Preface

Medical toxicology focuses on the short- and long-term adverse effects of medications, including drug–drug, drug–herb, and drug–disease interactions and drug overdoses. It is involved in the diagnosis, management, and prevention of acute and chronic poisonings due to, among others, occupational, environmental, and industrial toxic chemicals.

Medical toxicologists are also interested in substance abuse, venoms, toxins, and antidotes. In the field of medical toxicology, practitioners are physicians. Their primary specialization is generally in emergency medicine, occupational medicine, or pediatrics. Medical toxicologists can provide direct treatment and bedside consultation of acutely poisoned patients, including children in emergency departments, intensive care units, and other inpatient and outpatient units/clinics.

Medical toxicologists can also provide advice in poison control centers, contribute to pharmaceutical research and drug safety, and deal with health policy issues. Therefore, medical toxicology has a wide variety of working fields. Medical Toxicology focuses on the prevention and treatment of poisonings with venoms and toxins, treatment of envenomation, interactions in clinics, antidotes, and forensic toxicology.

This volume provides the reader with a general overview of the treatment of acute/ chronic poisonings including poisonings with drugs, venoms, and toxins, and the antidotes used in clinics.

> **Pınar Erkekoğlu** Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey

**Tomohisa Ogawa** Graduate School of Agricultural Science Tohoku University, Japan

**1**

Section 1

Introduction

Section 1 Introduction

**3**

poisonings [5].

**Chapter 1**

Toxicology

**1. Introduction**

Introductory Chapter: Medical

Toxicology is "the study of the occurrence, properties, detection, adverse effects, and regulation of biological, chemical or physical agents on living organisms." Modern toxicology focuses on the adverse effects of toxic substances (includ-

Since toxicology is a multidisciplinary science, the contributions and activities of toxicologists are widespread and diverse. Toxicologists are mainly concerned with the mechanisms of action of different agents as, we now know, all agents can lead to toxicity due to the exposure period and dose. However, for even the most known and oldest agents, the pathways or endogenous molecules they affect to create toxicity are still being investigated by scientists. As toxicologists, we also contribute to other scientific areas including medicine, physiology, and pharmacology while we receive the help from several branches of science. Toxicologists mainly recognize, identify, and quantify the hazards of foods, pharmaceuticals, workplace chemicals, household products, cosmetics, and personal care products along with toxins and venoms. Furthermore, toxicologists who work as members of academic, industrial, and governmental organizations can also develop the standards and regulations in order to protect human and animal health as well as the environment from the adverse effects of microorganisms, chemicals, or physical agents. In the modern era, toxicologists share methodologies and scientific knowledge to obtain

*Pınar Erkekoğlu and Suna Sabuncuoğlu*

ing toxins, venoms, and toxicants) at molecular level [1, 2].

accurate data about the unwanted effects of different agents [1, 3, 4].

Poison is any substance that leads to harmful effect/s to a living organism when taken by any route, either by accident or design. The history of poisons and poisoners has a long record dating back to the ancient times. In Homer's *Odyssey*, the first use of a specific antidote was documented. In three books (*De Antidotis I*, *De Antidotis II*, and *De Theriaca ad Pisonem*) written by Galen (AD 129–200), the development of a universal antidote was described in detail. Later, Nicander (197–170 BC) focused on the prevention of the gastrointestinal absorption of poisons, emesis induction by using an emetic agent and the mechanical stimulation of the hypopharynx. Greeks and Romans used oral wood charcoal to treat diseases such as anthrax and epilepsy. After 1960s, the use of activated charcoal was routinely recommended in many

Paracelsus (1493–1541), the "Father of Toxicology," was a physician-alchemist. He formulated many revolutionary ideas that form the basic structure of toxicology, pharmacology, and medicine today. The scientist indicated "*Dosis facit venenum*," which simply means "All substances are poisons; there is none which is not a poison.

**2. Poison, toxin, toxicant, and venom**

## **Chapter 1**
