Pharmacology & Toxicology
Toxicology
Managing patients with drug poisoning in intensive care, whether from pharmaceutical or recreational substances, requires a systematic approach. Effective management begins with a thorough assessment of severity and targeted diagnostic strategies. Clinical judgment is paramount, guiding the use of antidotes and supportive care tailored to each patient's needs.
Decontamination methods, such as gastric lavage and activated charcoal, are used judiciously, while hemodialysis and intravenous lipid emulsion (ILE) are considered for specific toxins. The EXTRIP Workgroup provides specialized guidance on extracorporeal purification, further enhancing treatment options. This comprehensive approach ensures rapid diagnosis and effective treatment, crucial for improving outcomes in critically ill patients.
Approach to the intoxicated patient
Pharmaceutical poisoning management
Critical care management of the patient with pharmaceutical poisoning
C. Hüser et al., Intensive Care Medicine (2025)
What’s inside
This review provides a structured, evidence-based approach to managing pharmaceutical poisoning in the ICU, emphasizing early resuscitation, toxicant identification, and targeted interventions. It covers the ABCDE approach to stabilization, diagnostic strategies, gastrointestinal decontamination, extracorporeal elimination, antidote therapy, and rescue strategies like intravenous lipid emulsion and ECMO.
Why it’s relevant
Pharmaceutical poisonings account for up to 10% of ICU admissions and require a balance of supportive care and toxicant-specific interventions. Clinicians must be prepared to rapidly stabilize vital functions, identify the causative agent, and escalate care as needed. This review equips intensivists with practical tools to optimize outcomes in this complex patient population.
Key focus
- ABCDE approach to initial resuscitation and stabilization
- Diagnostic workup: history, toxidromes, ECG, lab testing, imaging
- Gastrointestinal decontamination and enhanced toxicant elimination
- Antidote therapy: sodium bicarbonate, HIET, glucagon, and others
- Rescue strategies: intravenous lipid emulsion and ECMO indications
Drug poisoning
Management of pharmaceutical and recreational drug poisoning
Bruno Mégarbane et al., Annals of Intensive Care (2020)
What’s inside
This article provides comprehensive guidelines for managing drug poisoning in critically ill patients, focusing on both pharmaceutical and recreational drugs. It addresses the challenges and strategies for diagnosis, treatment, and supportive care in the ICU setting.
Why it’s relevant
Drug poisoning is a significant cause of morbidity and mortality, requiring specialized management in the ICU. Understanding the latest guidelines is crucial for healthcare professionals to effectively manage these cases and improve patient outcomes.
Key focus
- Severity Assessment and Triage: Emphasizes the importance of clinical judgment over specific scores for assessing severity.
- Diagnostic Approach: Recommends targeted toxicological analyses rather than routine screening.
- Supportive Care: Highlights the role of antidotes like naloxone and N-acetylcysteine in managing specific poisonings.
- Decontamination and Elimination: Discusses the limited role of gastric lavage and activated charcoal, and the use of hemodialysis for certain toxins.
- Recreational Drug Poisoning: Focuses on supportive care and the cautious use of antidotes.
- Cardiotoxicant Poisoning: Provides recommendations for managing poisoning with cardiotoxic effects, including the use of intravenous lipid emulsion (ILE) for specific cases.
Takeaway
The article underscores the importance of a systematic and tailored approach to managing drug poisoning in the ICU, with a focus on rapid diagnosis, appropriate use of antidotes, and supportive care to improve patient outcomes.
Extracorporeal purification
For guidance on the use of extracorporeal purification have a look here.