Introduction

Medical toxicology is a subspecialty of medicine focusing on toxicology and providing the diagnosis, management, and prevention of poisoning and other adverse effects due to medications, occupational and environmental toxicants, and biological agents. Medical toxicologists are involved in the assessment and treatment of a wide variety of problems, including acute or chronic poisoning, adverse drug reactions (ADRs), drug overdoses, envenomations, substance abuse, industrial accidents, and other chemical exposures.

Medical toxicology is officially recognized as a medical subspecialty by the American Board of Medical Specialties. Its practitioners are physicians, whose primary specialization is generally in emergency medicine, occupational medicine, or pediatrics. Medical toxicology is closely related to clinical toxicology, with the latter discipline encompassing non-physicians as well (generally pharmacists or scientists).

Medical toxicology

In recent times, there has also been a great concern about low dose chronic exposure to environmental chemicals such as Persistent Organic Pollutants (POPs) and heavy metals like lead. Many of these chemicals are known to be carcinogens and endocrine disruptors. Neurobehavioral disorders in children are also being linked to in-utero exposures.

In India, the exact number of toxic exposures is not known as there is no centralized reporting system. Studies published on hospital-based poisoning data from different parts of the country are the only source of information. Pesticides are the commonest agent involved and suicidal poisonings are much more common than accidental or occupational poisoning. Due to the easy access to highly toxic pesticides, which are used even in small farms, poisoning-related mortality is much higher and varies from 15 to 35%. Fatalities due to aluminum phosphide have been a great concern especially in northern parts of India. According to one estimate, deaths due to aluminum phosphide self-poisoning in India may be even more than those due to the Bhopal gas tragedy! Unlike organophosphates, there is no antidote for aluminum phosphide.

In the 1950s, poisoning was recognized as a leading cause of pediatric hospital admissions in the United States and this led to the creation of Poison Information Centers. Simultaneously, Clinical Toxicology developed as a sub discipline of Medicine and the American Association of Poison Control Centers (AAPCC) was established in 1958. It was largely due to the efforts of AAPCC that Poison Prevention Packaging Act was introduced in 1972. This led to child resistant packaging and a marked reduction in childhood poisonings.

Special populations, with respect to medical toxicology, represent individuals with a unique physiology that leads to altered pharmacokinetics. Therapeutic Drug Monitoring (TDM) is essential in these groups because the absorbance, metabolism, and clearance of drugs do not follow a clinically predicted route by standard PK. Altered drug PK and pharmacodynamics are reported in obese patients due to increased blood volume, body mass, and cardiac output.

The rate of obesity is fast growing and represents an emerging special population with respect to medical toxicology, in which effective and safe dosing must be determined for individuals of varying age who belong to this category.

The Journal of “Clinical Pharmacology and Toxicology Research” is using Editorial Tracking System to maintain quality and transparency to the author in the peer-review process. Review processing will be performed by the editorial board members of the Journal of “Clinical Pharmacology and Toxicology Research” or by Reviewers (outside experts in the field). Two independent reviewer’s approval (Minimum reviewer’s approval) followed by editor approval is obligatory for acceptance of any manuscript excluding an editorial.

Regards

Mary Wilson

Editorial office

Clinical Pharmacology and Toxicology Research

E-mail: pharmatoxicol@eclinicalsci.com