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Atlas of Human Poisoning and Envenoming, 2nd ed.

Atlas of Human Poisoning and Envenoming, 2nd ed

J. H. Diaz

CRC Press: Boca Raton, FL, US; 2015

The Atlas of Human Poisoning and Envenoming is an overview of toxicology specifically as it relates to poisoning and is divided into four sections: I. General Medical Toxicology, II. Environmental Toxicology, III. Industrial and Occupational Toxicology, and IV. Epidemiology and Statistics for Toxicology. Each section is further divided into chapters, with 36 chapters in total.

Section I, General Medical Toxicology, is divided into 16 chapters including pharmacology, general poisoning management and diagnostic workup, antidotes, nephrotoxicology, reproductive and perinatal toxicology, and neurotoxicology.

This section also covers the toxicity of various categories of drugs and chemicals including: antiseptics, drug additives, over-the-counter drugs, opioids, household products, illicit drugs, anticonvulsants, sedative-hypnotics, endocrine agents, cardiovascular drugs, antibiotics, and anticancer drugs. Chapter 1, Pharmacology, is a useful overview of xenobiotic absorption including routes of administration, rates of absorption, and factors affecting bioavailability. Distribution is discussed, including bound vs. unbound, physiochemical determinants, volume of distribution, and compartment models. Metabolism is also covered with overviews of rate, the CYP450 system, drug-drug interactions, excipients, therapeutic index, dose-response relationships, and elimination kinetics. The last couple of pages of this chapter discuss poisoning in children and the elderly. Chapter 2, General Poisoning Management, is devoted to preventing poison absorption and features topics such as emesis, lavage, activated charcoal, cathartics, and whole-bowel irrigation. Various types of elimination enhancement are also discussed. This chapter then moves on to patient assessment, including primary and secondary survey and treatment. The chapter concludes with unusual exposures, diagnostic odors of xenobiotics, and the pharmacokinetics of compartment models and elimination patterns. Chapter 3 covers the diagnostic workup of the poisoned patient and discusses laboratory testing, blood and serum concentration of some common xenobiotics, the utility of x-rays, CT scans, and ECGs, and includes some photo examples. Chapter 4, Poison Antidotes, covers toxidromes of parasympathetic and sympathetic toxins, herbal poisonings, central nervous system toxins, and metal exposure. Decontamination protocols are discussed, covering some of the material already presented in Chapter 2 with the addition of antivenom, antitoxins, antagonists, and chelation therapy. Chapter 5 begins a series of chapters on classes of xenobiotic poisonings and discusses antiseptics and drug additives. Each chapter in this series covers epidemiology, toxicology, clinical manifestations, diagnosis, treatment, and complications. Chapter 6 discusses over-the-counter drugs and opioid analgesics. Household-product poisonings are discussed in Chapter 7 and the xenobiotics are divided into alkalis, acids, disinfectants, food additives, aquarium and art products, batteries, cosmetics, hydrocarbons, alcohols, and glycols.

Chapter 8 is entitled Drug and Illicit Substance Abuse. This chapter briefly covers many different drugs and drug categories, some better than others. For example, the only date-rape drugs discussed are GHB and Rohypnol, thus perpetuating the misinformation that these two are the predominant drugs in this category. Clinical manifestations and treatment are also included. This chapter does contain a few references. Chapter 9 discusses anticonvulsants and sedative hypnotics with some of the same material covered in Chapter 8 repeated. Reproductive and perinatal toxicology and teratogenesis are discussed in Chapter 10. Pharmacokinetics, poisoning, substance abuse, and breast-feeding toxicokinetics are explained relevant to how xenobiotics may behave differently in these conditions. Hypoglycemia and other endocrine-agent toxicities are discussed in Chapter 11. Cardiovascular drug toxicity is discussed in Chapter 12, with subsections on children versus adults and lab diagnosis. In Chapter 13, antibiotic toxicity is discussed, which is a good addition as these drugs are so commonly prescribed. For some reason, mushroom poisoning is also briefly mentioned in this chapter. Anticancer drugs and human carcinogens are explored in Chapter 14. Chapter 15 covers environmental and occupational nephrotoxicology, including epidemiology and pathophysiology, with a discussion of direct and indirect renal failure as well as biomarkers of renal failure. Mushroom toxicity is discussed again along with hemlock and metals. There is also a pretest and a post-test in this chapter. Chapter 16 covers neurotoxicology including a discussion on what makes the nervous system more or less vulnerable to injury. Neuroanatomy is also discussed as well as mechanisms of action and symptomology; this chapter ends with conclusions on what types of xenobiotics damage specific areas of the brain.

Section II, Environmental Toxicology, starts with Chapter 17, Food Poisoning. Clinical manifestations and etiologic agents are discussed and there is a practice test at the end of this chapter with case examples. Chapter 18 is dedicated to seafood poisoning but also includes a discussion of freshwater inhabitants as well. Conclusions and a practice test are also included at the end of this chapter. Even though poisonous mushrooms are discussed in various chapters, Chapter 19 is devoted to mushroom poisoning. This chapter contains many photos and diagrams, which are very helpful in identifying and distinguishing poisonous versus nonpoisonous mushrooms. Herbal poisonings are discussed in Chapter 20 and are divided into plant oils and then further divided into what body system or organ is affected by the poisoning. This chapter also covers vitamin poisoning. Common poisonous garden and household plants are covered in Chapter 21. This is a very practical chapter as many people have these plants in their homes or gardens. This chapter also includes color photos of some of the plants along with the odd placement of color photos of toxic fish, starfish, mushrooms, snakes, spiders, and caterpillars. Chapters 22 through 25 describe bites or stings from various types of reptiles, including lizards, snakes, newts, toads, spiders, scorpions, bees, wasps, hornets, ants, moths, centipedes, and millipedes. Those insects that are vectors for diseases are also covered such as mosquitos, flies, midges, mites, lice, fleas, and ticks. Marine stings or bites from coral, starfish, sea urchins, jellyfish, hydroids, cone shells, octopuses, puffer fish, stingrays, bony fish, weaver fish, sea snakes, lionfish, and stonefish. Chapter 24 is devoted to tick paralysis. Chapter 26 covers poisoning that can occur through practice of Cajun, Voodoo, and Hoodoo traditions with the discussions covering some of the xenobiotics used in the practice of these traditions.

Section III, Industrial and Occupational Toxicology, opens with Chapter 27 discussing volatile organic chemicals and their clinical presentations and mechanism of toxicity. Chapter 28 is devoted to petrochemical toxicity including a discussion of the Deepwater Horizon platform explosion with a comparison to the Ixtoc oil spill. Chapter 29 covers industrial gas exposures and occupational lung disease. This chapter covers topics such as asphyxiates, pulmonary irritants, smoke inhalation, carbon monoxide, cyanide and hydrogen sulfide poisoning, and tear gas. Chapter 30 discusses metal and metalloid poisonings, covering lead in detail. No poisoning book would be complete without a discussion of rat poison. Chapter 31 covers rodenticides, insecticides, and herbicides. The chapter concludes with regulatory federal legislation regarding these substances and a chapter test. Chapter 32 covers radiation toxicology and discusses some of the major events associated with radiation and radiation poisoning; it includes a historical timeline from the discovery of x-rays to Fukushima Prefecture Japan in 2011. The science of radiation and various radiation sources are also discussed. Chapter 33 covers the topic of chemical, biological, and radiological weapons and warfare with information on definitions, history, and agents. There are also discussions of plagues, epidemics, and viruses. Chapter 34 is about workplace substance-abuse monitoring and seems out of place in this reference book. This chapter covers the MRO, chain of custody, forensic lab selection, and typical drugs, but is outdated when it comes to the latest drugs and analytical methodology. Chapter 35 is miscellaneous toxicants and includes discussions of 2-propenal, acrylamides, acrylates, anilines, azides, amines, bromides, carbon disulfide, chlorates, coal tar, dibromochloropropane, dimethylacetamide, dimethylformamide, dinitrobenzene, dinitrotoluene, epichlorohydrin, ethylene bromide, ethylene diamine, isocyanates, phthalates, fluoride compounds, and more.

Section IV, Epidemiology and Statistics for Toxicology, contains the last chapter, number 36, which covers these topics and includes discussions on probability, binomial distribution, descriptive statistics, summary analysis, variation, distribution, differential statistics, hypothesis testing, cohort and case-controlled studies, and ends with error and power.

This is a handy reference book and is written as such with brief information being relayed in the form of partial sentences and bullet points. The disappointing feature of this text is its lack of references for the reader that would like more information. The best feature of this text are the photos and diagrams used to illustrate specific points or to identify a poisonous creature or plant. This reference book may serve as a valuable addition to the libraries of many forensic science and toxicology practitioners.

Reviewed by: L. J. Marinetti, Redwood Toxicology Laboratory, Santa Rosa, CA, US
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Author:Marinetti, L.J.
Publication:Forensic Science Review
Article Type:Book review
Date:Jul 1, 2016
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