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Medical toxicology: a synopsis and study guide
  1. P Burdett-Smith

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    S Schonwald. (Pp 893; $89). Lippincott Williams and Wilkins, 2001. ISBN 0-7817-2613-1.

    This book has everything, which is the main problem.

    Its opening statement, that there an estimated 4–5 million cases of poisoning per annum in the USA sounds dramatic, but this is immediately qualified by the admission that 75% are treated at home (North American mums seemingly use ipecac syrup frequently), and that less than half of cases attending hospital require admission. In attempting therefore to cover every possible toxic compound available in American society, the book presents a smorgasbord of information, but at 862 pages of 9 point text with only two diagrams (the nomograms for paracetamol and aspirin serum levels), this is pretty indigestible stuff.

    I did immediately warm to the layout of the book. Divided into “Principles”, “Drugs”, “The home”, “Chemical products”, and “Natural toxins”, each entry is well presented in bite sized pieces with the same subheadings; introduction, pathophysiology, pharmacokinetics, etc. Unfortunately, this was marred, for me, by the multiple choice questions in a shaded box that followed each section. These provided the first irritation as I am used to shaded boxes containing summaries of the text and kept referring to them first. Combining these questions at the end of each chapter would have condensed the text and prevented them interrupting the flow.

    The entrée (principles of medical toxicology) serves up a good, if somewhat simplistic summary of the basic approach to the poisoned patient, gut decontamination, antidotes, etc.

    The main body of the text, describing the drugs themselves, is divided into Analgesics, Antiinfectives, Drugs of abuse and then interestingly, Systems toxicology, for example, haematology, cardiovascular, etc and Receptor toxicology, for example, serotonin, histamine.

    Three final offerings cover “The home” including food toxicology, “Chemical products”, including chemical warfare and radiation toxicology!, and finally “Natural toxins”—that is, animal and plant including herbal medicines.

    A synopsis is defined in the Oxford Concise English Dictionary as “a brief account dispensing with needless details”. Unfortunately, many of the entries in the book are redundant. When did you last treat a case of ethchlorvynol poisoning, or someone bitten by a Gila monster?? What is needed in the emergency department is rapidly accessible, up to date management of the effects of poisoning by a particular compound. This is where computer based information such as Toxbase really comes into its own. Much of the information in this book is interesting but instantly forgettable, especially where so many toxins are presented.

    Written by the director of toxicology in the department of emergency medicine in Ayer, Massachusetts, the book tries to appeal to toxicologists and emergency physicians alike. The blurb on the back cover promises to help the reader; “Assess the problem, identify the toxin, select the appropriate treatment, improve outcomes, and review for subspecialty certification in toxicology”. I was left feeling that it only succeeds in the last of these worthy aims.

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