Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient PDF
Preview Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient
Jeffrey Brent Senior Editor Keith Burkhart · Paul Dargan Benjamin Hatten · Bruno Megarbane Robert Palmer · Julian White Editors Critical Care Toxicology Diagnosis and Management of the Critically Poisoned Patient Second Edition Critical Care Toxicology Jeffrey Brent Senior Editor (cid:129) Keith Burkhart Paul Dargan (cid:129) Benjamin Hatten Bruno Megarbane (cid:129) Robert Palmer Julian White Editors Critical Care Toxicology Diagnosis and Management of the Critically Poisoned Patient Second Edition With675Figuresand487Tables SeniorEditor JeffreyBrent DepartmentofMedicine DivisionofClinicalPharmacology andToxicology UniversityofColorado SchoolofMedicine Aurora,CO,USA Editors KeithBurkhart PaulDargan FDA,OfficeofNew ClinicalToxicology Drugs/ImmediateOffice StThomas’Hospital CenterforDrugEvaluation SilverSpring,MD,USA andResearch SilverSpring,MD,USA BenjaminHatten BrunoMegarbane ToxicologyAssociates MedicalToxicologicalIntensive UniversityofColorado CareUnit SchoolofMedicine LariboisiereHospital Denver,CO,USA Paris-DiderotUniversity Paris,France RobertPalmer JulianWhite ToxicologyAssociates ToxinologyDepartment UniversityofColorado Women’sandChildren’sHospital SchoolofMedicine NorthAdelaide,SA,Australia Denver,CO,USA ISBN978-3-319-17899-8 ISBN978-3-319-17900-1(eBook) ISBN978-3-319-17901-8(printandelectronicbundle) DOI10.1007/978-3-319-17900-1 LibraryofCongressControlNumber:2017930938 1stedition:#Mosby2005 #SpringerInternationalPublishingAG2017 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeor part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway, andtransmissionorinformationstorageandretrieval,electronicadaptation,computersoftware,or bysimilarordissimilarmethodologynowknownorhereafterdeveloped. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthis publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Thepublisher,theauthorsandtheeditorsaresafetoassumethattheadviceandinformationinthis bookarebelievedtobetrueandaccurateatthedateofpublication.Neitherthepublishernorthe authorsortheeditorsgiveawarranty,expressorimplied,withrespecttothematerialcontained hereinorforanyerrorsoromissionsthatmayhavebeenmade.Thepublisherremainsneutralwith regardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations. Printedonacid-freepaper ThisSpringerimprintispublishedbySpringerNature TheregisteredcompanyisSpringerInternationalPublishingAG Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland Foreword CriticalCareToxicologybelongsineverycriticalcareunit,emergencydepart- ment,poisoncenter,library,emergencyresponsecenter,andonthemosteasily reachedshelfforanyoneinterestedinorwhocomesincontactwithmedical toxicology. This masterful compilation of information has many attributes, amongwhichare: (cid:129) Evidencebasedwell-referencedinformation (cid:129) Editorsandauthorswhoareexpertsintheirfields (cid:129) Conciseandclearpresentation (cid:129) Tablesthatconveycriticaldata (cid:129) Figuresanddiagramsthatareclinicallyrelevant (cid:129) Paragraphheadersthatallowfocusedaccesstoinformation (cid:129) Calculationsandformulasthatarefullyexplained (cid:129) Listsoftreatmentmaterialstoobtaininadvancewithcontactinformationof unusualitems (cid:129) Therapeutic dosages that are detailed enough to be utilized without addi- tionalreferences Inmostcases,diagnosticandtherapeuticinformationcanbeobtainedina few minutes given the book’s careful organization. For those patients pre- senting with complicated or multiple exposures, the structure provides a straightforward method of rapidly developing and working through a differ- entialdiagnosis. The quality of this book should come as no surprise after looking at the impressivelistingofauthors.Theeditors,eachofwhomIhaveknown,worked with, and respected for many years, have selected an international group of expertswhosecredibilityisunmatched.Theyrepresentthebestofourprofes- sion of medical toxicology and have written a large percentage of the most important and groundbreaking publications in our field. The editors and authorsarethemostsought-aftereducatorsinourannualtoxicologymeetings around the world and provide clinical expertise as well as leadership and trainingforallofuswhoworkinthiswideandvariedarea. In the preface to the first edition of Critical Care Toxicology, the word “passion”occursintheveryfirstsentence.Forallofuswhohaveeverwrittena scientificmonograph,paper,chapter,book,orpreparedateachingsession,the wordpassioncertainlydefinesamajorrequirementforpreparationofmaterials v vi Foreword thatwillcommunicatetheknowledgethatisintended.Ittakestimeandeffort to write something that will stand the test of time, and when written with passionitmeansthattheauthorhasnotskippedoveranythingandleftnothing ofimportanceunaddressed.Itrequiresthoroughknowledgeofthesubject,real world experience, fully researched literature, and draft after draft until com- municationisassured.Whenreadingthisbook,itisapparentthattheeditors andauthorshaveachievedtheirgoal. Beforewritingthisforeword,theeditorsprovidedmewithsomechapters fromthesecondedition.Inreviewingfourofthem–“Acid-base,”“Hypoten- sionandShock,”“Seizures,”and“AcuteRespiratoryDistressSyndrome”–it wasreadilyapparentthatthissecondeditionisanimprovementonanalready excellent book. More current materials are included as expected, but using thesechaptersasexamplestheauthorshavedramaticallyimprovedthisbook. Acid-baseinthecriticalcaresettingisacomplicatedandoftendifficultissue. To address that the authors have doubled the length of this chapter and substantially added information which will be valuable to all who utilize it. The chapters on hypotension and shock and acute respiratory distress syn- drome have been broken out of their previous locations and addressed com- prehensivelytoreflecttheirimportance.Thechapteronseizureshasalsobeen doubledinlengthandcontainsaconsiderableamountofnewinformationthat isclearlypresented. Theauthorshavealsoaddedspeedofaccesstothisbookthroughtheuseof atableofcontentsatthebeginningofeachchapter.Thisfurtherenhancesthe abilityofthereadertogettoananswerunderemergentcircumstances. Thebookalsohasanotherpurposethanjustprovidingcriticalinformation inaclinicalsetting.Itprovidesaveryreadableandunderstandableeducational experience for all those who are studying this area. This must include addressing controversial areas with which the reader may be familiar and if notfamiliaroughttobefamiliar,andthisbookengagesallofthis. Eventhoseofuswhohavebeeninthisfieldforalongtimestandtolearn somethingfromthisbook.Thediscussionofthestronganiongapintheacid- basechaptercoupledwiththeverypracticalexplanationsoftheotherfactorsin thisimportantareaistheclearestIhaveeverread.AnareainwhichIhavelittle knowledgeismalignanthyperthermia,andthischapterprovidesaclearexpla- nationalongwithevenaphonenumberandwebsitetogetadditionalupdated informationinwhatisapparentlyarapidlyevolvingissue.Theeditorsclearly wantreaderstogettherightanswerstotheirquestions. CriticalCareToxicologycoversalloftheareasinmedicaltoxicologyina seriesofwell-writtenchaptersfollowingtheexcellentchaptersthatprovidean approach to the critically poisoned patient and an understanding of toxic syndromes. Images of various aspects of toxicological encounters provide visualreinforcementofthewrittenmaterials. Theindexisverywelldoneandcomprehensive.Unlikethe7theditionin 1959ofNelson’spediatrictextwheretheeditor’sdaughter,whohatedhaving to produce the index, entered under B “Birds, for the” and listed the entire book, the index of Critical Care Toxicology was obviously prepared by someonewhohadapassionforhelpingreadersgettoanswers. Foreword vii Critical Care Toxicology provides a very valuable contribution to all aspects of medical toxicology from education to, as the title states, critical care.Itshouldbereadilyaccessibletoeveryonewhomayfacethisissuefrom formingadifferentialdiagnosistorenderingcare. RockyMountainPoisonandDrugCenter BarryH.Rumack Denver,Colorado DirectorEmeritus USA Preface to the Second Edition ThosereaderswhoarefamiliarwiththefirsteditionofCriticalCareToxicol- ogy(CCT)knowthatitwasaboutpassion–ourcollectivepassionforcaring forpatientswiththegroupoffascinatingphysiologicalderangementscaused byexogenouschemicalexposures.Whileourpassionforthefieldofclinical toxicology remains unabated, an additional theme that characterizes the sec- ondeditionofCriticalCareToxicologyisscientificevidence. Inthe10yearssincethepublicationofthefirstedition,aconsiderablebody ofnewscientificevidencehasemerged,newantidoteshavebecomeavailable, andsystematicreviewsandmeta-analyseshavebecomemorecommonplacein the field of clinical toxicology. Seizing upon the opportunity to provide a compendiumofthisaccumulatedevidence-basedknowledge,wehaveworked with our chapter authors to assure that they have stayed true to the existing bodyofempiricaldataand,inthemanyplaces,wheredatagapsexistidentify themsothattheuserofthisbookwillunderstandthebasisforthetreatment recommendationsweprovide.InorderfortheuserofCCTtoquicklydiscern the veracity of the evidence supporting the treatment recommendations pro- vided, we have adopted the US Public Health Service’s rating of scientific evidence. These gradings allow the reader to instantly know the level of scientificsupportforvarioustreatmentrecommendationsandthustobeable torelymostheavilyonwell-supportedtherapeuticmodalities. Wearehighlycognizantoftherealitythattherearemanyareaswherethe evidencebaserelatingtotreatmentdecisionsisinsufficient.Nevertheless,the cliniciantreatingthecriticallypoisonedpatientstillrequiresguidance.Given that so many of our chapter authors represent the world’s authority on their topic, we have also strongly encouraged them to give their highly informed opinionsonhowtoproceedinthemanyareaswherethereareclearknowledge gaps. Where they have supplied these opinions they have been identified as such,andwehaveworkedwiththemtoalsoexplaintheirthoughtprocesses underlyingtheseopinions. Weareveryproudofthegroupofchapterauthorsthathavebeenbrought together in CCT. Where possible we have endeavored to recruit a group of international experts in their respective subject matter who are also experi- enced clinicians, proficient in the intensive care of patients poisoned by the toxins and toxicants they have addressed. This quest for such a uniquely qualified group of chapter authors has required us to seek out scholars from manyareasoftheworld.Beingsuchhighlyrespectedindividuals,ourchapter ix x PrefacetotheSecondEdition authorsareforthemostpartverybusywiththeirvariousacademicandclinical pursuits.Wearegreatlyindebtedtothemforthegenerousdonationofthetime theygaveustonotonlyproducetheirexcellentchaptersbutalsotoputupwith our compulsively detailed editing and challenges to them for justification of theinformationcontainedintheirchapters.Inmostinstances,theyhavedone sobecausetheywerededicatedtotheideaofworkingwithustoachievethe goalsenumeratedabove. CriticalCareToxicologyisnotastatictextbookinthetraditionalsense.The onlineversionisalivingdynamicdocumentthatcan,andwill,beupdatedas needed and new chapters will be provided beyond the date of the original publicationofthecurrentedition.Inthisway,wewillfeelconfidentthatyou, thereaderofCCT,willhavethemostup-to-dateinformationavailabletoyou inyourcareofyourcriticallypoisonedpatients. JeffreyBrent KeithBurkhart PaulDargan BenjaminHatten BrunoMegarbane RobertPalmer JulianWhite Preface to the First Edition Tous,thisbookisaboutpassion.Itistheresultofthepassionweshareforthe clinicalchallengeswefaceeverydayincaringforcriticallypoisonedpatients and in understanding their unique and enchanting pathophysiology and its therapeuticimplications.Thisisapassionwehopetoelicitinallwhoventure into the world of clinical toxicology as they read this book. To the medical toxicologist, the care of the seriously poisoned patients merges the diverse worlds of critical care, emergency medicine, pharmacology, altered drug pharmacokinetics (hence the term “toxicokinetics”), diagnostic challenges, multisystem involvement in often otherwise healthy patients, and the use of specificandoftenesoterictreatmentstrategiesandantidotes. Beforeembarkingontheextraordinarilylabor-intensiveactivityofgener- ating a book of this depth and complexity, we queried the importance of producing another clinical toxicology textbook. We are aware of several excellent general clinical toxicology textbooks on the market and appreciate theirattemptstoachieveafargreaterbreadththanthepresentwork.However, toxicology is such a broad field that general textbooks encompassing all of clinical toxicology necessarily must limit the extent of their coverage of the intensivecareunitmanagementofmajorpoisonings.Thus,theintensivist,and critically poisoned patients, deserve a reference that specifically addresses their needs. This needismade allthe more importantbythe life-threatening natureofmanyofthesepoisonings.Starkevidenceofthecomplexityofjust theseissuesisthattocoverthemadequatelyrequired160chaptersand1633 pages. Our goal was to have the most knowledgeable and experienced medical toxicologistsauthorrelevantchapters.Inordertoachievethisgoalwedrafted ourcolleagueswithuniqueexperienceandexpertiseworldwide.Aswitnessed byourcontributor list,all continents,except Antarctica, arerepresented. We proudly boast that our collective chapter authors represent a significant pro- portionofthemostexperiencedcriticalcaretoxicologistsintheworld.Med- icaltoxicologistsinterestedinacutecaretendtobedomiciledatthebedside,in poisoncenters,orboth.Becauseofthehighlyclinicalnatureofthisbook,we selectedauthorswithapredominantlybedsidecareorientation. WiththereadyaccesstofactsanddataviatheInternet,theverynatureof hardcopybookshaschangeddramatically.Nolongerisitnecessaryforbooks to be compendia of facts. However, electronic databases cannot convey the reasoned clinical approaches and the synthesis of pathophysiology with xi
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