Tox i c o l o g y 16 9

Specific Poisons

6 Enhanced elimination
Consider for specific poisonings in consultation with the ICU. Obtain addi-
tional advice from a Poisons Information Service.
(i) Multiple-dose activated charcoal (MDAC): give repeated
25–50 g charcoal every 4 h. This may be useful in severe
dapsone, carbamazepine, phenobarbitone (phenobarbital),
quinine and theophylline poisoning and possibly salicylate
poisoning.
(ii) Haemodialysis, charcoal haemoperfusion and urinary pH
modification are alternatives in certain severe poisonings.

7 Antidotes
These drugs counter the effects of the poison, but only exist for a few specific
agents.

8 Admit the patient following ED resuscitation, supportive care, decontami-
nation and antidote administration to the ED observation unit, medical
team or ICU, depending on t he clinica l severit y of poisoning.

9 All patients require psychiatric evaluation and management following their
medical care.

SPECIFIC POISONS

Obtain advice as necessary regarding toxic ingestions 24 h a day from the Poisons
Information Centre on 13 11 26 in Australia, and in New Zealand on 03 479 7248
(or 0800 764 766 within New Zealand only).

Advice in the UK is available from the National Poisons Information Service
(NPIS), comprising four individual units (Birmingham, Cardiff, Edinburgh,
Newcastle). The NPIS coordinates an internet and telephone service to assist in
the diagnosis, treatment and management of all types of poisonings.

● TOXBASE® is an online resource for the routine diagnosis, treatment and
management of patients exposed to toxic substances. Use this as the first point
of contact for poisons advice. It is available on http://www.toxbase.org/
● Specialist consultants are available for telephone advice in more complex
clinical cases. A 24-h number 0844 892 0111 will direct callers to the relevant
local centre in the UK.

Warning: gastric lavage is rarely if ever used, and induced emesis is

! positively contraindicated.