of documents published elsewhere. The information found on the site spans the spectrum from solid peer-reviewed research to fanciful creative writing.

    “The library contains [more than] 20,000 documents related to psychoactives including images, research summaries and abstracts, media articles, experience reports, information on chemistry, dosage, effects, law, health, traditional and spiritual use, and drug testing.”

    Nearly 25,000 people visit the site each day, making for more than 2.8 million unique visitors in the past year. In fact, the site is so popular that it is regularly monitored by law enforcement agents as well as drug users. Law enforcement uses the information on this site to stay current with the latest drugs being used in the schools and on the streets of America and elsewhere.

    The American Academy of Clinical Toxicology maintains a useful web site that can be accessed at The site provides links to important information in many toxicology categories, including chemistry, government, industry, industrial hygiene, MSDS documents, natural toxicants, pharmaceuticals, and regulatory issues among other things. One of the most useful things to be found on this site are the various position papers published by the academy. Currently there are five such position statements are available on the site. These are listed in the table.

    These statements are actually systematically developed clinical guidelines. They have been created and reviewed by experts in medical toxicology, and provide string information regarding the topics addressed. The stated purpose for these documents is “to provide those involved in the care of poisoned patients with a source of up-to-date peer-reviewed information.” I would suggest that these position papers be required reading for all emergency physicians.

    For those seeking reliable information regarding the important topics surrounding biological terrorism, I would suggest a visit to the American College of Emergency Physicians (ACEP) web site at Click on the link entitled bioterrorism, and you will find a page dedicated to access to important resources specifically regarding smallpox and anthrax as well as other information sources addressing chemical and nuclear aspects of terrorism.

    In addition, one will find a clickable link to ACEP's Terrorism Response Task Force report. This document contains the college's recommendations for a strategic plan that includes short- and long-term goals to promote education and research, protect health care workers, and develop a coordinated emergency medicine community response plan for weapons of mass destruction events.

    Finally, I recommend the site located at This site contains an enormous amount of information, some quite scientific and reliable and some a bit less so. However, the strength of the site is the large number of photos of various species of snake. In addition, the site houses some interesting statistical information including the venom chart, which lists various venomous species and the dose of venom their bites may yield and the lethal amount of venom for each species.

    Conferences Listed on

    Listings of meetings in emergency medicine and related fields are now listed on Emergency Medicine News' web site, To view the listings, click on Events.

    To list a meeting in Emergency Medicine News and on the web site, send the name of the meeting, date, location, sponsor, and contact information, including a phone number to: Emergency Medicine News, 345 Hudson St., 16th Fl., New York, NY 10014; (201)358–8596 (fax); [email protected].

    Position Statements Available on the American Academy of Clinical Toxicology Web Site

    • ▪ Ipecac syrup
    • ▪ Single-dose activated charcoal
    • ▪ Cathartics
    • ▪ Whole bowel irrigation
    • ▪ Gastric lavage

    Source: Michael I. Greenberg, MD, MPH, June

    © 2003 Lippincott Williams & Wilkins, Inc.