1. Use fomepizole rather than ethanol to treat toxic alcohol exposure.
Though it is not yet considered standard of care, near ubiquitous use of fomepizole is beneficial. It is easier to administer, and although more expensive than alcohol for the actual antidote, overall therapy is less intensive and less expensive due to decrease monitoring and critical care stay.2. Use IV n-acetylcysteine rather than oral n-acetylcysteine to treat acetaminophen toxicity.
Although the IV formulation is more expensive, its use is only 24 hours rather than 72 hours, decreasing length of stay.3. Use octreotide to treat sulfonylurea-induced hypoglycemia.
This antidote in inexpensive and its use prevents precipitous rises and dips of serum glucose, and avoids the need for repeat glucose infusions.4. Use early dialysis.
Dialysis is expensive, but preventing sequelae from poisoning, such as with salicylate, or diminishing the overall duration of poisoning, such as with methanol, decreases morbidity and critical care stays.5. Avoid wasted costs on unnecessary lab tests.
Though a battery of lab assays are often obtained for patients with poison exposure, few are ever needed. The commonly indicated assays are bedside glucose measurement, serum electrolytes, and acetaminophen level, as well as serum drug levels for specific poisons. Drug of abuse screening, PT/PTT, CBC, and other ancillary tests should not be routinely obtained.6. Discharge after two to four hour observation.
Traditional observation of poison exposed patients has been six hours. This is based on dogma rather than evidence. Certain poisons warrant observation for a particular period of time, but, as a general rule, a two to four hour observation period appears to be appropriate for most patients. If you have any doubt, contact a poison center or toxicologist and specifically ask if the poison in question mandates prolonged observation or admission.