Atlas of Human Poisoning and Envenoming, Second Edition

920 Pages·2014·32.175 MB·English

by  Diaz, James H.

Second Edition

Atlas of
HUMAN
POISONING
and
ENVENOMING

Second Edition

Atlas of
HUMAN
POISONING
and
ENVENOMING
James H. Diaz
LSUHSC
School of Public Health
New Orleans, Louisiana, USA

Boca Raton London New York
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Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Section i General Medical toxicology
Chapter 1 The Pharmacology of Human Poisoning and Envenoming . . . . . . . . . . . . . . . . . . 3
Chapter 2 General Poisoning Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Chapter 3 Diagnostic Work-Up of the Poisoned Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Chapter 4 Poison Antidotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Chapter 5 Toxicity of Antiseptics and Drug Additives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Chapter 6 Poisonings with Over-the-Counter and Opioid Analgesics . . . . . . . . . . . . . . . . . 89
Chapter 7 Household Product Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
Chapter 8 Drug and Illicit Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Chapter 9 Anticonvulsants and Sedative-Hypnotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
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Chapter 10 Reproductive and Perinatal Toxicology and Teratogenesis . . . . . . . . . . . . . . . 217
Chapter 11 Hypoglycemic and Other Endocrine Agent Toxicity . . . . . . . . . . . . . . . . . . . . 233
Chapter 12 Cardiovascular Drug Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Chapter 13 Antibiotic Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Chapter 14 Anticancer Drug Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Chapter 15 Environmental and Occupational Nephrotoxicology . . . . . . . . . . . . . . . . . . . .281
Chapter 16 Neurotoxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Section ii environmental toxicology
Chapter 17 Food Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .359
Chapter 18 Seafood Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Chapter 19 Mushroom Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395

Chapter 20 Herbal Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Chapter 21 Common Poisonous Household and Garden Plants . . . . . . . . . . . . . . . . . . . . . 443
Chapter 22 Bites and Stings: Terrestrial Envenomings . . . . . . . . . . . . . . . . . . . . . . . . . . . .477
Chapter 23 Common Arthropod Vectors of Infectious Diseases . . . . . . . . . . . . . . . . . . . .525
Chapter 24 Tick Paralysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .557
Contents vii
Chapter 25 Bites and Stings: Marine Envenomings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569
Chapter 26 Voodoo, Hoodoo, and Cajun Traditions and Poisonings . . . . . . . . . . . . . . . . . 583
Section iii industrial and occupational toxicology
Chapter 27 Volatile Organic Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
Chapter 28 Petrochemical Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .629
Chapter 29 Industrial Gas Exposures and Occupational Lung Diseases . . . . . . . . . . . . . . 645
Chapter 30 Metal and Metalloid Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .673
Chapter 31 Pesticide Poisonings: Insecticides, Rodenticides, and Herbicides . . . . . . . . . . 707
Chapter 32 Radiation Toxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727
Chapter 33 Chemical, Biological, and Radiological Weapons and Warfare . . . . . . . . . . . . 747
Chapter 34 Workplace Substance Abuse Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . .769

Chapter 35 Miscellaneous Toxicants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 813
Section iV epidemiology and Statistics for toxicology
Chapter 36 Epidemiology and Statistics for Toxicology . . . . . . . . . . . . . . . . . . . . . . . . . . .843
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855

Preface
Since the first edition of this atlas was published in 2006, there have been many changes
in the manner in which clinicians are examined for clinical competencies during their
residencies, certified in their primary and secondary fields after completing training, and peri-
odically recertified in all areas of their expertise . Some significant changes include annual com-
puter-based examinations with passing scores required for residents to progress to advanced
levels; computer-based national board certification examinations administered near the end of
residency training and later after fellowships or periods of active practice; and computer-based
national recertification examinations every 10 years . Today, most provider organizations, hos-
pital staffs, and health insurance companies require proof of recertification by examination for
their medical providers to maintain hospital practice privileges and to qualify for reimburse-
ments of services .
All these required examinations share similarly structured test questions that are now rede-
signed to assess clinical acumen and judgment rather than rote recall . Frequently, the test ques-
tions will begin with an image of a patient, a radiograph or electrocardiogram, a lesion or
wound, or a venomous animal or plant . Following a short vignette of the clinical encounter,
typically a mini-history and physical examination, the examinee will face a series of multiple-
choice questions based on the image and its vignette . Since the images are rarely analyzed or
interpreted, examinees must quickly identify the images and any potential adverse outcomes
and proceed to answer a series of questions that follow . Initial mistakes in analyzing and inter-
preting images and any associations with their accompanying vignettes will result in not one,
but several, incorrect answers, in a required test–subject category .
The second edition of the Atlas of Human Poisoning and Envenoming will continue to serve
as a visual and written reminder of the ubiquitous sources of toxins and toxoids in the environ-
ment and the outcomes of accidental and intentional toxic exposures in humans . The atlas has
been redesigned as a ready resource with bulleted text, tables, and figure legends that resemble
the vignettes that accompany national examination images to better prepare practitioners from
several fields for image-intense, computer-based examinations in their respective fields . The
atlas will be a useful study guide for emergency physicians, emergency medical service first
responders, poison control center professionals, military physicians, family practitioners, physi-
cian assistants, preventive medicine and veterinary medicine practitioners, public health offi-
cers, occupational medicine specialists, pediatricians, and health science and medical students
preparing for a professional lifetime of image-intense national examinations .
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x Atlas of Human Poisoning and Envenoming
Several new chapters have been added to the second edition, including chapters on the
prescription and illicit drug abuse epidemics, environmental and occupational nephrotoxicol-
ogy and neurotoxicology, tick paralysis, and petrochemical toxicants . The atlas will conclude
chapters on biological, chemical, and radiological warfare agents; workplace substance abuse
screening and monitoring; and epidemiological design and statistical analysis of toxicological
investigations .