Most poisonings are due to deliberate self harm. The agents ingested vary with locality. In Europe analgesics, antidepressants, benzodiazepines, cardiovascular drugs and drugs of abuse predominate. In developing countries pesticides and natural toxins feature more, and venomous snake bites are a daily fact of life.Study of poisons management has tended to lag behind other areas of therapeutics, with few formal clinical trials. Most data is from cohort studies on effects in overdose. These allow an understanding of the relative toxicity of drugs in overdose and have stimulated basic scientific studies on mechanisms. Important new scientific studies are coming from South East Asia where poisoning mortality is high due to the toxicity of ingested agents. A core strategy linking basic science and clinical care is now developed in specialized units across the world. The concentration of patients within specialized clinical units has facilitated this work. A definitive demonstration of improved treatment is reduced morbidity and mortality, but few studies have been designed to show this. Most rely on surrogate end points. The key target has been to better identify patients at risk and target them for earlier active intervention or clinical study. Studies in patients with poisoning also have the potential to widen knowledge of the clinical pharmacology of a drug.
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