Do medical toxicologists use physostigmine to treat anticholinergic toxidrome?
2.5 out of 5 stars
The Use of Physostigmine by Toxicologists in Anticholinergic Toxicity. Watkins JW et al. J Med Toxicol 2014 Dec 16 [Epub ahead of print]
Abstract
Physostigmine is a carbamate that reversibly inhibits acetylcholinesterase, the enzyme that breaks down acetylcholine (ACh). By so doing, it increases the levels of ACh in synapses, serving as an antidote for drugs and agents causing anticholinergic syndrome. Unlike neostigmine, physostigmine crossed the blood-brain-barrier and has both peripheral and central effects.
Decades ago, physostigmine was routinely used with some frequency to treat overdose with ...
Source: The Poison Review - February 18, 2015 Category: Toxicology Authors: Leon Tags: Medical anticholinergic toxidrome physostigmine ToxIC registry Source Type: news
Hemodialysis in acute methanol poisoning: is there really good evidence?
3.5 out of 5 stars
Recommendations for the Role of Extracorporeal Treatments in the Management of Acute Methanol Poisoning: A Systematic Review and Consensus Statement. Roberts DM et al. Crit Care Med 2015 Feb;43:461-472.
Abstract
The Extracorporeal Treatment in Poisoning (EXTRIP) Workgroup was established to provide evidence-based guidance on the use of hemodialysis and other methods of extracorporeal treatment in various toxic exposures. The workgroup has published previous papers giving their recommendations regarding poisoning by acetaminophen, lithium, carbamazepine, barbiturate, tricyclic antidepressants, and thall...
Source: The Poison Review - February 17, 2015 Category: Toxicology Authors: Leon Tags: Medical evidence-based recommendations extracorporeal treatment extrip hemodialysis methanol toxic alcohol Source Type: news
Must-read: another adverse effect associated with tramadol
4 out of 5 stars
Tramadol and Hypoglycemia: One More Thing to Worry About. Nelson LS, Juurlink DN. JAMA Intern Med 2015 Feb 1;175(2):194-5
Reference
Hypoglycemia associated with use of tramadol has been noted previously in scattered case reports, after both overdose and therapeutic ingestion, involving patients with and without diabetes. In this month’s issue of JAMA Internal Medicine, Fournier et al. presented a large case-control study comparing patients started on tramadol for pain with similar patients started on codeine. They found that the tramadol patients had a significantly increased risk of hospitalizati...
Source: The Poison Review - February 10, 2015 Category: Toxicology Authors: Leon Tags: Medical adverse effect hypoglycemia tramadol ultram Source Type: news
The New Yorker on use of psilocybin to treat cancer patients
Recommended long-read of the week is Michael Pollan’s New Yorker article “The Trip Treatment,” a look at research being done at several medical centers — including New York University and Johns Hopkins — into the use of the psychedelic drug psilocybin to ameliorate anxiety and depression in cancer patients.
Similar work had been started half a century ago, but was essentially abandoned after the image of psychedelics became tainted by the excesses of the 1960s, and the Controlled Substances Act of 1970 made it virtually impossible to obtain the drug even for research purposes.
Part of the research...
Source: The Poison Review - February 9, 2015 Category: Toxicology Authors: Leon Tags: Medical cancer New Yorker oncology psilocybin psychedlics Source Type: news
News flash: dead overdose victims can have drugs in the GI tract
1.5 out of 5 stars
Retained drugs in the gastrointestinal tracts of deceased victims of oral drug overdose. Livshits Z et al. Clin Toxicol 2014 Dec 30:1-6 [Epub ahead of print]
Abstract
This is certainly one of the more bizarre medical papers I’ve seen for quite some time.
The main objective of the study was to determine the presence of “undigested or partially digested” tablets found at autopsy in the GI tracts of oral drug overdose fatalities.
Why would they be interested in this question? Apparently to argue that aggressive gastrointestinal decontamination may have benefit even late after oral ingesti...
Source: The Poison Review - February 6, 2015 Category: Toxicology Authors: Leon Tags: Medical activated charcoal cadaver study gastric emptying gastric lavage gastrointestinal decontamination ingestion intoxication overdose whole bowel irrigation Source Type: news
Colorado’s experience with medical effects of legalizing marijuana
3 out of 5 stars
The Implications of Marijuana Legalization in Colorado. Monte AA et al. JAMA 2015 Jan 20;313:241-2.
No abstract available
This brief article, from the Department of Emergency Medicine at the University of Colorado and the Rocky Mountain Poison and Drug Center, gives a concise summary of the medical consequences following Colorado’s legalization of marijuana.
Although Colorado changed its state constitution in 2000 to allow medical marijuana, such use did not really become common until October 2009, when a U.S. Department of Justice memorandum indicated that the DOJ would not prosecute medical marij...
Source: The Poison Review - February 5, 2015 Category: Toxicology Authors: Leon Tags: Medical cannabis cannabis hyperemesis syndrome colorado marijuana medical marijuana recreational marijuana Source Type: news
NEJM discussion of ethylene glycol poisoning misses crucial points
2 out of 5 stars
Case 4-2015: A 49-Year-Old Man with Obtundation Followed by Agitation and Acidosis. Cooper CM, Baron JM. N Engl J Med 2015 Jan 29;372:465-473.
Reference
This episode of the Journal‘s “Case Records of the Massachusetts General Hospital” series is the latest of their amazing inept discussions of medical toxicology cases. Yet again, the discussants do not include a medical toxicologist or emergency physician. Given the level of toxicological awareness evidenced by this case presentation, it’s fortunate that the patient did well.
A unresponsive 49-year-old man was found outside with a ...
Source: The Poison Review - February 3, 2015 Category: Toxicology Authors: Leon Tags: Medical case records of the massachusetts general hospital ethylene glycol poisoning fomepizole management medical toxicology new england journal of medicine Source Type: news
The Bud Light Commercial Too Toxic for the Super Bowl
//www.youtube.com/watch?v=cYIN-b8qjmo
In case you missed it when TPR posted this clip on previous Super Bowl Sundays, here is the toxicology-themed Bud Light commercial that was banned from the air during Super Bowl XLI in 2007. (Source: The Poison Review)
Source: The Poison Review - February 1, 2015 Category: Toxicology Authors: Leon Tags: Medical apology bot 3000 bud light fish poisoning fugu super bowl tetrodotoxin Source Type: news
Tox Tunes #93: Lithium (Evanescence)
As with the Nirvana song of the same title, the lyrics are not completely clear as to whether the singer is describing the experience of the drug, or using it as a metaphor for emotional ambivalence. (We should note that in fact Nirvana’s “Lithium” never mentions the drug in its lyrics.)
I thought of this song after reviewing the new paper from the EXTRIP workgroup paper on extracorporeal treatment of lithium toxicity. (Source: The Poison Review)
Source: The Poison Review - January 26, 2015 Category: Toxicology Authors: Leon Tags: Medical evanescence lithium tox tunes Source Type: news
Saturdays with SMACC: Hinds & May debate cricoid pressure
At the 2014 smaccGOLD conference in Australia, two motorsport enthusiasts, Drs. Brent May (@DocBrent) and John Hinds (@DocJohnHinds) engaged in a very amusing debate about the efficacy of cricoid pressure in managing airways. Taking the pro side, Dr. May argued that applying cricoid pressure is superior (or at least non-inferior) to not doing so in preventing aspiration. Dr. Hinds’ position was that . . . well, it’s best summed up in this graphic:
The combatants were introduced by Minh Le Cong (@ketaminh).
By the way, SMACC is giving away several free student registrations to the smaccUS Chicago conference t...
Source: The Poison Review - January 24, 2015 Category: Toxicology Authors: Leon Tags: Medical brent may cricoid pressure debate john hinds SMACC Source Type: news
Hemodialysis in lithium poisoning: what is the evidence?
3.5 out of 5 stars
Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. Decker BS et al. Clin J Am Soc Nephrol 2015 Jan 12 [Epub ahead of print]
Abstract
The purpose of this review, from the Extracorporeal Treatments in Poisoning (EXTRIP) workgroup, was to give evidence-based recommendations related to use of hemodialysis and other extracorporeal modalities in the treatment of lithium toxicity.
The goal of enhanced elimination in lithium poisoning is to avoid the syndrome of irreversible lithium-effectuated nerutoxicity (SILENT), which causes persistent cerebell...
Source: The Poison Review - January 24, 2015 Category: Toxicology Authors: Leon Tags: Medical extracorporeal treatment extrip hemodialysis indications lithium poisoning Source Type: news
Evidence does not support use of long-term opioid therapy for chronic pain
3.5 out of 5 stars
The Effectivenss and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Chou R et al. Ann Intern Med 2015 Jan 13 [Epub ahead of print]
Abstract
Although prescription opioids have been advocated and used for long-term treatment of chronic non-cancer pain, there is scant literature supporting such use. Most studies have been limited to a time period of 3 months or less. The purpose of this literature review was to assess the evidence pertaining to safety and effectiveness of long-term (> 1 year) opioid therapy fo...
Source: The Poison Review - January 22, 2015 Category: Toxicology Authors: Leon Tags: Medical chronic pain long-term opioids prescription analgesics Source Type: news
Tox Tunes #92: Born in Chicago (Paul Butterfield)
This is my favorite live version of Paul Butterfield’s blues classic “Born in Chicago” (written by Nick Gravenites.) It also features Rick Danko on bass and Blondie Chaplin on guitar. Although this visceral and gritty song does not specifically mention drugs, they are certainly alluded to in the lyrics:
Well, my first friend went down
When I was 17 year old
Well, my first friend went down
When I was 17 years old
Well, there’s one thing I can say about that boy
He gotta go
Well, my second friend went down
When I was 21 years of age
Well, my second friend went down
When I was 21 years of age
Well, th...
Source: The Poison Review - January 19, 2015 Category: Toxicology Authors: Leon Tags: Medical blondie chaplin born in chicago paul butterfield rick danko tox tunes Source Type: news
Tox in the news: 72 die in Mozambique from poisoned beer
Mozambique
In a very strange story that’s been developing all week, the Washington Post reported that at least 72 people died in Mozambique after consuming poisoned beer offered at a funeral gathering. Details are scarce and the poison (or poisons) has not yet been identified, but a limited clinical scenario can be gleaned from reading news coverage.
Apparently, the funeral was an all-day affair. The beer was brewed in and served from a 210 liter container. People who drank the beer only in the morning were not affected. However, those who had the beer in the afternoon were sick by the next morning, with diarrhea ...
Source: The Poison Review - January 16, 2015 Category: Toxicology Authors: Leon Tags: Medical crocodile bile mozambique nyazema poisoned beer tox in the news Source Type: news
TPR Podcast Episode #7: Interview with Guy Weinberg about lipid rescue therapy
NOTE: The audio quality of this recording is understandable but definitely choppy and sub-optimal. However, the concepts discussed are so important that we are uploading the file for those who want to listen. We will also post a transcript of the discussion in the next few days.
In this episode the TPR team interviews Dr. Guy Weinberg from the Department of Anesthesia at the University of Illinois Medical Center in Chicago. Dr. Weinberg, among his many other accomplishments, was instrumental in developing the modality of lipid rescue therapy in treating cardiotoxicity caused by parenteral injection of local anesthetics su...
Source: The Poison Review - January 14, 2015 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news
