As an ongoing project we will be posting targeted case-based question-&-answer postings designed to highlight important principles, pitfalls, and ‘tricks of the trade’ for the clinical assessment and management of poisoned and envenomed patients.
The problems are based on cases seen in hospitals in Australia, calls to the Poison Information Centre, as well as a variety of other sources including published books and papers, presentations and toxicology meetings.
We hope they will be useful to non-specialists – who may have to see patients in EDs, ICUs and/or remote settings without the benefit of an “on site” toxicology service – as well as the “budding” clinical toxicologist.
Toxicology Conundrums
| 001 | 002 | 003 | 004 | 005 | 006 | 007 | 008 | 009 | 010 |
| 011 | 012 | 013 | 014 | 015 | 016 | 017 | 018 | 019 | 020 |
| 021 | 022 | 023 | 024 | 025 | 026 | 027 | 028 | 029 | 030 |
| 031 | 032 | 033 | 034 | 035 | 036 | 037 | 038 | 039 | 040 |
Toxicology Cases By Diagnosis
| Acute dystonic reaction | 030 |
| Antidepressant, citalopram | 017 |
| Antidepressant, tricyclic | 022 |
| Buprenorphine (suboxone) | 006 |
| Chloral hydrate | 020 |
| Fish, Lionfish | 013 |
| Fish, Stingray | 012 |
| Jellyfish, Box (Chironex fleckeri) | 010 |
| Jellyfish, Irukandji syndrome | 008 — 009 |
| Mercury, elemental | 002 |
| Octopus, Blue-ringed | 011 |
| Paracetamol (RSI) | 001 |
| QT prolongation | 017 |
| Seizures, toxic | 023 |
| Serotonin toxicity | 024 |
| Snake, unknown | 005 |
| Snake bite envenoming challenge | 026 |
| ‘Sniff a poison’ challenge | 027 |
| Spider, necrotizing arachnidism | 018 |
| Spider, Redback | 003 — 004 |
| Spider, White-tailed | 018 |
| Strychnine | 007 |
| Theophylline | 014 |
| Thyroxine | 019 |
| Toxidrome challenge | 025 |
| Two pills can kill a toddler | 029 |
| Warfarin | 015 — 016 — 021 |
| Verapamil | 028 |
The approach used is based on the “The Toxicology Handbook” (by Lindsay Murray, Frank Daly, Mark Little, and Mike Cadogan) – with links to other references where appropriate. Remember if you require urgent assistance with poisoning or envenoming – contact the Australia Poisons Information Service [PIC].
"I need help... Someone's stolen my Tox Handbook!"
nice pic for toxicology