50 A toxic situation: the roles of pharmacists and poison control centers
50 A toxic situation: the roles of pharmacists and poison control centers
Kari Taggart, PharmD, BCCCP
Sejal Patel, PharmD, BCPS, BCCCP
David E. Zimmerman, PharmD, BCCCP
Topic Area
Toxicology
Learning Objectives
At the end of this case, students will be able to:
- Recall the role of poison control centers in toxicologic emergencies
- Describe pharmacist roles in identifying and managing toxicologic emergencies
- Recommend resources to utilize to manage toxicologic emergencies
Introduction
Intentional and unintentional poisonings unfortunately occur all too frequently in the United States. In 2019, the American Association of Poison Control Centers (AAPCC) logged over 2.1 million human exposures into the National Poison Data System (NPDS).1 The AAPCC is made up of 55 poison centers located around the United States and Puerto Rico and serves a vital role to the healthcare community and the public in educating and assisting with the management of toxicologic emergencies. Poison control centers are made up of physicians, pharmacists, nurses, and health educators and respond to calls (1-800-222-1222) from healthcare professionals and the public regarding both human and animal poisonings 24 hours a day, seven days a week, 365 days a year.2
Emergency departments (EDs) and hospitals must be equipped to identify and manage toxicologic emergencies. Patients (pediatrics or adults) can present with either intentional or unintentional ingestions of single or multiple substances; hence, quick assessments and histories are vital. Common questions asked include: “what and how much was ingested?” or “when was the ingestion?” If able, a thorough patient history should be taken to determine prescription history and use of illicit substances, over-the-counter medications, and herbal supplements. A physical exam should be done to assess for any toxidromes, such as those resulting from antimuscarinic, sympathomimetic, opioid, sedative-hypnotic, or others.
Pharmacists in the institutional setting play important roles in information gathering, assessment, and management in these situations.3 In situations where the patient is unconscious, pharmacists can utilize their skills in reviewing the electronic health record and/or calling community pharmacies to determine which potential medications the patient could have ingested. Following patient evaluation, pertinent laboratory studies, electrocardiogram (EKG), radiographic imaging, and other diagnostics can be conducted. Some of these labs may be run in the facility but some hospitals may have to send them out (leading to a delay in the lab result returning) and pharmacists should know which lab assays are completed in the hospital. Based upon patient vitals and diagnostic results, antidotal and/or resuscitative therapy should be initiated if warranted. The local Poison Control Center or toxicologic services can be consulted at any point during this process to assist with evaluation, diagnostics, and treatment. Patient admi