In reply to David Williams comments ; I am in total agreement.
Here in Wrexham we have fallen foul to many such instances when a
poisons unit ( no names mentioned ! ) has given advice on lab
investigations following overdoses, and unfortunately in some cases
caused confusion over therapeutic / toxic ranges.
One particular case involved a child who had overdosed on mum's iron
tablets, and the poison's unit had recommended that I should measure
serum iron/TIBC every hour, on the hour, for 8 hours.
This was before the installation of our air-tube system, and after it
had taken the first sample 90 minutes to arrive in the lab, and the
second sample 110 minutes to arrive, the paediatrician admitted defeat
and stopped further requests.
Peter
Peter Howell
Head Biomedical Scientist - Non-Routine Biochemistry & NPT
Medical Biochemistry Department
Wrexham Maelor Hospital NHS Trust
WREXHAM
Tel : 01978 725252
Fax : 01978 366520
E-mail : [log in to unmask]
-----Original Message-----
From: Trevor Gray [SMTP:[log in to unmask]]
Sent: 11 November 1998 18:18
To: Dr D G Williams
Cc: [log in to unmask]
Subject: Re: Poisons advice
In message <[log in to unmask]>, Dr D G Williams
<david-
[log in to unmask]> writes
>Further to the discussion on thyroxine overdose, while I have never
been
>asked to deal with that, I have, over the years, had some fairly rum
>requests following junior medical staff telephoning a "poisons
centre"
>(unspecified). The local poisons centre in Newcastle has now issued
>guidelines for the clinical management of common overdoses,
including
>which laboratory investigations should be done in given cases
including
>requests for assays (for drugs) which are simply not available.
While
>this is laudable, we still find that these guidelines are not being
>followed, and we still recieve unusual requests following a
telephone
>call to a "poisons centre".
>Am I alone in thinking that it is about time somebody took a good
hard
>look at the quality and appropriateness of the advice offered? In my
>experience, the advice usually comes from somebody sitting in front
of a
>database.
>
>David Williams
>
Further to the discussion about overdoses, when I was SR at the West
Midlands Poisons Unit, the staff reading out the information from the
(Edinburgh) database were the nursing staff on the Poisons Ward who
had
a much more practical and hard-nosed attitude towards what was
necessary
although they were trained to give out the information on the screen
and
give limited practical advice. If necessary, there was always a
medic.
on call for further advice on patient management. The situation may
not
now be the same, but it might be worth finding out what the West
Midlands Unit (at City - old Dudley Road - Hospital, Birmingham)
offer
in the way of advice. As far as analyses were concerned, the
Toxicology
lab. at the Hospital would provide a very wide range of tests out of
hours - far wider than normally available, but although we made use
of
the standard repertoire, the exotic tests were rarely requested
out-of-
hours. There are very few situations in which tests cannot be
delayed
until the next morning. As far as thyroxine is concerned, propanolol
is
a fairly good treatment for symptoms.
--
Trevor Gray
Dept. of Clinical Chemistry,
Northern General Hospital,
Sheffield S5 7AU
0114 271 4309
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