Abstract
Disposition of Toxic Drugs and Chemicals in Man (DTDCM) has been one of the handful of prominent reference publications in the fields of general toxicology and analytical chemistry since it was first published. There have been 8 previous editions. The first publication was 290 pages with less than 200 entries, was in a different format, and was published in 1978. This latest ninth edition is 1877 pages with over 1200 entries, which is nearly 280 entries more than the eighth edition that was published in 2008. Not only does this growth reflect the vast increase in chemical and drug development in society, it provides the reader with a sense of the longevity of this much needed contribution to medical toxicology and overall scientific community. The primary thrust of this publication is to present in a single yet convenient source of the current critical information on the disposition of the chemicals most frequently encountered in episodes of human poisoning. The entries span a wide range of chemicals including, but not limited to, pharmaceuticals, chemotherapeutic agents, drugs of abuse, herbal drugs, doping agents, nutrients, industrial chemicals, pesticides, environmental contaminants, explosives, and dietary supplements. Since the publication of the first edition, Dr Baselt has kept DTDCM up-to-date with the ever-changing world of chemical/drug development including pharmacotherapeutics, pharmacodynamics, drug metabolism, as well as bio- and chemical-analyses. Each entry includes the common usage and occurrence of the chemical, the body fluid concentrations of substances in normal and/or therapeutic situations, concentrations found in fluids and tissues in instances of overt toxicity, general clinical toxicology, a brief description of known specific procedures for chemical/biological analysis, and a summary of the current knowledge of the metabolic fate of the substance in man. With each succeeding edition, Baselt has enhanced the text with additional information within each entry such as the inclusion of the blood–plasma concentration ratio, pharmacogenetic data, and in vitro drug stability. It appears that these volumes will continue in the future since the field is constantly changing and this author has very precisely found one of the best formats to present all this massive amount of critical data that many researchers have found to be user friendly. The publication has become a stalwart in the annals of general and forensic toxicology and—no doubt—will have a continuing presence in the future of these and other closely related scientific disciplines.
Interestingly, Dr Robert J. Flanagan wrote a very public critique of the book on Amazon.com in September 2009 indicating that the eighth edition was an invaluable resource; however, he proclaimed a note of caution when examining the data presented in the book. In that review, Flanagan wrote that the “proper interpretation of analytical data requires not only an understanding of the circumstances surrounding a case, but also an appreciation of the circumstances under which any data cited to aid interpretation were produced.” 1 As a practicing toxicologist, I concur with Flanagan’s view that many factors are involved in attempting to characterize toxicity. Apparently, taking that critique to heart, Baselt also agreed with that observation and—while I am certainly not privy to any behind-the-scenes logistics that occurred after that review—this newly released ninth edition includes “a prologue devoted to the interpretation of bioanalytical testing results” 2 written by none other than that reviewer from Amazon.com, Robert J. Flanagan of the King’s College (London). I might add that Flanagan’s eight page addition—which is entitled “Guidelines for the Interpretation of Analytical Toxicology Results” does provide a fairly in-depth review of the various factors that make the application of analytical toxicology such a rigorous exercise. While Flanagan’s prologue outlines the numerous variables in some detail, it may also be seen as a disclaimer for the book in general—reminding the reader that what data are presented must be viewed through the prism of many circumstances and conditions that affect the proper interpretation of quantitative data. This is a consideration about which those who read the publication are already aware. Nevertheless, it adds depth and nicely complements the ninth edition and provides a reminder to those in the field and a guide post to the reader who is not in the field, of the many mitigating factors necessary for evaluation of such data. That being said, the work—while the entries are not exhaustive—provides continuing excellent guidance and information providing the reader an immediate comprehendible thumbnail assessment of the human toxicology for a given chemical.
One of the truly useful aspects of Baselt’s book is that he has painstakingly collected decades of scientific knowledge as well as the most recent literature on the various aspects of each of these chemicals and has organized these data into a useful standard format within each entry. This format gives the reader a format that is immediately recognizable, including from where data are located and whether or not there is known scientific information for a particular section entry. Furthermore, the reader is directed to references handily located at the end of each entry rather than at the end of the book if one seeks further detailed information about the subject chemical. The references have been updated and consist of the most prominent and recent references available for the given topic. The chemicals are arranged in alphabetical rather than in functional or chemical groupings, which can be useful to the casual user who may not be familiar with the chemical structure and function.
With the addition of so many drugs and chemicals, there is a continuing complicated overlay that results in ever increasing diagnostic problems for researchers not only because of the large number of the products per se but because of their varied and complex interactions with the human body. Baselt has striven to simplify these complex issues by concisely summarizing the findings in a standard format so the reader can easily find the target chemical and can immediately visualize in a page or 2 what is known about the general characteristics, metabolic fate, toxicity, and bio- and chemical-analyses of that chemical of concern.
In summary, the ninth edition of DTDCM is a time-tested, comprehensive compilation of the analytical chemical science of chemicals which have been commonly noted in human overdoses. Baselt has researched, evaluated, and organized these data into a clear, concise, consistent, and quite usable format that has stood the test for over 3 decades of use in the field. A valuable enhancement to this edition includes a prologue describing the mitigating factors in the interpretation of these data, thus providing the reader with a foundation for practical application of these data to the circumstance at hand. This book not only is highly recommended for inclusion in the personal library of those needing a reliable reference for general clinical toxicity but also is an indispensable reference source for practicing pharmacologists, clinical chemists, forensic scientists, pathologists, and clinicians as well as students of any of these disciplines. Most institutional libraries already have this authoritative reference publication in-house available for their scientific staff and know just how valuable it is. My recommendation is that any individual or institution that has an earlier edition should obtain this latest/ninth edition because it has not only nearly 280 new entries but also been thoroughly updated with the latest medical/scientific information on all entries.