To Awake a Sleeping Beauty
Every year over 1,000 hospital admissions for accidental poisoning, attempted suicide, or drug overdosage occur in this city and there is no doubt that the size of this problem is increasing.
A large variety of drugs are taken and the specific treatment of the more common poisonings is adequately dealt with in an excellent monograph of Mathew and Lawson. It will help however to consider some general principles of how to tackle the acute problem clinically. You can:
(1) Prevent the drug entering the body’s circulation (stomach washouts)
(2) Prevent the drug reaching its site of action once in the body
(3) Prevent the drug from exerting its effect at this site by
(a) direct competitive inhibition
(b) providing alternative metabolic pathways to overcome drug action
(4) Enhance the rate of drug metabolism
(5) Remove the drug from body— (diuresis, dialysis).
Of these methods, the first, and the last to a lesser extent, is widely used in practice in this country. Again I
refer you to Mathew’s book for the details.
I am interested in the third of these, that is to prevent the drug from exerting its effect at its site of action by providing alternative metabolic pathways, with particular reference to barbiturate poisoning, which constitutes the largest single group of agents encountered in clinical practice.
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