title: [Charcoal, cocaine and rattlesnakes: evidence-based treatment of poisoning].
abstract: BACKGROUND
  Since ancient times poisoning has been treated medicinally. Clinical toxicology, in the narrow sense of the term, developed from the foundation of specialized medical treatment units for poisoning and the formation of the first poison information centers in the second half of the twentieth century. Historically, the first poison information centers were often localized at pediatric clinics or departments of internal medicine. It became increasingly more obvious that this pooling of competences made sense.
  
  
  OBJECTIVE
  This article gives a general introduction in clinical toxicology and presents the functions and key activities of emergency poison centers.
  
  
  METHODS
  The organisation and work of a poisons centre is demonstrated on the basis of the Poisons Information Center (GIZ) North annual report for 2011. In a short summary the basic principles of clinical toxicology are elucidated: the primary removal of poisons by gastric lavage and administration of activated charcoal, secondary removal of poisons by enhanced elimination using hemodialysis, hemoperfusion, multi-dose activated charcoal and molecular adsorbent recirculating systems (MARS) and the indications for administration of specific antidotes or antivenins (antisera against poisoning by poisonous animals).
  
  
  RESULTS
  Gastric lavage is indicated within 1 h after ingestion of a potentially life-threatening dose of a poison. In cases of poisoning with substances which penetrate the central nervous system (CNS) gastric lavage should be performed only after endotracheal intubation due to the risk of aspiration. The basic management of poisoned patients by emergency medicine personnel out of hospital and on the way to hospital is presented. The Bremen list, a compilation of the five antidotes, atropine, 4-dimethylaminophenol (4-DMAP), tolonium chloride, naloxone and activated charcoal for out of hospital treatment by emergency doctors is presented.
  
  
  CONCLUSIONS
  In all, even questionable cases of poisoning consultation at emergency poison centers is recommended. An extensive list of all German speaking poison information centers is available on the homepage of GIZ-Nord (http://www.giz-nord.de).
authors.affiliation: GIZ-Nord (Giftinformationszentrum-Nord der Länder Bremen, Hamburg, Niedersachsen und Schleswig-Holstein), Zentrum Pharmakologie und Toxikologie , Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland, aschaper@giz-nord.de.
authors.forename: A
authors.initials: A
authors.lastname: Schaper
mesh_terms: D000818:Animals; D000931:Antidotes / Q000627:therapeutic use*; D002606:Charcoal / Q000627:therapeutic use*; D003042:Cocaine / Q000506:poisoning*; D017839:Crotalus; D004635:Emergency Medicine; D019317:Evidence-Based Medicine; D005858:Germany; D006464:Hemoperfusion; D006801:Humans; D007106:Immune Sera; D007253:Information Centers / Q000458:organization & administration*; D007442:Intubation, Intratracheal; D011039:Poison Control Centers / Q000458:organization & administration*; D006435:Renal Dialysis; D012909:Snake Bites / Q000628:therapy*; D012910:Snake Venoms / Q000037:antagonists & inhibitors; D007507:Therapeutic Irrigation; D014116:Toxicology
chemical_list: D000931:Antidotes; D007106:Immune Sera; D012910:Snake Venoms; D002606:Charcoal; D003042:Cocaine
references.citation: J Toxicol Clin Toxicol. 2004;42(7):933-43
references.pmid: 15641639
references.citation: Ann Emerg Med. 2005 Sep;46(3):263-71
references.pmid: 16126138
references.citation: J Toxicol Clin Toxicol. 2004;42(1):1-26
references.pmid: 15083932
references.citation: J Toxicol Clin Toxicol. 1997;35(7):721-41
references.pmid: 9482427
references.citation: Clin Toxicol (Phila). 2005;43(2):61-87
references.pmid: 15822758
references.citation: Pediatr Emerg Care. 2000 Feb;16(1):26-7
references.pmid: 10698139
references.citation: J Toxicol Clin Toxicol. 2004;42(2):133-43
references.pmid: 15214617
references.citation: J Toxicol Clin Toxicol. 1997;35(7):711-9
references.pmid: 9482426
references.citation: J Toxicol Clin Toxicol. 1999;37(6):731-51
references.pmid: 10584586