ACEP Toxicology Section Antidote App (free)
This simple but very useful app, from the Toxicology Section of the American College of Emergency Physicians, provides basic information about uses and dosing of basic antidotes used in toxicology. Version 1.1 covers approximately 50 different antidotes from A (acetylcysteine) to T (thiamine).
Of course, clinical judgment is still required when considering these treatments, and most situations requiring use of the antidotes listed would justify consultation with a poison center. For example, one of the potential indications listed for hyperbaric oxygen (HBO) therapy in carbon monoxide (CO) poisoning is myocardial ischemia....
Source: The Poison Review - March 27, 2015 Category: Toxicology Authors: Leon Tags: Medical ACEP american college of emergency physicians android antidotes app iOS Source Type: news
Review: 23 patients with laboratory-confirmed MDPV exposure
Methylenedioxypyrovalerone (MDPV)
3.5 out of 5 stars
Acute Methylenedioxypyrovalerone Toxicity. Fruberg BA et al. J Med Toxicol 2014 Dec 3 [Epub ahead of print]
Abstract
This is an impressive paper, but for reasons the authors thoroughly discuss in their limitations sections, there is somewhat less here than meets the eye.
The authors retrospectively reviewed patients seen over a 2-year period at 10 different hospitals who were entered into the ToxIC Registry and coded under a term consistent with “bath salt” exposure. Cases were eligible for the study if they had blood and/or urine laboratory confirmation p...
Source: The Poison Review - March 25, 2015 Category: Toxicology Authors: Leon Tags: Medical bath salts MDPV methylenedioxyphyrovalerone ToxIC registry Source Type: news
Non-controlled and over-the-counter drugs of abuse
2.5 out of 5 stars
Abuse of Medications That Theoretically Are Without Abuse Potential. Reeves RR et al. South Med J 2015 Mar;108:151-157.
Abstract
This review of noncontrolled prescription and over-the-counter drugs that can be and have been abused for non-medical or recreational purposes is rather sketchy and anecdotal (as the authors admit,) but nevertheless contains some useful information.
Classes of drugs discussed include:
Cold & Cough products: pseudoephedrine, ephedrine, oxymetazoline, dextromethorphan
Anticholinergics: diphenhydramine, benztropine, trihexyphenidyl (Artane)
Antipsychotics: quetiapine,...
Source: The Poison Review - March 24, 2015 Category: Toxicology Authors: Leon Tags: Medical cough/cold preparations dextromethorphan medication abuse otc over-the-counter Source Type: news
Tox Tunes #94: Cocaine Blues (David Bromberg)
Along comes Sally with her nose all tore
The doctor says she can’t sniff no more
He says that cocaine’s for horses, it’s not for men
He says it’s gonna kill me but he don’t say when
During the American folk music revival that started in the 1930s and continued into the 1960s and 70s, many musicians rediscovered the rich vein of drug themes that ran through the history of blues and country songs. I first heard Luke Jordan’s “Cocaine Blues” through David Bromberg’s excellent cover version.
Jordan (1882-1952) made several recordings for Victor Records in Charlotte NC and ...
Source: The Poison Review - March 23, 2015 Category: Toxicology Authors: Leon Tags: Medical cocaine blues david bromberg luke jordan tox tunes Source Type: news
Keef Kat, Boddahfinger, and other marijuana edibles — how should they be regulated
3 out of 5 stars
Half-Baked — The Retail Promotion of Marijuana Edibles. MacCoun RF, Mello MM. N Engl J Med 2015 Mar 12;372:989-991.
Full Text
This Perspective piece — from authors at the Stanford Schools of Law and Medicine — discusses problems raised by the increasing availability of marijuana edibles in some states. Often, these products are manufactured in forms that are enticing to children (such as cookies, candy bars, and gummy bears) and packaged to look like familiar consumer products. It have written about this problem previously in several columns for Emergency Medicine News — to read them, click here...
Source: The Poison Review - March 20, 2015 Category: Toxicology Authors: Leon Tags: Medical FDA food and drug administration marijuana edibles schedule I drug THC Source Type: news
Sympathomimetic toxidrome: is it scorpion envenomation or methamphetamine?
Centruroides sculpturatus
2.5 out of 5 stars
Methamphetamine Ingestion Misdiagnosed as Centruroides sculpturatus Envenonmation. Strommen J, Shirazi F. Case Rep Emerg Med Epub 2015 Jan 14.
Full Text
Native to the American southwest and Mexico, Centruroides sculpturatus is the most venomous scorpion in North America. Its venom contains a variety of toxins, including α-toxins that inhibits deactivation of voltage-gated sodium channels causing excitation of both the sympathetic and parasympathetic autonomic systems. In addition, the venom causes catecholamine release. Sympathetic effects usually predominate. Patients oft...
Source: The Poison Review - March 10, 2015 Category: Toxicology Authors: Leon Tags: Medical anascorp antivenom centruroides sculpturatus methamphetamine scorpion sting sympathomimetic toxidrome Source Type: news
Protonix (pantoprazole) can cause a false positive urine screening test for THC
3.5 out of 5 stars
13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire. Felton D et al. Pediatrics 2015 Mar 2 [Epub ahead of print]
Abstract
The package insert for Protonix (pantoprazole) states:
There have been reports of false positive urine screen tests for tetrahydrocannabinol (THC) in patients receiving protein pump inhibitors.
The source of these reports have not been clear, and no cases have previously been reported in the literature. This paper describes a 13-year-old girl who presented to hospital with an episode of recurrent cyclic vomiting syndrome, who was diagnose...
Source: The Poison Review - March 6, 2015 Category: Toxicology Authors: Leon Tags: Medical cannabis false-positive marijuana pantoprazole protonix THC urine drug screen Source Type: news
Intravenous lipid emulsion in oral overdoses: what is the optimal dosing?
This article is an attempt to arrive at a rational dosing schedule for LE in oral overdoses. The authors consider a number of factors:
Very high doses of lipid emulsion have been associated with adverse effects, including acute respiratory distress syndrome
The FDA recommends a maximum dose of 12.5 mL/kg/day when LE is used for nutritional support
The antidotal action of LE may depend on both the “lipid sink” effect and direct cardiac inotropy
Both of the above effects require creation of a moderately lipemic plasma
Combining these considerations with pharmacologic calculations, the authors make the followi...
Source: The Poison Review - March 5, 2015 Category: Toxicology Authors: Leon Tags: Medical dosing intralipid lipid emulsion lipid rescue therapy Source Type: news
TPR Podcast Episode #8: Pearls from NACCT
Discussion of Dr. Millard Bass’ JAMA article “Sudden Sniffing Death” (SSD)
SSD occurs after sniffing, bagging, or huffing a volatile hydrocarbon inhalant
Hypothesis: death results from sensitization of the myocardium to catecholamines, resulting in cardiac arrhythmias
Capsaicin for Cannabinoid Hyperemesis Syndrome
Initial idea to use capsaicin in the treatment of cannabinoidhyperemesis syndrome (CHS) stemmed from:
Symptomatic relief from hot showers or baths often reported by patients
Realization that TRPV1 receptor is activated by both hot temperatures and capsaicin
Case reports from California and Ne...
Source: The Poison Review - March 1, 2015 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast cannabinoid hyperemesis syndrome capsaicin cream clenbuterol NACCT phenibut sudden sniffing death syndrome tpr podcast Source Type: news
Is lipid emulsion therapy effective in calcium-channel-blocker and beta-blocker overdose?
2 out of 5 stars
Role of intravenous lipid emulsions in the management of calcium channel blocker and β-blocker overdose: 3 years experience of a university hospital. Sebe A et al. Postgrad Med 2015 Feb;127:119-124.
Abstract
The authors of this study, from Cukurova University School of Medicine in Turkey, retrospectively reviewed patients admitted to their hospital who were treated with lipid rescue therapy (LRT) for refractory hypotension, heart block, or cardiac arrest following overdose from a calcium-channel-blocker (CCB) or a beta-blocker (BB).
They identified 15 patients(9 CCB, 6 BB.) There were two cardiac arre...
Source: The Poison Review - February 28, 2015 Category: Toxicology Authors: Leon Tags: Medical beta blocker overdose calcium channel blocker overdose intralipid lipid emulsion lipid rescue therapy Source Type: news
Tox on the web: 12 students hospitalized at Wesleyan College after “Molly” overdose
Four students arrested at Wesleyan College after “Molly” overdoses: Last weekend a dozen students and visitors at Wesleyan University in Middletown, Connecticut were hospitalized after apparently ingesting a drug or drugs labelled as “Molly.” Two victims were in critical condition and were medevacked to Hartford Hospital, the only Level 1 Trauma Center in the region. By mid-week, these two patients were still in hospital but reported to be improving. Four students have been arrested in connection with this incident.
As @forensictoxguy pointed out on his blog “The Dose Makes The Poison,̶...
Source: The Poison Review - February 27, 2015 Category: Toxicology Authors: Leon Tags: Medical activated charcoal cleanse designer drug detox guy weinberg intralipid lipid rescue therapy mdma molly tox talk wesleyan Source Type: news
Excellent review of lipid rescue therapy
3.5 out of 5 stars
Intravenous Lipid Emulsion in the Emergency Department: A Systematic Review of Recent Literature. Cao D et al. J Emerg Med 2014 Dec 19 [Epub ahead of print]
Abstract
This excellent comprehensive review of lipid rescue therapy (LRT) is vitiated only by the unavoidable fact that available clinical evidence is so inconclusive. As the authors point out, published literature consists mostly of case reports and small case series. The vast majority of these reported cases have good outcomes and reflect positive effects from ILE, but the evidence is marred by multiple confounding variables (such as concurren...
Source: The Poison Review - February 25, 2015 Category: Toxicology Authors: Leon Tags: Medical intralipid lipid emulsion lipid rescue therapy lipid sink Review Source Type: news
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2.5 out of 5 stars
Evaluation of Residual Toxic Substances in the Stomach Using Upper Gastrointestinal Endoscopy for Management of Patients With Oral Drug Overdose on Admission. Miyauchi M et al. Medicine 2015 Jan;94:e463
Abstract
Despite many flaws, this paper has some interesting data that the authors use to come to exactly the wrong conclusion.
The authors studied patients presenting with oral non-liquid drug overdose. Using endoscopy they classified the contents of the stomach as: 1) tablet/food phase; 2) soluble/fluid phase; and 3) reticular/empty phase.(I’m not clear on the precise meaning of a “tablet/f...
Source: The Poison Review - February 24, 2015 Category: Toxicology Authors: Leon Tags: Medical gastric empyting gastric lavage gastrointestinal decontamination Source Type: news
Sundays with SMACC: Sonowars 2014
SonoWars from Social Media and Critical Care on Vimeo.
At the SMACC Gold conference last March in Australia, an epic Sonowars contest pitted the Northern Hemisphere against the Southern Hemisphere. Representing the North were Matt Dawson and Mike Mallin from the Ultrasound Podcast. Meeting the bell for the lands down under were James Rippey and Adrian Goudie from Ultrasound Village and The Sono Cave. The battle is both amusing and informative. The entire session lasts about 90 minutes. If time is limited, start watching at 56:00, where Dr. Rippey builds a heart out of clay to teach echocardiographic anatomy, and Dr. Malli...
Source: The Poison Review - February 22, 2015 Category: Toxicology Authors: Leon Tags: Medical SMACC Chicago SMACC Gold sonowars Source Type: news
Treating severe drug-induced hyperthermia with an ice-water bath
3 out of 5 stars
Ice water submersion for rapid cooling in severe drug-induced hyperthermia. Laskowski LK et al. Clin Toxicol 2015 Mar;53:181-184.
Abstract
There is still debate about the optimal method of cooling severely hyperthermic patients, such as those with core temperature > 104oF (40oC) who are exhibiting changes in mental status. Some common techniques include ice packs to the groin and axillae, cooling blankets, along with convection (evaporation) techniques such as cool sprays and fans. There is little debate, however, about the proposition that the faster these extremely hyperthermic patients are cooled th...
Source: The Poison Review - February 21, 2015 Category: Toxicology Authors: Leon Tags: Medical active cooling drug-induced hyperthermia ice-water bath Source Type: news
