Clinical Toxicology: Principles & Mechanisms

Abstract

What is clinical toxicology? Frank Barile begins with the traditional definition—the discipline within toxicology concerned with the toxic effect of agents whose intent is to treat, ameliorate, modify, or prevent disease states, or the effect of drugs which, at one time, were intended to be used as such. But he expands it to include agents used with non-therapeutic intent—for example, alcohol and drugs of misuse and chemical byproducts of industrial development. This liberal definition is appropriate in a book that not only explores mechanisms of action but also goes into clinical findings and management. The contents are divided into three parts. Part I offers a fascinating read for the non-toxicologist, clearly laying out and defining the principles of toxicology. A slight drawback for Europeans is the North American orientation (in terms of regulation) but no matter—the information is all there. Professionals in primary care would be well-advised to read the chapters on the classification of toxins and the effects of these agents in man (persisting disagreements about certain classifications have little relevance to the practising clinician). Parts II and III respectively explore the toxicity of therapeutic and non-therapeutic agents. For the former a typical chapter offers historical background, the clinical role, the metabolism, the mechanisms of toxicity, the signs and symptoms of toxicity and the clinical management of acute overdose. The extent of each section varies from agent to agent but each provides enough information, or sources of further information, to allow appropriate management. My criticisms? Barile is not a clinician (his background is pharmacy, pharmacology and toxicology) and other ‘contributors’ are predominantly from his own department. Sometimes the book does not indicate the source of input on clinical management and I think this should be flagged more clearly. The book contains the now almost obligatory section on terrorism by radiation, toxins or biological agents; it does not disappoint but I did get the impression, from the lack of hard data, that these chapters were tagged on as afterthoughts. Finally, the production: my reservations apply, I am afraid, to many books from CRC Press. The layout is unadventurous, with paragraph numbering that drives me mad. No colour images are included (and few even in black and white)—a particular shame in relation to physical signs which, once seen, would be instantly recognized in the clinical setting. Nevertheless, I recommend this work as a source of reference for anyone working in primary care or emergency medicine.