The field of clinical toxicology has grown dramatically over the last few decades. Along with that growth have come numerous publications pertaining to this field. Part one of this book addresses the basic toxicologic principles and provides a brief overview of basic toxicologic definitions, regulatory bodies, and toxicokinetics. Parts two and three of this book provide overviews of the toxicities of therapeutic and nontherapeutic agents, respectively.
I commend the author for the inclusion of a diverse group of nontherapeutic agents. The current clinical toxicology books available on the market tend to focus on the therapeutic agents, with nontherapeutic agents briefly added. This book addresses many unique nontherapeutic agents that may be encountered by the clinician. The format is concise and clear so that information can be gleaned rapidly by those perusing this book. The charts found within this book add greatly and also allow quick review of information.
The greatest weakness of this book, ironically, is in its discussion of clinical management. Each specific toxin mentioned has an associated well-written, concise review of its pharmacology and mechanism of toxicity, but the discussion pertaining to the clinical management of specific toxicities is often too brief, and at times too antiquated, to be useful clinically in the management of patients manifesting signs of toxicity. For example, the chapter on calcium channel blockers glosses over only a few of the recommended therapies. Other therapies available to the clinician for the treatment of calcium channel blocker overdose, such as sodium bicarbonate and insulin, are not mentioned and yet are important to consider in the treatment of these poisonings. In another example, the author advocates that syrup of ipecac “should be part of all household medicine cabinets”. The majority of clinical toxicologists over the past decade have actually withdrawn their support of syrup of ipecac in the management of poisonings. In 2003, the American Academy of Pediatrics issued a statement that “ipecac should no longer be used routinely as a home treatment strategy, that existing ipecac in the home should be disposed of safely.” (Pediatrics 2003;112:1182–5). For clinicians using this book for the management of patients manifesting signs of toxicity, the limited scope of the clinical management sections could lead to incomplete therapy.
- © 2005 The American Association for Clinical Chemistry
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