New approaches in managing drug overdosage and poisoning.

The incidence of drug o ver dosage and poisoning has continued to increase over the past decade, and this form of self induced disease imposes a major burden on the health services. Un? fortunately, specific antidotes are available for very few drugs or poisons, and treatment (at least for the deeply unconscious patient) depends largely on supportive treatment based on the standard principles of intensive care. In this context there have been important advances with the spread of intensive care units and the general availability of facilities for comprehensive monitoring and cardiorespiratory support. New developments in drug treatment include the use of agents such as dopa mine for maintaining renal function in the presence of hypo? tension. With a better understanding of the mechanisms of drug action and the application of pharmacokinetic principles there have been other important advances in the management of poisoning, particularly in the use of specific antidotal treatment and specialised techniques for drug removal such as haemo perfusion. In addition, improvements in drug analytical methodology have allowed a more critical evaluation of estab? lished procedures for the enhancement of drug elimination. In one sense some advances in management have been negative. Thus physostigmine is no longer recommended for anticholinergic poisoning, and the general use of techniques such as forced diuresis and dialysis has declined greatly. The advantages of a conservative approach with a minimum of meddlesome medical interference are becoming more widely appreciated.