CLINICAL TOXICOLOGY 12(3), pp. 335-356 (1978)
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Toxicology Information Resources for Poison Control Centers
JOSEPH C. VELTRI, Pharm.D.
*
Associate Director Intermountain Regional Poison Control Center Salt Lake City, Utah 84132 ANTHONY R TEMPLE, M.D. Director Intermountain Regional Poison Control Center Salt Lake City, Utah 84132
INTRODUCTION The area encompassed by the discipline “toxicologytt is indeed broad, multifaceted, and varied depending on the definition used. Within the discipline many qualifiers are used to define the a r e a s of clinical practice o r scientific study and r esearch that allow u s to focus o u r concerns within a reasonably narrow scope. Qualifiers commonly used include clinical o r medical toxicology, environmental toxicology, industrial hygiene, forensic toxicology, and analytic toxicology. Unfortunately, a considerable amount of overlap occurs among these definitions, which presents a problem in the area of poison control (clinical toxicology) and the management of emergent problems associated with acute human exposure to toxic agents. *Reprint requests to: Joseph C. Veltri, Pharm.D., 50 North Medic al Drive, Bldg. 428, Salt Lake City, Utah 84132. 335 Copyright 0 1978 by Marcel Dekker, Inc All Rights Reserved Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission i n writing from the publisher
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It is o u r experience that most c a l l s to poison control c e n t e r s deal with a toxic exposure o r poisonings where the agent o r a description of the agent is known (see p. 282, this issue). Since neither undertreatment n o r overtreatment of a poisoning is ideal, i t follows that a calm and collected attitude with the judicious u s e of drugs and approp r i a t e therapy is generally far m o r e effective than medical heroics. In many c a s e s poison c e n t e r staff are faced with determining whether the d e g r e e of exposure is sufficient to require treatment and what treatment s e e m s appropriate f o r the circumstances. As such, accur a t e a s s e s s m e n t of the severity of a n intoxication requires the capability to s e a r c h and evaluate the toxicology l i t e r a t u r e accurately and rapidly. Unfortunately, data that are both clinically significant and a c c u r a t e are not always available within a single definitive resource. In fact, the available data often require a good deal of integration and interpretation, even when the appropriate s o u r c e s are located. Therefore, we have attempted to categorize many of the available toxicology information r e s o u r c e s with respect to t h e i r relative clinical significance in dealing with clinical o r medical toxicology problems. The intent of this classification is to provide a categorization of toxicology r e s o u r c e s which s e e m s most appropriate to the needs of information providers within poison control centers. The m a t r i x f o r m a t classifies the available r e s o u r c e s both as to type and scope. The definition of the type of resource is based upon the rapidity with which data can be retrieved and the l a g time required f o r new data to be incorporated into the resource. The definition of the scope of the r e s o u r c e is based upon the direct applicability of the data when used by trained poison information providers, CLASSIFICATION SCHEME FOR INFORMATION RESOURCES T y p e of R e s o u r c e Basic Information Resources Basic information r e s o u r c e s are those r e s o u r c e s that allow rapid a c c e s s to recent data of clinical significance. They provide enough information s o that appropriate decisions regarding toxicity and severity can be made rapidly by a poison c e n t e r staffer who h a s a minimum amount of clinical experience in toxicology. However, specific training in information retrieval, integration, and a s s e s s m e n t would likely be required to u s e the data appropriately. Such a r e s o u r c e has the capability f o r rapid updating of material, hopefully in a mann e r that continually upgrades the clinical significance of i t s data.
TOXICOLOGY RESOURCES
337
Secondary Information Resources Secondary information r e s o u r c e s are those r e s o u r c e s that provide a compilation of information of a general categorical nature, synthesizing in s o m e detail clinical experience o r original a r t i c l e s to which one can then refer. These are textbooks, compendia, reviews, and review compilations.
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P r i m a r y Information Resources P r i m a r y information r e s o u r c e s a r e basically original journal a r t i c l e s o r r e p o r t s that provide c a s e studies, clinical t r i a l s , animal experiments, o r s i m i l a r original scientific data. S c o D e of I n f o r m a t i o n General Clinical Toxicology Resources General clinical toxicology r e s o u r c e s include information related to the wide range of toxic problems of significance to humans. They are not r e s t r i c t e d in scope, and one would expect to be able to find s o m e type of clinically relevant m a t e r i a l about the vast majority of common, major, o r pathophysiologically unique poisonings. These r e s o u r c e s would include ( t o varying d e g r e e s ) data o r discussions pertaining to any o r all of the following: product identification, assessment of the toxicity of a given exposure, pathophysiology of the toxic effects of an agent, common signs and symptoms of toxic exposures, emergency c a r e of the poisoned patient, and general treatment of poisonings. These r e s o u r c e s may contain animal data as well as human experiences; however, the bulk of the data pertains to the pathophysiologic effects of the substances when introduced into living organisms. Specific Clinical Toxicology Resources Specific clinical toxicology r e s o u r c e s include information of clinic a l significance to humans related to a specific o r limited area of clinical toxicology. These r e s o u r c e s are restricted in scope and may deal with a specific topic such as plant o r venom toxicity, o r they may deal with a specific organ such as o c u l a r o r renal toxicity. A s in the general clinical toxicology r e s o u r c e s (GCTR), the data included could pertain to identification, a s s e s s m e n t of pathophysiologic effects, signs and symptoms of intoxication, etc. Because of the specific nature of these r e s o u r c e s they generally present information of g r e a t e r depth than do the general clinical toxicology r e s o u r c e s , and t h e data may be animal as well as human.
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Related Toxicology Resources
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Related toxicology r e s o u r c e s include reference m a t e r i a l s dealing with toxicology but are not designed to provide acute poisoning management information. These r e s o u r c e s generally include d i s c r e t e pieces of information that may be utilized in the development of a n overall a s s e s s m e n t of poisoning, but their focus is not clinical (human). Resources whose p r i m a r y focus is analytic toxicology, veterinary toxicology, environmental toxicology, industrial toxicology, and forensic toxicology would fit in this category. Supporting Resources Supporting r e s o u r c e s may provide insight into the toxicology of various agents, but t h e i r use in the clinical toxicology setting generally r e q u i r e s a sophisticated u s e r since the focus of these r e s o u r c e s is not toxicology directly, but one of the supporting disciplines encompassed by toxicology. These would include, but a r e not limited to, texts o r a r t i c l e s about pharmacology, physiology, chemistry, biochemi s t r y , biopharmaceutics, internal medicine, pediatrics, clinical diagnosis, clinical pathology, etc. The data found within these r e s o u r c e s generally r e q u i r e s a high level of integration to apply them to a problem in clinical toxicology. Table 1 is a matrix, based on the above definitions of type and scope of toxicology information resources. Every attempt has been made to make the table as comprehensive and c u r r e n t as possible with r e s p e c t to general and specific clinical toxicology resources. However, the regional nature of s o m e r e s o u r c e s and the unavailability of o t h e r res o u r c e s make i t impossible to have a n all-inclusive table of resources. With r e g a r d to the related toxicology r e s o u r c e s and supporting res o u r c e s , only those used by the Intermountain Regional Poison Control Center w e r e included, and many r e s o u r c e s which fall in these categories may have been omitted. In any event, the table can be used as a guide to a s s i s t poison control (information) c e n t e r s in a s s u r i n g thems e l v e s that these r e s o u r c e s have been identified and a t least reviewed, since s o m e may be unnecessary o r undesirable f o r individual poison c e n t e r libraries.
Basic
General clini- National Clearinghouse for cal toxicology Poison Control Centers r es o u rces Computer Terminal, by NCPCC, Department of Health, Education, and Welfare, Food and Drug Administration, Wash., D.C. Poisondex by Micromedex, Inc., Denver, CO. A rapid acces s source of specific information. Users are provided with a notebook-size film file of microfiche car ds, with each c a r d containing over 2000 entries. Products are listed alphabetically on the cards. Once the card is inserted in the viewer, the u s e r is directed to the specific product, its ingredients, and p roper treatment, including related information concerning pharmacology, clinical ef-
Tme Accidental Poisoning i n Childhood, Edward Press. American Academy of Pediatrics. Clinical Toxicology, S. Locket, ed. The C. V. Mosby Co. Clinical Toxicology, by Clinton H. Theines and Thomas J. Haley. Lea and Febiger. Clinical Toxicology of Commercia1 Products, by M. N. Gleason, R. E. Gosselin, H. C. Hodge, and R. P. Smith. Williams & Wilkins, Balt., MD. Emergency Treatment and Care, by Thomas Flint, Jr. and Harvey D. Cain. W. B. Saunders Co. Handbook of Common Poisonings in Children, U.S. Department of Health, Education, and Welfare. HEW Publication Company. Handbook of Poisoning: Diagnosis and Treatment, by R. H.
Secondary
Scope
(Continued)
Clinical Toxicology, Marcel Dekker, Inc., New York, NY. Critical Reviews in Toxicolopy, CRC Press, Inc., Cleveland, OH. Poison Control Center Master File by the Intermountain Regional Poison Control Center, Salt Lake City, UT. Toxicology (An international journal concerned with the effects of chemicals on living systems. ) Elsevier/ North-Holland, Amst erda m ; printed in The Netherlands. Toxicology and Applied Pharmacology, Academic Press, New York and London.
Primary
TABLE 1. Type and Scope of Toxicology Information Resources
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Secondary Dreisbach. Lang Medical Publications, Los Altos, CA. Poisoning, by W. F. VonOettingen. Paul Hoeber, Inc. Poisoning: Toxicology, Symptoms, Treatments, by Jay M. Arena. Charles C. Thomas. Publisher, Springfield, IL. The Toxic Substances List, by H erbert E. Christensen, Thomas T. Luginbyhl, and Benigna S. Carroll. Health, Education, and Welfare Publication. Toxicity Bibliography, National Library of Medicine, Department of Health, Education, and Welfare, Public Health Service, National Institute of Health. Also available on-line as Toxline. Toxicology of Drugs and Chemicals, by William B. Deichmann and Horace W. Gerarde. Academic Press, NY.
fects, range of toxicity, role of the laboratory, and m aj or references. A complete new s e t of computer generated microfiche is sent to each u s e r quarterly. This update incorporates all new and revised data, plus all requests f o r new data from us ers. Poison Index Car d File, by National Clearinghouse for Poison Control Centers, Department of Health, Education, and Welfare, FDA, Wash., D.C. Toxifile, by Chicago Micro Corporation, Chicago. Subs c r i b e r s to Toxifile are provided with a notebooksized film file of microfiche c a r d s which is an index to the film file, and a microfiche viewer. T o determine the toxicity of and treatment f o r a particular
Scope
Basic
TABLE 1 (Continued)
Toxicon, Pergamon Press, NY. (International journal devoted to the exchange of knowledge on poisonous reaction to animals, plants, and micro-organisms. Official journal of the International Society of Toxicology. ) Veterinarv and Human Toxicology, American College of Veterinary Toxicologists, Manhattan, KS.
Primary
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product, one looks the product up in the File Directory to find i t s microfiche c a r d and f r a m e number. The ent r ies in the File Directory a r e listed by trade name and by manufacturer. New information is filmed and sequentially added to the file monthly. The File Directory is updated and reprinted quarterly with monthly supplements.
Acute Barbiturate Poisoning, H. Matthew, Excerpta Medica, A m s t e rdam . Clinical Handbook of Economic Poisons: Emergency Information for Treating Poisoning, by Wayland J. Hayes, Jr. U.S. Government Printing Office, Wash., D.C.
Toxicology: Review and P r o s .Dect.,bv W. A. M. Duncan. %erp"ta Medica. Toxicology-The Basic Science of Poisons, by L. J. C asaret t and J. Doull. MacMillan Publishing Co., Inc., NY. Treatment of Common Acute Poisonings, by H. M. Mathew and A. J. Lawson. Churchill Livings tone. Clinical Toxicology, by C. J. Polson and R. N. Tattersall. J. P. Lippincott Co., Phil., PA. Poisoning by Drugs and Chemi__ cal s, by P e t e r Cooper, Year Book Medical Pub., Inc., Chicago.
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Food and Cosmetic Toxicology, Pergarnon Press, NY
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342 VELTRI AND TEMPLE
Human Poisoning f r o m Native a n d Cultivated P l a n t s , by J. W. Hardin a n d J. M. A r e n a , Duke University Press, D u r h a m , NC. I n d u s t r i a l Toxicology, by Alice Hamilton a n d H a r r i e t L. Hardy. Publishing S c i e n c e s Group, InC. L a b o r a t o r v D i a m o s i s of Diseases C i u s e d yby Toxic Agents, by F. W. Sunderman a n d F. W. Sunderman, Jr. W a r r e n H. G r e e n , Inc. Medical Botany: P l a n t s Affecting M a n ' s Health. bv W a l t e r H. Lewis. John Wiley an'd s o n s . M e r c u r y i n the Environment, L a r s F r i b e r g a n d J a r o s l a v Vostel, eds. CRC Press. M u s h r o o m s of Colorado a n d Adjacent A r e a s . bv M a n Hallock W e l l s a n d D. h. Mikhell." D e n v e r Museum of N a t u r a l H i s t o r y , Denver, CO. N a r c o t i c P l a n t s , by William Emboden, Jr. T h e Macmillan Co. Neuropoisons-Their Pathophysiol o ve -i c a l Actions. P o i s o n s of Animal Origin, by L. L. Simpson. Plenum Press, N. Y. -London.
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Basic
TABLE 1 (Continued)
Primary
Neuropoisons-Their Pathophysiological Actions, Poisons of Plant Origin, by L. L. Simpson and D. R. Curtis. Plenum Press, N.Y.London. Occupational Lung Diseases, by W. K. C. Morgan and A. Seaton. W. B. Saunders Co., Phil., PA. Pesticide Handbook, Donald E. H. Frear, ed. College Science Publishers. Physicians Desk Reference, Medical Economics Co. Plant Toxicity and Dermatitis, by K. F. LamDe and R F a m r s t r o m . Williams i n d W i k i n s ci. Poisonous Plants, by Richard A. Howard and G. P. DeWolf, Jr. Arnoldia Jamaica Plain, MA. Poisonous Dwellers of the Desert, bv N. N. Dodge. Messenger Graphics, Phienix, AZ. Poisonous Plants of the U.S. and Canada, by J. M. Kingsbury. Prentice-Hall, Inc., Englewood Cliffs, NJ.
Secondary
Scope
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TOXICOLOGY RESOURCES
Related toxicology resources
Type
Basic
TABLE 1 (Continued)
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Amphetamines: Toxicity and Addiction, by Oriana J. Kalant. University of Toronto Press and C h a r l e s C. Thomas.
Toxicology of Pesticides, by Waylard J. Hayes, Jr., Will i a m s k w i k i n s CO. Toxicological P r o b l e m s of Drug Combinations. S. B. -~Baker and G. A. Neuhaus, eds. Excerpta Medica. Treatment Manual for Acute Drug Abuse Emergencies, P e t e r C. Bourne, ed., U.S. Dept. of HEW. Industrial Hygiene and Toxicology, F. Patty, D. F'assett, and D. I r i s h , eds. Interscience Publ., NY.
Secondary
Scope
Archives of Environmental Health, American Academy of Occupational Medicine and American College of Preventive Medicine, AMA, Chicago, IL.
Primary
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Cadmium in the Environment, by L. F r i b e r g , M. P i s c a t o r , and G. Nordberg. CRC Press, Cleveland, OH. Chemical and Biological Aspects of Drug Dependence, by S. J. Mule and H. Brill. CRC Press, Cleveland, OH. Chemicals and Health (Report on the Panel on Chemicals and Health of the P r e s i d e n t ' s Science Advisory Committee), by H. G. Stever. U.S. Government Printing Office, Wash., D. C. Chlorinated Insecticides: Biological and Environmental Aspects, by G. T. Brooks. CRC Press, Cleveland, OH. Chlorinated Insecticides: Technology and Application, by G. T. Brooks, CRC P r e s s , Cleveland, OH. Clinical Aspects of the Teratogenicity of Drugs. bv H. Nishimura and T. Tanimura, Excerpta Medica, American Elsevier Publ. Co., Inc.
Press.
Relation to t h e i r Plasma Concentrations, D. S. Davies and B. N. C. Prichard. Univ. P a r k
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TABLE 1 (Continued)
Primary
Dangers to Children and Youth, bv J. M. Arena. Moore Publ. Co. Dangerous P r o p e r t i e s of Industrial Materials, by N. I. Sax. Van Nostrand Rheinhold Co., NY. Desk Reference on Drug Abuse, State of New York Dept. of Health. Drug Abuse (Current Concepts and Research), by Wolfren Keup. Charles C. Thomas, Springfield, IL. Drugs Chemicals and Blood Dyscrasias. bv M. Swanson and R Cook. f i g i t e l l i g e n c e Publ., Inc. Drug Effects on the Fetus, by H. Tuchman. Adis Press. Drug Induced Diseases, by L. Meyler and H. M. Peck, eds. Excerpta Medica. Drug Induced Blood Disorders, by G. C. DeGruchy, Blackwell Scientific Publ. Drug Induced Ocular Side Effects and Drug Interaction, by F. T. Fraunfelaer. Lea & Febiger Co. Drug Treatment Principles and Prac-
Secondary
Scope
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tice of Clinical Pharmacology and Therapeutics, by G. S. Avey. Adis P r e s s , Sydney Pub. Sciences Group. Epidemiology of DDT, J. E. Davies and W. F. Edmundson, eds. Futura Publishing Co., Inc. Essentials of Toxicology, T. A. Loomis. Lea & Febiger. Hallucinogenic Drugs, by F. Christine Brown. Charles C. Thomas, Springfield, IL. Handbook of Analytical Toxicology, by I. Sunshine. CRC Press, Cleveland, OH. Handbook of Veterinary Drugs, by Irving S. Rossoff. American P h a r m a ceutical Assoc., Wash., D.C. Handbook of Veterinary P r o c e d u r e s and Emergency Treatment, R. Kirk and S. Bistner. W. B. Saunders Co. Hazards of Medicine, by E r i c W. Martin. J. B. Lippincott Co., Philadelphia, PA. Intravenous Incompatabilities, by D. Michalski and M. S. Cohon. University of Wisconsin P r e s s . Pesticides in Clinical Practice: Identification, Pharmacology, and TheraDeutics. bv R. L. Brown. Charles C. Thomas, Springfield, IL.
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Adverse Reaction File, Abstracts from the international l i t e r a t u r e on a l l d r u g reactions, both suspected and confirmed, a r e p r e p a r e d by the FDA and supplied to the Poison Cent e r f o r this file. T h e r e are o v e r 14,000 a b s t r a c t in this file. deHaen Drugs in Use. Reference l i b r a r y of clinical d r u g
Type
Supporting resources
TABLE 1 (Continued)
Primary
AMA Drug Evaluations, by AMA Journal of Clinical P h a r m a c o l o w . AmeriDept. of Drugs. Publishing can College &'Clinical Sciences Group, Inc., Acton, Pharmacy, N.Y. PubMA. l i s h e s original p a p e r s Ambulatory P e d i a t r i c s , by M. on the clinical and pharGreen and R J. Haggerty, eds. macologic effects of W. B. Saunders Co. American Drug Index, by C h a r l e s the newer d r u g s and 0. Wilson and T. E. Jones. J. B. pharmaceutical preparations. Lippincott Co. American Hospital Formulary Service, by J. A. Oddis. Ameri-
P e r s i s t e n t Pesticides in the Environment, by C. A. Edwards. CRC Press, Cleveland, OH. Side Effects of Drugs, by L. Melyer. Publ. at regular intervals by E x c e r p L Medical Foundation, N.Y. Veterinary Toxicology, by R D. Radeleff, Lea and Febiger, Philadelphia, PA.
Secondary
Scope
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experience that is extracted regularly from o v e r 400 biomedical journals. Consists of 20,000 c a r d s ( s t a r t i n g 1970) containing in f o rmat ion on the therapeutic use, efficacy, and toxicology of drugs studied in humans. About 6000 new c a r d s a r e published annually. Iowa Drug Information Service. Clinical and d r u g inforZ i o n s e r v i c e of the College of Pharmacy, University of Iowa.
can Society of Hospital P h a r m a c i s t s , Wash., D.C. Antiepileptic Drugs, D. M. Woodbury, J. K. Penry, and R. P. Schmidt, eds. Raven Press, Publishers, NY. Blood D i s o r d e r s Due to Drugs and Other Agents, by R. H. Girdwood. Excerpta Medical, Amsterdam. Body Fluids in Pediatrics, R. W. Winters, ed. Little Brown &Co. Canadian Drug Identification Code, National Health Education and Welfare. Chemical Abstracts, American Chemical Society, Columbus, OH. (Abs t r a c t s of a l l scientific and technical p a p e r s containing new information of chemical and chemical engineering i n t e r e s t . ) Also available on line as C hem - Abs t r a c t s On - Line. Clinical Chemistry Effects of Drugs on Clinical Laboratory T e s t s , by D. S. Young and V. Gibberman. The Clinical Pathology Dept., Clinical Center, National Institute of Health, Bethesda, MD. Clinical Effects of Interaction Between D i g s , L. E. Cluff and J. C. P e t r i e , eds. American Elsevier Publishing Co., NY.
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Clinical Pharmacology, K. L. Melmon and H. F. Morreli, eds. The MacMillan Co. Color Additives Guide, The Pharmaceutical Manufacturers Association. Current Drug Handbook, by M. W. a l c o n e r , H. R. Patterson, and E. A. Gustafson. W. B. Saunders Co., PhiladelphiaLondon- Toronto. Current Pediatric Therapy, by S. Gellis and B. Kagan. W. B. Saunders Co. Current Therapy, by H. F. Conn, W. B. Saunders Co., Philadelphia-London- Toronto. Drug Interactions, P. L. Morselli, S. N. Cohen, and S. Garattini, eds. Raven Press, NY, Monographs of the Mario Negri Institute for Pharmacological Research.
~
Secondary
Scope Primary
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Drugs of Choice, by Walter Model. The C. V. Mosby Co., St. Louis, MO. Drug Identification Guide, Medical Economics Co. Drug Interactions: A Handbook for Clinical Use, by S. N. Cohen and M. F. Armstrong. Williams & Wilkins Co. Drug Interactions, by Philip D. Hansten. Lea & Febiger Co. Drug Therapy, The New England Journal of Medicine, Massachusetts Medical Society. Edible Wild Plants, by Oliver P. Medsger. The MacMillan Co. Evaluations of Drug Interactions, American Pharmaceutical Assoc., ed. American Pharmaceutical Association. E xt ra Pharmacopoeia, by W. Martindale, The Pharmaceutical P r e s s , London. Field Guide to Western Mushrooms, by Alexander H. Smith. The University of Michigan P r e s s . Fluoridation, by F. J. Maier. CRC P r e s s . Cleveland. Ohio. Facts and Comparisons, Erwin K. Kastrup, ed. Facts and Comparisons, Inc.
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Toxicology Information Resources for Poison Control Centers
JOSEPH C. VELTRI, Pharm.D.
*
Associate Director Intermountain Regional Poison Control Center Salt Lake City, Utah 84132 ANTHONY R TEMPLE, M.D. Director Intermountain Regional Poison Control Center Salt Lake City, Utah 84132
INTRODUCTION The area encompassed by the discipline “toxicologytt is indeed broad, multifaceted, and varied depending on the definition used. Within the discipline many qualifiers are used to define the a r e a s of clinical practice o r scientific study and r esearch that allow u s to focus o u r concerns within a reasonably narrow scope. Qualifiers commonly used include clinical o r medical toxicology, environmental toxicology, industrial hygiene, forensic toxicology, and analytic toxicology. Unfortunately, a considerable amount of overlap occurs among these definitions, which presents a problem in the area of poison control (clinical toxicology) and the management of emergent problems associated with acute human exposure to toxic agents. *Reprint requests to: Joseph C. Veltri, Pharm.D., 50 North Medic al Drive, Bldg. 428, Salt Lake City, Utah 84132. 335 Copyright 0 1978 by Marcel Dekker, Inc All Rights Reserved Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission i n writing from the publisher
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It is o u r experience that most c a l l s to poison control c e n t e r s deal with a toxic exposure o r poisonings where the agent o r a description of the agent is known (see p. 282, this issue). Since neither undertreatment n o r overtreatment of a poisoning is ideal, i t follows that a calm and collected attitude with the judicious u s e of drugs and approp r i a t e therapy is generally far m o r e effective than medical heroics. In many c a s e s poison c e n t e r staff are faced with determining whether the d e g r e e of exposure is sufficient to require treatment and what treatment s e e m s appropriate f o r the circumstances. As such, accur a t e a s s e s s m e n t of the severity of a n intoxication requires the capability to s e a r c h and evaluate the toxicology l i t e r a t u r e accurately and rapidly. Unfortunately, data that are both clinically significant and a c c u r a t e are not always available within a single definitive resource. In fact, the available data often require a good deal of integration and interpretation, even when the appropriate s o u r c e s are located. Therefore, we have attempted to categorize many of the available toxicology information r e s o u r c e s with respect to t h e i r relative clinical significance in dealing with clinical o r medical toxicology problems. The intent of this classification is to provide a categorization of toxicology r e s o u r c e s which s e e m s most appropriate to the needs of information providers within poison control centers. The m a t r i x f o r m a t classifies the available r e s o u r c e s both as to type and scope. The definition of the type of resource is based upon the rapidity with which data can be retrieved and the l a g time required f o r new data to be incorporated into the resource. The definition of the scope of the r e s o u r c e is based upon the direct applicability of the data when used by trained poison information providers, CLASSIFICATION SCHEME FOR INFORMATION RESOURCES T y p e of R e s o u r c e Basic Information Resources Basic information r e s o u r c e s are those r e s o u r c e s that allow rapid a c c e s s to recent data of clinical significance. They provide enough information s o that appropriate decisions regarding toxicity and severity can be made rapidly by a poison c e n t e r staffer who h a s a minimum amount of clinical experience in toxicology. However, specific training in information retrieval, integration, and a s s e s s m e n t would likely be required to u s e the data appropriately. Such a r e s o u r c e has the capability f o r rapid updating of material, hopefully in a mann e r that continually upgrades the clinical significance of i t s data.
TOXICOLOGY RESOURCES
337
Secondary Information Resources Secondary information r e s o u r c e s are those r e s o u r c e s that provide a compilation of information of a general categorical nature, synthesizing in s o m e detail clinical experience o r original a r t i c l e s to which one can then refer. These are textbooks, compendia, reviews, and review compilations.
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P r i m a r y Information Resources P r i m a r y information r e s o u r c e s a r e basically original journal a r t i c l e s o r r e p o r t s that provide c a s e studies, clinical t r i a l s , animal experiments, o r s i m i l a r original scientific data. S c o D e of I n f o r m a t i o n General Clinical Toxicology Resources General clinical toxicology r e s o u r c e s include information related to the wide range of toxic problems of significance to humans. They are not r e s t r i c t e d in scope, and one would expect to be able to find s o m e type of clinically relevant m a t e r i a l about the vast majority of common, major, o r pathophysiologically unique poisonings. These r e s o u r c e s would include ( t o varying d e g r e e s ) data o r discussions pertaining to any o r all of the following: product identification, assessment of the toxicity of a given exposure, pathophysiology of the toxic effects of an agent, common signs and symptoms of toxic exposures, emergency c a r e of the poisoned patient, and general treatment of poisonings. These r e s o u r c e s may contain animal data as well as human experiences; however, the bulk of the data pertains to the pathophysiologic effects of the substances when introduced into living organisms. Specific Clinical Toxicology Resources Specific clinical toxicology r e s o u r c e s include information of clinic a l significance to humans related to a specific o r limited area of clinical toxicology. These r e s o u r c e s are restricted in scope and may deal with a specific topic such as plant o r venom toxicity, o r they may deal with a specific organ such as o c u l a r o r renal toxicity. A s in the general clinical toxicology r e s o u r c e s (GCTR), the data included could pertain to identification, a s s e s s m e n t of pathophysiologic effects, signs and symptoms of intoxication, etc. Because of the specific nature of these r e s o u r c e s they generally present information of g r e a t e r depth than do the general clinical toxicology r e s o u r c e s , and t h e data may be animal as well as human.
338
VELTRI AND TEMPLE
Related Toxicology Resources
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Related toxicology r e s o u r c e s include reference m a t e r i a l s dealing with toxicology but are not designed to provide acute poisoning management information. These r e s o u r c e s generally include d i s c r e t e pieces of information that may be utilized in the development of a n overall a s s e s s m e n t of poisoning, but their focus is not clinical (human). Resources whose p r i m a r y focus is analytic toxicology, veterinary toxicology, environmental toxicology, industrial toxicology, and forensic toxicology would fit in this category. Supporting Resources Supporting r e s o u r c e s may provide insight into the toxicology of various agents, but t h e i r use in the clinical toxicology setting generally r e q u i r e s a sophisticated u s e r since the focus of these r e s o u r c e s is not toxicology directly, but one of the supporting disciplines encompassed by toxicology. These would include, but a r e not limited to, texts o r a r t i c l e s about pharmacology, physiology, chemistry, biochemi s t r y , biopharmaceutics, internal medicine, pediatrics, clinical diagnosis, clinical pathology, etc. The data found within these r e s o u r c e s generally r e q u i r e s a high level of integration to apply them to a problem in clinical toxicology. Table 1 is a matrix, based on the above definitions of type and scope of toxicology information resources. Every attempt has been made to make the table as comprehensive and c u r r e n t as possible with r e s p e c t to general and specific clinical toxicology resources. However, the regional nature of s o m e r e s o u r c e s and the unavailability of o t h e r res o u r c e s make i t impossible to have a n all-inclusive table of resources. With r e g a r d to the related toxicology r e s o u r c e s and supporting res o u r c e s , only those used by the Intermountain Regional Poison Control Center w e r e included, and many r e s o u r c e s which fall in these categories may have been omitted. In any event, the table can be used as a guide to a s s i s t poison control (information) c e n t e r s in a s s u r i n g thems e l v e s that these r e s o u r c e s have been identified and a t least reviewed, since s o m e may be unnecessary o r undesirable f o r individual poison c e n t e r libraries.
Basic
General clini- National Clearinghouse for cal toxicology Poison Control Centers r es o u rces Computer Terminal, by NCPCC, Department of Health, Education, and Welfare, Food and Drug Administration, Wash., D.C. Poisondex by Micromedex, Inc., Denver, CO. A rapid acces s source of specific information. Users are provided with a notebook-size film file of microfiche car ds, with each c a r d containing over 2000 entries. Products are listed alphabetically on the cards. Once the card is inserted in the viewer, the u s e r is directed to the specific product, its ingredients, and p roper treatment, including related information concerning pharmacology, clinical ef-
Tme Accidental Poisoning i n Childhood, Edward Press. American Academy of Pediatrics. Clinical Toxicology, S. Locket, ed. The C. V. Mosby Co. Clinical Toxicology, by Clinton H. Theines and Thomas J. Haley. Lea and Febiger. Clinical Toxicology of Commercia1 Products, by M. N. Gleason, R. E. Gosselin, H. C. Hodge, and R. P. Smith. Williams & Wilkins, Balt., MD. Emergency Treatment and Care, by Thomas Flint, Jr. and Harvey D. Cain. W. B. Saunders Co. Handbook of Common Poisonings in Children, U.S. Department of Health, Education, and Welfare. HEW Publication Company. Handbook of Poisoning: Diagnosis and Treatment, by R. H.
Secondary
Scope
(Continued)
Clinical Toxicology, Marcel Dekker, Inc., New York, NY. Critical Reviews in Toxicolopy, CRC Press, Inc., Cleveland, OH. Poison Control Center Master File by the Intermountain Regional Poison Control Center, Salt Lake City, UT. Toxicology (An international journal concerned with the effects of chemicals on living systems. ) Elsevier/ North-Holland, Amst erda m ; printed in The Netherlands. Toxicology and Applied Pharmacology, Academic Press, New York and London.
Primary
TABLE 1. Type and Scope of Toxicology Information Resources
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Secondary Dreisbach. Lang Medical Publications, Los Altos, CA. Poisoning, by W. F. VonOettingen. Paul Hoeber, Inc. Poisoning: Toxicology, Symptoms, Treatments, by Jay M. Arena. Charles C. Thomas. Publisher, Springfield, IL. The Toxic Substances List, by H erbert E. Christensen, Thomas T. Luginbyhl, and Benigna S. Carroll. Health, Education, and Welfare Publication. Toxicity Bibliography, National Library of Medicine, Department of Health, Education, and Welfare, Public Health Service, National Institute of Health. Also available on-line as Toxline. Toxicology of Drugs and Chemicals, by William B. Deichmann and Horace W. Gerarde. Academic Press, NY.
fects, range of toxicity, role of the laboratory, and m aj or references. A complete new s e t of computer generated microfiche is sent to each u s e r quarterly. This update incorporates all new and revised data, plus all requests f o r new data from us ers. Poison Index Car d File, by National Clearinghouse for Poison Control Centers, Department of Health, Education, and Welfare, FDA, Wash., D.C. Toxifile, by Chicago Micro Corporation, Chicago. Subs c r i b e r s to Toxifile are provided with a notebooksized film file of microfiche c a r d s which is an index to the film file, and a microfiche viewer. T o determine the toxicity of and treatment f o r a particular
Scope
Basic
TABLE 1 (Continued)
Toxicon, Pergamon Press, NY. (International journal devoted to the exchange of knowledge on poisonous reaction to animals, plants, and micro-organisms. Official journal of the International Society of Toxicology. ) Veterinarv and Human Toxicology, American College of Veterinary Toxicologists, Manhattan, KS.
Primary
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product, one looks the product up in the File Directory to find i t s microfiche c a r d and f r a m e number. The ent r ies in the File Directory a r e listed by trade name and by manufacturer. New information is filmed and sequentially added to the file monthly. The File Directory is updated and reprinted quarterly with monthly supplements.
Acute Barbiturate Poisoning, H. Matthew, Excerpta Medica, A m s t e rdam . Clinical Handbook of Economic Poisons: Emergency Information for Treating Poisoning, by Wayland J. Hayes, Jr. U.S. Government Printing Office, Wash., D.C.
Toxicology: Review and P r o s .Dect.,bv W. A. M. Duncan. %erp"ta Medica. Toxicology-The Basic Science of Poisons, by L. J. C asaret t and J. Doull. MacMillan Publishing Co., Inc., NY. Treatment of Common Acute Poisonings, by H. M. Mathew and A. J. Lawson. Churchill Livings tone. Clinical Toxicology, by C. J. Polson and R. N. Tattersall. J. P. Lippincott Co., Phil., PA. Poisoning by Drugs and Chemi__ cal s, by P e t e r Cooper, Year Book Medical Pub., Inc., Chicago.
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Food and Cosmetic Toxicology, Pergarnon Press, NY
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342 VELTRI AND TEMPLE
Human Poisoning f r o m Native a n d Cultivated P l a n t s , by J. W. Hardin a n d J. M. A r e n a , Duke University Press, D u r h a m , NC. I n d u s t r i a l Toxicology, by Alice Hamilton a n d H a r r i e t L. Hardy. Publishing S c i e n c e s Group, InC. L a b o r a t o r v D i a m o s i s of Diseases C i u s e d yby Toxic Agents, by F. W. Sunderman a n d F. W. Sunderman, Jr. W a r r e n H. G r e e n , Inc. Medical Botany: P l a n t s Affecting M a n ' s Health. bv W a l t e r H. Lewis. John Wiley an'd s o n s . M e r c u r y i n the Environment, L a r s F r i b e r g a n d J a r o s l a v Vostel, eds. CRC Press. M u s h r o o m s of Colorado a n d Adjacent A r e a s . bv M a n Hallock W e l l s a n d D. h. Mikhell." D e n v e r Museum of N a t u r a l H i s t o r y , Denver, CO. N a r c o t i c P l a n t s , by William Emboden, Jr. T h e Macmillan Co. Neuropoisons-Their Pathophysiol o ve -i c a l Actions. P o i s o n s of Animal Origin, by L. L. Simpson. Plenum Press, N. Y. -London.
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Basic
TABLE 1 (Continued)
Primary
Neuropoisons-Their Pathophysiological Actions, Poisons of Plant Origin, by L. L. Simpson and D. R. Curtis. Plenum Press, N.Y.London. Occupational Lung Diseases, by W. K. C. Morgan and A. Seaton. W. B. Saunders Co., Phil., PA. Pesticide Handbook, Donald E. H. Frear, ed. College Science Publishers. Physicians Desk Reference, Medical Economics Co. Plant Toxicity and Dermatitis, by K. F. LamDe and R F a m r s t r o m . Williams i n d W i k i n s ci. Poisonous Plants, by Richard A. Howard and G. P. DeWolf, Jr. Arnoldia Jamaica Plain, MA. Poisonous Dwellers of the Desert, bv N. N. Dodge. Messenger Graphics, Phienix, AZ. Poisonous Plants of the U.S. and Canada, by J. M. Kingsbury. Prentice-Hall, Inc., Englewood Cliffs, NJ.
Secondary
Scope
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TOXICOLOGY RESOURCES
Related toxicology resources
Type
Basic
TABLE 1 (Continued)
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Biological Effects of Drum In
Amphetamines: Toxicity and Addiction, by Oriana J. Kalant. University of Toronto Press and C h a r l e s C. Thomas.
Toxicology of Pesticides, by Waylard J. Hayes, Jr., Will i a m s k w i k i n s CO. Toxicological P r o b l e m s of Drug Combinations. S. B. -~Baker and G. A. Neuhaus, eds. Excerpta Medica. Treatment Manual for Acute Drug Abuse Emergencies, P e t e r C. Bourne, ed., U.S. Dept. of HEW. Industrial Hygiene and Toxicology, F. Patty, D. F'assett, and D. I r i s h , eds. Interscience Publ., NY.
Secondary
Scope
Archives of Environmental Health, American Academy of Occupational Medicine and American College of Preventive Medicine, AMA, Chicago, IL.
Primary
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Cadmium in the Environment, by L. F r i b e r g , M. P i s c a t o r , and G. Nordberg. CRC Press, Cleveland, OH. Chemical and Biological Aspects of Drug Dependence, by S. J. Mule and H. Brill. CRC Press, Cleveland, OH. Chemicals and Health (Report on the Panel on Chemicals and Health of the P r e s i d e n t ' s Science Advisory Committee), by H. G. Stever. U.S. Government Printing Office, Wash., D. C. Chlorinated Insecticides: Biological and Environmental Aspects, by G. T. Brooks. CRC Press, Cleveland, OH. Chlorinated Insecticides: Technology and Application, by G. T. Brooks, CRC P r e s s , Cleveland, OH. Clinical Aspects of the Teratogenicity of Drugs. bv H. Nishimura and T. Tanimura, Excerpta Medica, American Elsevier Publ. Co., Inc.
Press.
Relation to t h e i r Plasma Concentrations, D. S. Davies and B. N. C. Prichard. Univ. P a r k
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Basic
TABLE 1 (Continued)
Primary
Dangers to Children and Youth, bv J. M. Arena. Moore Publ. Co. Dangerous P r o p e r t i e s of Industrial Materials, by N. I. Sax. Van Nostrand Rheinhold Co., NY. Desk Reference on Drug Abuse, State of New York Dept. of Health. Drug Abuse (Current Concepts and Research), by Wolfren Keup. Charles C. Thomas, Springfield, IL. Drugs Chemicals and Blood Dyscrasias. bv M. Swanson and R Cook. f i g i t e l l i g e n c e Publ., Inc. Drug Effects on the Fetus, by H. Tuchman. Adis Press. Drug Induced Diseases, by L. Meyler and H. M. Peck, eds. Excerpta Medica. Drug Induced Blood Disorders, by G. C. DeGruchy, Blackwell Scientific Publ. Drug Induced Ocular Side Effects and Drug Interaction, by F. T. Fraunfelaer. Lea & Febiger Co. Drug Treatment Principles and Prac-
Secondary
Scope
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tice of Clinical Pharmacology and Therapeutics, by G. S. Avey. Adis P r e s s , Sydney Pub. Sciences Group. Epidemiology of DDT, J. E. Davies and W. F. Edmundson, eds. Futura Publishing Co., Inc. Essentials of Toxicology, T. A. Loomis. Lea & Febiger. Hallucinogenic Drugs, by F. Christine Brown. Charles C. Thomas, Springfield, IL. Handbook of Analytical Toxicology, by I. Sunshine. CRC Press, Cleveland, OH. Handbook of Veterinary Drugs, by Irving S. Rossoff. American P h a r m a ceutical Assoc., Wash., D.C. Handbook of Veterinary P r o c e d u r e s and Emergency Treatment, R. Kirk and S. Bistner. W. B. Saunders Co. Hazards of Medicine, by E r i c W. Martin. J. B. Lippincott Co., Philadelphia, PA. Intravenous Incompatabilities, by D. Michalski and M. S. Cohon. University of Wisconsin P r e s s . Pesticides in Clinical Practice: Identification, Pharmacology, and TheraDeutics. bv R. L. Brown. Charles C. Thomas, Springfield, IL.
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Adverse Reaction File, Abstracts from the international l i t e r a t u r e on a l l d r u g reactions, both suspected and confirmed, a r e p r e p a r e d by the FDA and supplied to the Poison Cent e r f o r this file. T h e r e are o v e r 14,000 a b s t r a c t in this file. deHaen Drugs in Use. Reference l i b r a r y of clinical d r u g
Type
Supporting resources
TABLE 1 (Continued)
Primary
AMA Drug Evaluations, by AMA Journal of Clinical P h a r m a c o l o w . AmeriDept. of Drugs. Publishing can College &'Clinical Sciences Group, Inc., Acton, Pharmacy, N.Y. PubMA. l i s h e s original p a p e r s Ambulatory P e d i a t r i c s , by M. on the clinical and pharGreen and R J. Haggerty, eds. macologic effects of W. B. Saunders Co. American Drug Index, by C h a r l e s the newer d r u g s and 0. Wilson and T. E. Jones. J. B. pharmaceutical preparations. Lippincott Co. American Hospital Formulary Service, by J. A. Oddis. Ameri-
P e r s i s t e n t Pesticides in the Environment, by C. A. Edwards. CRC Press, Cleveland, OH. Side Effects of Drugs, by L. Melyer. Publ. at regular intervals by E x c e r p L Medical Foundation, N.Y. Veterinary Toxicology, by R D. Radeleff, Lea and Febiger, Philadelphia, PA.
Secondary
Scope
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experience that is extracted regularly from o v e r 400 biomedical journals. Consists of 20,000 c a r d s ( s t a r t i n g 1970) containing in f o rmat ion on the therapeutic use, efficacy, and toxicology of drugs studied in humans. About 6000 new c a r d s a r e published annually. Iowa Drug Information Service. Clinical and d r u g inforZ i o n s e r v i c e of the College of Pharmacy, University of Iowa.
can Society of Hospital P h a r m a c i s t s , Wash., D.C. Antiepileptic Drugs, D. M. Woodbury, J. K. Penry, and R. P. Schmidt, eds. Raven Press, Publishers, NY. Blood D i s o r d e r s Due to Drugs and Other Agents, by R. H. Girdwood. Excerpta Medical, Amsterdam. Body Fluids in Pediatrics, R. W. Winters, ed. Little Brown &Co. Canadian Drug Identification Code, National Health Education and Welfare. Chemical Abstracts, American Chemical Society, Columbus, OH. (Abs t r a c t s of a l l scientific and technical p a p e r s containing new information of chemical and chemical engineering i n t e r e s t . ) Also available on line as C hem - Abs t r a c t s On - Line. Clinical Chemistry Effects of Drugs on Clinical Laboratory T e s t s , by D. S. Young and V. Gibberman. The Clinical Pathology Dept., Clinical Center, National Institute of Health, Bethesda, MD. Clinical Effects of Interaction Between D i g s , L. E. Cluff and J. C. P e t r i e , eds. American Elsevier Publishing Co., NY.
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Clinical Pharmacology, K. L. Melmon and H. F. Morreli, eds. The MacMillan Co. Color Additives Guide, The Pharmaceutical Manufacturers Association. Current Drug Handbook, by M. W. a l c o n e r , H. R. Patterson, and E. A. Gustafson. W. B. Saunders Co., PhiladelphiaLondon- Toronto. Current Pediatric Therapy, by S. Gellis and B. Kagan. W. B. Saunders Co. Current Therapy, by H. F. Conn, W. B. Saunders Co., Philadelphia-London- Toronto. Drug Interactions, P. L. Morselli, S. N. Cohen, and S. Garattini, eds. Raven Press, NY, Monographs of the Mario Negri Institute for Pharmacological Research.
~
Secondary
Scope Primary
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Drugs of Choice, by Walter Model. The C. V. Mosby Co., St. Louis, MO. Drug Identification Guide, Medical Economics Co. Drug Interactions: A Handbook for Clinical Use, by S. N. Cohen and M. F. Armstrong. Williams & Wilkins Co. Drug Interactions, by Philip D. Hansten. Lea & Febiger Co. Drug Therapy, The New England Journal of Medicine, Massachusetts Medical Society. Edible Wild Plants, by Oliver P. Medsger. The MacMillan Co. Evaluations of Drug Interactions, American Pharmaceutical Assoc., ed. American Pharmaceutical Association. E xt ra Pharmacopoeia, by W. Martindale, The Pharmaceutical P r e s s , London. Field Guide to Western Mushrooms, by Alexander H. Smith. The University of Michigan P r e s s . Fluoridation, by F. J. Maier. CRC P r e s s . Cleveland. Ohio. Facts and Comparisons, Erwin K. Kastrup, ed. Facts and Comparisons, Inc.
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