Total toxicology

Medical toxicology of natural substances. Foods, fungi, medicinal herbs, plants, and venomous animals.

Donald G Barceloux. New York: Wiley, 2008 (xxi + 1157 pp). ISBN 978 0 471 72761 3.

Books on clinical toxicology are usually either pocket-sized manuals offering quick and easy reference to doctors treating acutely poisoned patients, or enormous tomes of information, much of it not directly relevant to the clinician and often out of touch with current management. Barceloux’s Medical toxicology of natural substances breaks out of that mould. This book is the first of a series of four major textbooks replacing Ellenhorn’s Medical toxicology, reflecting the rapid growth in clinical toxicology and its evidence base over the past decade. Planned further volumes cover recreational, occupational, and pharmaceutical poisoning.

The text’s layout is consistent throughout, with historical facts providing an interesting backdrop to more detailed analytical and toxicokinetic data, before clinical and management issues are discussed. A Californian emergency physician, Barceloux is clearly very comfortable with acute management; his recommendations are current and evidence-based, and the book could easily be used to guide acute management despite its size and impressive detail. Textbooks published in the United States are often reluctant to consider other parts of the world — in contrast, Barceloux provides a detailed region-by-region examination where necessary.

Of minor irritation, secondary rather than primary references are cited. As well, the publisher hasn’t supported the outstanding content with comparable publication quality. A decent cover and coloured illustrations throughout, rather than just a few pages in the middle, would have improved the overall package.

Nevertheless, from lepidopterism to latrodectism, syndromes caused by the squirting cucumber to licorice, cholera to platypus envenoming, this wonderful book covers an enormous subject with attention to detail and direct clinical relevance in a style that is surprisingly easy to read. The remaining volumes will be eagerly awaited by clinical toxicologists everywhere.