23.1 INTRODUCTION

The nature of poisoning including its laboratory diagnosis and medical management has changed dramatically over the last 30 years. There is now a wider range of drugs and other substances taken in "overdose" or involved in cases of suspected abuse or "accidental" poisoning (see Table 23.1). Many of the cases in the UK admitted to hospital Accidental & Emergency Departments involve ingestion of alcohol, non-opioid analgesics, e.g. paracetamol; antidepressants, e.g. selective serotonin re-uptake inhibitors (SSRI) and tricyclic antidepressants; benzodiazepines, e.g. diazepam and illicit drugs. However, the length of hospital stay is relatively short in most cases, <24h, and mortality is very low, <1%. The majority of deaths from poisoning occur outside of hospital care and in recent years there has been a significant increase in deaths due to illicit drug use, particularly heroin. This situation is in sharp contrast to the problem in many developing countries where a far larger proportion of poisoned patients may have ingested pesticides or corrosive chemicals, or occupationally or environmentally exposed to many other hazardous substances including natural toxins.

Over recent years, there has been an increased emphasis on supportive care in the clinical management of acutely poisoned patients; also the acute...