الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Severe clinical illness can occur following overdose or exposure to certain chemicals and illicit substances. Many agents produce toxidromes, which allows the physician to identify a probable poisoning syndrome and empirically determine the most appropriate management. Those toxidromes discussed include:
1. Classic opioid toxidrome
2. Sedative-hypnotic toxidrome.
3. Sympathomimetic toxidrome.
4. Anticholinergic toxidrome.
5. Cholinergic toxidrome.
Knowledge of the various routes of decontamination, emerging antidotal therapies, and opportunities for enhanced elimination allow for provision of optimal care in the critical care setting. Many cases of poisoning present diagnostic and therapeutic challenges.
In chapter 2 in this essay we focus on most common drug overdoses and toxins:
1. Acetaminophen toxicity:
Its clinical manifestations was divided into 4 stages starting with nausea, vomiting, pallor and diaphoresis reaching to hepatic encephalopathy and maybe death from multiorgan system failure in stage 3. For patients who survive stage 3 recovery occurs in stage 4. Its treatment included GI decontamination, administration of acetaminophen antidote (acetyl-cysteine) and in severe cases liver transplantation maybe needed.
2. Carbon monoxide toxicity:
In the acute stage CO toxicity manifests by headache, dizziness, pallor, nausea and also cardiovascular dysrhythmias that may lead to cadiac arrest and death in severe cases. rhabdomyolisis and renal failure may also occur. Treatment of CO posisoning is mainly supportive treatment and hypebaric oxygen therapy and isocapnic hyperpnea is useful in treatment.
3. Cardiac glycosides intoxication:
Cardiac glycosides toxicity is very common as digitalis is still used in heart failure and atrial fibrillation its diagnosis usually by ECG changes with cardiac arrhythmias. management starts with supportive measures, GI decontamination and treatment with its antidote (Digitalis fab fragments).
4. Miscellaneous central nervous system intoxicants:
Newer antidepressants drugs included the selective serotonin-norepinephrine reuptake inhibitors such as venlafaxine which toxicity manifests as minor alterations of conscious level, tachycardia, hypertension and seizures have also been reported. And it includes also norepinephrine-dopamine reuptake inhibitors such as bupropion which manifests with seizures and QT interval prolongation.
Atypical neuroleptic drugs toxicity usually manifests as loss of protective airway reflexes and lack of appropriate ventilatory support and seizures have also been reported, also cardiovascular toxicity can be seen.
Treatment consists of supportive care and securing airway and anticonvulsant treatment mainly with benzodiazipines or barbiturates.
5. Methanol and ethylene glycol intoxication:
Management starts with supportive reatment with securing airway breathing and circulation with correction of metabolic acidosis and electrolytes. Alcohol dehydrogenase inhibition with ethanol or fomepizole is also important.
6. Salicylates toxicity:
Priorities in management of salicylate toxicity is stabilization of the cardiorespiratory status, rehydration and correction of metabolic and electrolyte abnormalities. Also lavage of gastric contents and activated charcoal may reduce the toxicity. In cases of severe poisoning hemodialysis should be considered.
Also, in this essay some of the most common natural toxins were discussed regarding its diagnosis and management.