Clinical toxicology encompasses the expertise in the specialties of medical toxicology, applied toxicology, and clinical poison information.
Important components of the initial clinical encounter with a poisoned patient include stabilization of the patient, clinical evaluation (history, physical, laboratory, and radiology), prevention of further poison absorption, enhancement of poison elimination, administration of antidote, and supportive care with clinical follow-up.
HISTORY OF CLINICAL TOXICOLOGY
Historical Aspects of the Treatment of Poisoning
The history of poisons and poisoners dates to ancient times. The use of toxic smoke can be traced to as early as 2000 BC in ancient India, and formulas for creating poisonous and noxious vapors have also been found from 1000 BC in Chinese writings. Documentation regarding the use of antidotes can be found in the Odyssey and Shastras from approximately 600 BC. From 129 to 200 AD, Galen wrote De Antidotis I, De Antidotis II, and De Theriaca ad Pisonem that described the development of a universal antidote known as alexipharmic or theriac by King Mithridates VI of Pontus who lived from 132 to 63 BC. The antidote reportedly contained 36 or more ingredients that were ingested every day, conferring protection against a broad spectrum of poisons, such as venomous stings and bites from vipers, spiders, and scorpions. Refinement of theriac (antidote) formulations continued for nearly 2000 years, however, William Heberden wrote Antitheriaka: An Essay on Mithridatium and Theriaca in 1745 questioning the effectiveness of these products.
The use of oral charcoal can be dated to early Greek and Roman civilization when wood charcoal was used for the treatment of maladies such as anthrax and epilepsy. By the 1960s, the use of activated charcoal became routinely recommended for the treatment of patients poisoned with substances thought to be adsorbed by charcoal.
Modern Development of Effective Antidotes for Poisoning
The search for safe and effective antidotes has been challenging. It was not until the mid-twentieth century that a scientific and systematic approach to drug development became possible and, in fact, became a requirement by newly created regulatory agencies in charge of controlling the sale and distribution of medicinal products.
The therapeutic area of poison treatments and prophylaxis presents several challenges including the inability to perform controlled human studies to evaluate efficacy, due to the small numbers of poisoned patients available for enrollment in therapeutic trials and the often-sporadic occurrence of specific poisonings. In 2002, the Food and Drug Administration (FDA) enacted the Animal Efficacy Rule, which allows FDA to approve products for serious or life-threatening conditions caused by exposure to lethal biological, chemical, radiological, or nuclear substances without human efficacy testing.
INTRODUCTION OF THE POISON CONTROL CENTER
Advances in clinical toxicology and improvements in the quality of care of the poisoned patient ...