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Troublesome toxins
  1. A Parfitt,
  2. J A Henry
  1. Academic Department of Accident and Emergency Medicine, Imperial College School of Medicine, St Mary's Hospital, London W2 1NY, UK

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    The treatment of patients with acute poisoning admitted to the emergency department is discussed

    Acute poisoning now accounts for about 3%–5% of emergency department attendances in most countries with developed medical services.1,2 Each patient presents a challenge to the skills of the doctor, who has to deal not only with the toxic effects of the poison but also with the mental state of the patient, anxious parents, friends or relatives. Because of this, many doctors find the poisoned patient more difficult to deal with than a “straightforward” medical or surgical case. Here we consider a few current topics in poisoning.


    Some junior doctors still think that a decision not to empty the stomach might lead to an appearance in the coroner's court. However, there is no evidence that reducing absorption of ingested toxins shortens the duration of admission to hospital or saves life.3 Syrup of ipecacuanha, although an effective emetic, does not effectively empty the stomach and should not be used. Gastric lavage also has drawbacks and may force poisons through the pylorus into the proximal small intestine.4 Consensus of expert opinion in Europe and the USA considers activated charcoal the preferred treatment …

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