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Advances in the treatment of poisoning I.

I N T R O D U C T I O N Over the last three decades the number of cases of acute poisoning in England and Wales has steeply and progressively risen and currently there are 110,000 hospital admissions per annum from this cause alone. In many District General Hospitals poisoned patients account for 20% of all emergency medical admissions and a sixth of those requiring admission to an intensive care unit. Yet, relatively little is known about the pharmacokinetic and metabolic effects of many drugs or poisons taken commonly in overdose. Treatment is thus often less rationally based than it ought to be, and occasionally invasive and inappropriate therapeutic techniques are employed when attention to supportive measures would be more effective in preventing a fatal outcome. This two-part review draws attention to some recent advances in the management of acute poisoning which result from either a better understanding of the mechanisms of toxicity (theophylline, P-adrenoceptor blocking drugs, tricyclic antidepressants) or elegant developments in biotechnology (digoxin).