Tox Myths and Mistruths

On Saturday 11th June 2016, The Irish Intensive Care Society Annual Scientific Meeting in Dublin will incorporate a Toxicology Symposium, celebrating the 150th anniversary of the Irish National Poisons Information Center. The full programme is available here (pdf), and from the point-of-view of a tox-obsessed intensivist, it looks pretty exciting! The international line-up alone includes Donna Seger (USA), Bruno Mégarbane (France), Leon Gussow of The Poison Review fame (USA) and John Myburgh (Australia). In addition, I will be speaking about ‘Tox Myths and Mistruths’, and the resources for the talk are provided below.

Toxicological myths and mistruths

What we think we know about the management of critically ill poisoned and envenomed patients is haunted by dogma. Most of the things we do, we do because we think they might work, not because we know they will work.

Why is this the case? What can be done about it?

We will consider these questions as we delve into some of the myths and mistruths of critical care toxicology. We will find out whether glucagon antidotal therapy should be renamed ‘gluca-gone’, consider whether calcium in digoxin toxicity really ‘turns hearts to stone’, attempt to unravel the puzzle of liver transplantation for paracetamol toxicity and ride the rollercoaster of antivenom therapy for Australian snakebite envenoming. Finally, we will consider the wider implications in our search for truth in critical care.

References and additional resources:

  1. Nickson CP. Calcium, Digoxin Toxicity and ‘Stone Heart’ Theory. [updated and cited 30 April 2016]. Available from:
  2. Nickson CP. Does Antivenom Work? [updated and cited 30 April 2016]. Available from:
  3. Nickson CP. Dogma and Pseudoaxioms. [updated and cited 30 April 2016]. Available from:
  4. Nickson CP. Glucagon as an antidote. [updated and cited 30 April 2016]. Available from:
  5. Nickson CP. Liver transplantation for Paracetamol Toxicity. [updated and cited 30 April 2016]. Available from:

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