Category : Correspondence

Counselling is important in treatment of deliberate self-harm.

Chepsy C Philip
Clinical Haematology, Christian Medical College, Ludhiana, Punjab 141008 (India); chepsyphilip@gmail.com

Key words: Poisoning; Toxidromes

Citation: Philip CC. Counselling is important in treatment of deliberate self-harm. Anaesth Pain & Intensive Care 2014;18(3):316-17

The article on poisoning with amitraz was an interesting read.1 The authors have reported a case of deliberate self-poisoning with amitraz; detailing its presentation with an approach to its management. They have rightly indicated that there are no known antidotes. In this case though there was a suspicion of the agent used, it might not always be the case. In poisoning, when the agent is unknown, the clinical syndrome of symptoms and signs may suggest one of the recognizable toxidromes, which can guide treatment; resuscitation, of course, remains an important component of the management.2,3 It should be recognized that an accurate history might not be gathered at presentation to the emergency room.4-6When etiological agent is known or is subsequently revealed, specific antidotes may be available and these offer the opportunity to reduce morbidity and mortality.2 Importantly, in cases of deliberate self poisoning, treatment should not end with decontamination and reversal of symptoms alone. A routine referral and follow up with a psychiatrist is to be encouraged.

REFERENCES

  1. Bansal P, Dureja J. Amitraz: An unusual poisoning [Case report]. Anaesth, Pain & Intensive Care 2014;18:46-8.
  2. McGlone MM, Teece SC. Management of the poisoned patient. Anaesthesia & Intensive Care Med 2010;14:453-6.
  3. Little M. Emergency management and resuscitation of poisoned patients: perspectives from “down under”. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2009;17(1):36. [PubMed][Free Full Text]
  4. Witting MD, Hayes BD, Schenkel SM, Drucker CB, DeWane MP, Lantry Iii JH, et al. Emergency Department Medication History Taking: Current Inefficiency and Potential for a Self-Administered Form. The Journal of Emergency Medicine. 2013;45:105-10. [PubMed]
  5. Philip CC, Badhan V. What else could it be? History-quintessential forever! Oman Med J. 2012;27:178. [PubMed][Free Full Text]
  6. Mazer M, DeRoos F, Hollander JE, McCusker C, Peacock N, Perrone J. Medication History Taking in Emergency Department Triage Is Inaccurate and Incomplete. Academic Emergency Medicine. 2011;18:102-4. [PubMed]