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Disposition of Toxic Drugs and Chemicals in Man, 6th Edition.

Disposition of Toxic Drugs and

Chemicals in Man, 6th Edition. Randall

Baselt. Foster City, CA: Biomedical

Publications, 2002, 1150 pp.,

$135.00. ISBN 0-9626523-5-0.

My laboratory has an older copy of this book, which I have used as a reference many times. Thus I was pleased to be able to evaluate the newest release of this book. This latest edition has been expanded significantly in both coverage and size; it provides information for 599 substances encountered in human poisonings--up considerably from the 482 compounds covered in the previous edition. Human and veterinary pharmaceuticals, illicit drugs, solvents, inhalants, insecticides, metals, natural toxins, household chemicals, homeopathic compounds, dietary supplements, anabolic steroids, and chemical warfare agents are all included.

Individual compounds are covered alphabetically in the book, with essential information summarized in two to three pages. The format is similar for all compounds. The chemical structure as well as any known information about half-life, volume of distribution, and fraction bound to protein are listed. Concise individual sections follow, describing the occurrence and usage of the drug, blood concentrations (based on dosage studies), metabolism and excretion, toxicity (side effects, concentrations in overdoses and fatalities), and analysis. A list of references is then provided.

Although information is provided about the accepted therapeutic ranges, metabolism, and clearance of many drugs, the book has an orientation toward clinical or forensic toxicology. The sections on toxicity often highlight postmortem fluid and tissue concentrations in fatal poisonings. Nonetheless, the information in this book is relevant to the clinical laboratory, as can be illustrated by two questions that I received while reviewing this book. The first was an inquiry about potential toxicity from tramadol in a patient with hepatic insufficiency. The section on tramadol described the hepatic conjugation of this drug as well as the analgesic efficacy of the metabolite O-desmethyltramadol, which provided helpful information. The second question involved a suspected Amanita phalloides poisoning. This book contains a section on amanitin, the major toxin for this class of mushroom. I was able to obtain further information about this toxin from the literature references provided.

A comparison of this book with two other toxicology texts will help readers to ascertain the place that this book may serve in their laboratories. My bookshelf also contains Fenton's The Laboratory and the Poisoned Patient ($49.00), and Ellenhorn's Medical Toxicology ($160.00). Each of these three books possesses unique attributes. Like Fenton's book, Disposition of Toxic Drugs and Chemicals in Man provides alphabetical, concise descriptions of pharmacokinetic properties, toxicity, interpretive data, and a summary of analytical methods. Fenton's book is less comprehensive, with 83 subject entries compared with Baselt's book, but the smaller number of drugs and toxins covered represent those more pertinent to a clinical laboratory. The Laboratory and the Poisoned Patient also provides coverage of related testing and is less expensive. Ellenhorn's Medical Toxicology, with its 2047 pages and numerous figures and tables, is certainly more comprehensive in its coverage. Furthermore, it also includes the principles of poison management. Ellenhorris book is divided into chapters dealing with classes of drugs and toxins, compared with the A-to-Z format followed by Baselt and Fenton. It also has a higher price.

With each new edition, Baselt continues to make improvements by adding new drugs and chemicals. It is possible to pick up the book and quickly find information about a compound of interest. Additionally, the large number of drugs and chemicals included makes it likely that the compound in which you are interested will be found. This is a book that every pathology department should consider keeping on its reference shelves.

Thomas M. Annesley

University of Michigan Medical Center

1500 East Medical Center Dr.

Ann Arbor, MI 48109-0054
COPYRIGHT 2002 American Association for Clinical Chemistry, Inc.
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Author:Annesley, Thomas M.
Publication:Clinical Chemistry
Date:Nov 1, 2002
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