الفهرس 
GENERAL CONSIDERATIONS IN THE EVALUATION & TREATMENT OF DRUG POISONING & OVERDOSESOnly 14 pages are availabe for public view
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Abstract
Poisoning or intoxication is defined as the occurrence of harmful effects resulting from exposure to a foreign chemical or xenobiotic. Such effects may be local or systemic and objective or subjective. In the absence of signs or symptoms, external or internal body contact with a potentially harmful amount of a chemical is merely considered an exposure.
Even though they may not appear acutely ill, all poisoned patients should be treated as if they have a potentially life-threatening intoxication.
Poisoning is usually functional and reversible. Hence, if vital signs and organ function can be supported, complete recovery will occur on elimination of the offending agent. However, if normal activity of the target site is essential for cell viability, an exposure may result in necrosis. Although organ systems usually have excess or reserve functional capacity, if enough cells are affected, their function may become impaired. In addition, if the organ system is essential for life and its function cannot be artificially maintained, death may ensue.
Poisoning should always be considered in patients with metabolic abnormalities (especially acid-base disturbances), gastroenteritis, or changes in behavior or mental status of unclear etiology. Drug intoxication is a risk factor for trauma and suicide and should also be considered in all injured patients.
The principal objectives in the diagnosis and evaluation of the poisoning are recognition of an exposure or poisoning, identification of the offending agent(s), prediction of potential toxicity, and assessment of the severity of clinical effects. Treatment objectives include provision of supportive care, prevention of chemical absorption, prevention or reversal of poisoning by the use of antidotes, enhancement of chemical elimination, safe disposition, and prevention of subsequent exposures. Accurate diagnostic evaluation is a prerequisite for optimal management.
Meticulous supportive care is necessary to maintain physiologic and biochemical homeostasis and to prevent secondary complications (e.g., anoxia, aspiration, bedsores, shock-induced organ injury and sepsis) until detoxification can be accomplished by normal mechanisms or therapeutic interventions.
Effective response to increasing fatal drug overdoses requires strengthening regulatory measures to reduce unsafe use of drugs, increasing physician awareness regarding appropriate pharmacologic treatment of pain and psychiatric problems, supporting best practices for treating drug dependence, and potentially modifying prescription drugs to reduce their potential for abuse. State agencies that manage prescription-monitoring programs should use such systems to proactively identify 1) patients who abuse drugs and fill multiple prescriptions from different health-care providers and 2) providers whose prescribing practices are outside the standards of appropriate medical care. Both federal and state prevention measures should be evaluated periodically to determine their effectiveness.
Adults with accidental poisoning should be educated regarding the safe use of drugs and other chemicals. Assistance with the administration of medications may be required for visually impaired, elderly, retarded, or confused patients. Preventive education may be indicated for health care providers who have committed dosing errors or who are unaware of adverse drug interactions. When poisoning results from environmental or workplace exposure, the appropriate governmental agency should be notified. Unsafe working conditions should be brought to the attention of employers. Industrial hygiene and occupational health services should be offered if available. Finally, physicians have a duty to warn the general public (e.g., via press releases) of acute environmental hazards.