552	O. Singh and P. Nasa

Step 8: Enhanced elimination

•Alkalinization of urine may help in excretion of drug in the urine in poisonings such as salicylates, phenobarbital, and chlorpropamide.

•Dialysis and charcoal hemoperfusion should be considered in severe poisoning if the toxin can be removed by dialysis (Table 68.3).

Step 9: Use antidotes to common poisons

•Antidotes should be used early in the course in which the effects of poisoning can be counteracted (Table 68.4).

Suggested Reading

1.Holstege CP, Dobmeier SG, Bechtel LK. Critical care toxicology. Emerg Med Clin North Am. 2008;26(3):715–39.

This article reviews the general approach and management of the critically poisoned patient and also specific toxin class and its complications.

2.Linden CH. General considerations in the evaluation and treatment of poisoning. In: Irwin RS, Cerra FB, Rippe JM, editors. Intensive Care Medicine. New York: Lippincott Williams & Wilkins; 2008.

The book discusses the principles in the evaluation and management of general poisoning and specific poisoning.

3.Brent J, Wallace KL, Burkhart KK, editors, et al. Critical care toxicology: diagnosis and management of the critically poisoned patient. Philadelphia: Elsevier Mosby; 2005.

This is the first major critical care toxicology resource that details patient care from hospital admission and treatment all the way through stabilization, monitoring, and discharge.

4.Mokhlesi B, Leiken JB, Murray P, Corbridge TC. Adult toxicology in critical care. Chest. 2003;123:577–92.

This review describes the management of poisoning as well as the recommended guidelines.

5.Giannini AJ. An approach to drug abuse, intoxication and withdrawal. Am Fam Physician. 2000;61:2763–74.

The review discusses the symptomatic effects of drug abuse that are a result of alterations in the functioning of the various neurotransmitters or their receptors such as acetylcholine, dopamine, gamma-aminobutyric acid, norepinephrine, opioids, and serotonin.