Toxicology Primer poison icon

Acetaminophen (APAP) Poisoning

General Recommendation

General Recommendation

ECTR is suggested in severe APAP poisoning (2D)

Barbiturates Poisoning

General Recommendation

General Recommendation

  • ECTR is recommended in severe long-acting barbiturate poisoning (1D)

Carbamazepine Poisoning

General Recommendation

General Recommendation

  • ECTR is suggested in severe carbamazepine poisoning (2D)

Methanol Poisoning

General Recommendation

General Recommendation

  • ECTR is recommended in severe methanol poisoning (1D)

Lithium Poisoning

General Recommendations

General Recommendation

  • ECTR is recommended in patients with severe Li poisoning (1D)

Metformin Poisoning

General Recommendation

General Recommendation

  • ECTR is recommended in severe metformin poisoning (1D)

Salicylates Poisoning

General Recommendation

General Recommendation

  • ECTR is recommended in severe salicylate poisoning (1D)

Thallium Poisoning

General Recommendation

General Recommendation

  • ECTR is recommended in severe Tl poisoning (1D)

Tricyclic Antidepressants Poisoning

General Recommendations

General Recommendation

  • We recommend NOT to perform ECTR in patients with TCA poisoning. (1D)

Valproic Acid Poisoning

General Recommendation

General Recommendation

  • ECTR is recommended in severe VPA poisoning (1D)

NB: ECTR = extracorporeal treatment
Click here for levels of evidence

LevelTherapy / Prevention, Aetiology / HarmPrognosisDiagnosisDifferential diagnosis / symptom prevalence studyEconomic and decision analyses
1aSR (with homogeneity*) of RCTsSR (with homogeneity*) of inception cohort studies; CDR”  validated in different populationsSR (with homogeneity*) of Level 1 diagnostic studies; CDR”  with 1b studies from different clinical centresSR (with homogeneity*) of prospective cohort studiesSR (with homogeneity*) of Level 1 economic studies
1bIndividual RCT (with narrow Confidence Interval”¡)Individual inception cohort study with > 80% follow-up; CDR”  validated in a single populationValidating** cohort study with good” ” ”  reference standards; or CDR”  tested within one clinical centreProspective cohort study with good follow-up****Analysis based on clinically sensible costs or alternatives; systematic review(s) of the evidence; and including multi-way sensitivity analyses
1cAll or none§All or none case-seriesAbsolute SpPins and SnNouts” “All or none case-seriesAbsolute better-value or worse-value analyses ” ” ” “
2aSR (with homogeneity*) of cohort studiesSR (with homogeneity*) of either retrospective cohort studies or untreated control groups in RCTsSR (with homogeneity*) of Level >2 diagnostic studiesSR (with homogeneity*) of 2b and better studiesSR (with homogeneity*) of Level >2 economic studies
2bIndividual cohort study (including low quality RCT; e.g., <80% follow-up)Retrospective cohort study or follow-up of untreated control patients in an RCT; Derivation of CDR”  or validated on split-sample§§§ onlyExploratory** cohort study with good” ” ”  reference standards; CDR”  after derivation, or validated only on split-sample§§§ or databasesRetrospective cohort study, or poor follow-upAnalysis based on clinically sensible costs or alternatives; limited review(s) of the evidence, or single studies; and including multi-way sensitivity analyses
2c“Outcomes” Research; Ecological studies“Outcomes” Research Ecological studiesAudit or outcomes research
3aSR (with homogeneity*) of case-control studies SR (with homogeneity*) of 3b and better studiesSR (with homogeneity*) of 3b and better studiesSR (with homogeneity*) of 3b and better studies
3bIndividual Case-Control Study Non-consecutive study; or without consistently applied reference standardsNon-consecutive cohort study, or very limited populationAnalysis based on limited alternatives or costs, poor quality estimates of data, but including sensitivity analyses incorporating clinically sensible variations.
4Case-series (and poor quality cohort and case-control studies§§)Case-series (and poor quality prognostic cohort studies***)Case-control study, poor or non-independent reference standardCase-series or superseded reference standardsAnalysis with no sensitivity analysis
5Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”Expert opinion without explicit critical appraisal, or based on economic theory or “first principles”