4,919 results match your criteria Clinical Toxicology[Journal]


Intramuscular sodium tetrathionate as an antidote in a clinically relevant swine model of acute cyanide toxicity.

Clin Toxicol (Phila) 2019 Apr 22:1-7. Epub 2019 Apr 22.

a Department of Emergency Medicine, School of Medicine , University of Colorado , Aurora , CO , USA.

Background: Cyanide is a metabolic poison used in multiple industries and is a high threat chemical agent. Current antidotes require intravenous administration, limiting their usefulness in a mass casualty scenario. Sodium tetrathionate reacts directly with cyanide yielding thiosulfate and the non-toxic compound thiocyanate. Read More

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https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1
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http://dx.doi.org/10.1080/15563650.2019.1602272DOI Listing
April 2019
2 Reads

Evidence of fentanyl use is common and frequently missed in a cross-sectional study of emergency department patients in Baltimore, Maryland.

Clin Toxicol (Phila) 2019 Apr 22:1-3. Epub 2019 Apr 22.

b Center for Substance Abuse Research (CESAR) , University of Maryland , College Park , MD , USA.

Objective: Fentanyl-associated deaths have risen in Maryland, but the prevalence of illicit fentanyl use is unknown. Our objective was to measure whether fentanyl is present among emergency department (ED) patients seeking care for a drug overdose.

Design: The prevalence of fentanyl use was determined using a cross-sectional study of a convenience sample of adult ED patients with complaints of apparent opioid overdose, withdrawal from opioids, and/or requesting treatment for their substance use disorder (SUD) between February and April, 2018. Read More

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http://dx.doi.org/10.1080/15563650.2019.1605078DOI Listing
April 2019
1 Read

Pediatric guanfacine exposures reported to the National Poison Data System, 2000-2016.

Clin Toxicol (Phila) 2019 Apr 22:1-7. Epub 2019 Apr 22.

b Center for Health Equity and Quality Research, UF Health - Jacksonville , Jacksonville , FL , USA.

Introduction: The purpose of this study was to characterize the frequency, reasons for exposure, clinical manifestations, treatments, duration of effects, and medical outcomes of pediatric guanfacine exposures reported to the National Poison Data System (NPDS) from 2000 to 2016.

Methods: Data extracted from poison control center call records for pediatric (0-5 years, 6-12 years, and 13-19 years), single-substance guanfacine ingestions reported to NPDS between 2000 and 2016 was retrospectively analyzed.

Results: A total of 10927 cases were identified for analysis. Read More

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http://dx.doi.org/10.1080/15563650.2019.1605076DOI Listing
April 2019
1 Read

Cannabis use and acute coronary syndrome.

Clin Toxicol (Phila) 2019 Apr 9:1-11. Epub 2019 Apr 9.

a Department of Emergency Medicine , University of California Davis Medical Center , Sacramento , CA , USA.

Introduction: Cannabis smoking can result in elevation of heart rate and blood pressure immediately after use, possibly from sympathetic nervous system stimulation and parasympathetic nervous system inhibition. Vascular inflammation, platelet activation, and carboxyhemoglobin generation have also been proposed as potential side effects of cannabis smoking. As such, an association between cannabis use and acute coronary syndrome has been postulated. Read More

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http://dx.doi.org/10.1080/15563650.2019.1601735DOI Listing
April 2019
1 Read

Publication outcomes of abstracts presented at an international toxicology conference.

Clin Toxicol (Phila) 2019 Apr 7:1-3. Epub 2019 Apr 7.

c Department of Emergency Medicine and Section of Medical Toxicology, School of Medicine , University of Colorado , Denver , CO , USA.

Introduction: The timely and formal publication of material presented at national and international meetings is critical to the dissemination of new information to the medical community. The conversion rates for toxicology abstracts to full-text publications at previous North American toxicology meetings were low. No study has assessed the publication rate from the European Association of Poisons Centers and Clinical Toxicologists (EAPCCT). Read More

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http://dx.doi.org/10.1080/15563650.2019.1599902DOI Listing

Enhanced toxicity from powder cocaine use in comparison to crack cocaine use - an observational study in the intensive care unit.

Clin Toxicol (Phila) 2019 Apr 3:1-2. Epub 2019 Apr 3.

b Laboratory of Toxicology , Lariboisière Hospital, Federation of Toxicology APHP, Paris-Descartes University, INSERM UMRS-1144 , Paris , France.

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https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1
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http://dx.doi.org/10.1080/15563650.2019.1596281DOI Listing
April 2019
7 Reads

The relationship between antemortem and postmortem morphine concentrations.

Clin Toxicol (Phila) 2019 Mar 23:1-4. Epub 2019 Mar 23.

c Honorary Professor of Clinical Pharmacology , West Midlands Centre for Adverse Drug Reactions , Birmingham , United Kingdom of Great Britain and Northern Ireland.

Context of the Article: An important forensic problem is whether the presence of a drug such as morphine caused or contributed to a death or was merely incidental. The reliance that can be based on postmortem drug concentrations remains controversial. To investigate this further we obtained antemortem and postmortem samples of individuals admitted to hospital who were receiving morphine and who died in hospital. Read More

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http://dx.doi.org/10.1080/15563650.2019.1591430DOI Listing

Coagulopathy and bleeding associated with salicylate toxicity.

Clin Toxicol (Phila) 2019 Mar 22:1-4. Epub 2019 Mar 22.

d Department of Emergency Medicine , Oregon Poison Center, Oregon Health and Science University , Portland , OR , USA.

Introduction: Salicylate toxicity is a common cause of morbidity and hospitalization. Animal and human studies suggest that salicylates cause a dose-dependent inhibition of the activation of factors 2, 7, 9, and 10. However, limited reports of coagulopathy or major bleeding from salicylate toxicity exist. Read More

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http://dx.doi.org/10.1080/15563650.2019.1593432DOI Listing
March 2019
1 Read

Prospective evaluation of a clinical decision tool to reduce childhood admissions to PICUs for poisoning: ReCAP.

Clin Toxicol (Phila) 2019 Mar 22:1-5. Epub 2019 Mar 22.

a Department of Pediatrics, Division of Critical Care Medicine, Children's Healthcare of Atlanta at Egleston , Emory University School of Medicine , Atlanta , GA , USA.

Aim: To prospectively validate a pediatric clinical prediction model to identify children at low risk of clinically significant ingestions to prevent unnecessary pediatric intensive care unit (PICU) admissions.

Methods: Calls received by the Georgia Poison Center about children for acute ingestions between May 25, 2017 and May 17, 2018 were scored in real time using the full, age-stratified, and simplified clinical scoring tool to reduce childhood admissions to PICUs for poisoning (RECAP). Clinically significant ingestions with a poison center recommendation of PICU admission are defined in the simple RECAP model as ingestion of clonidine, ethanol, an oral anti-hyperglycemic agent, or exposure to carbon monoxide, as well as the presence of symptoms occurring within 2 h for an immediate release, or 4 h for an extended release, medication exposure. Read More

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http://dx.doi.org/10.1080/15563650.2019.1590587DOI Listing

Ventricular tachycardia in a patient with sigmoid volvulus on treatment with donepezil.

Clin Toxicol (Phila) 2019 Mar 21:1-3. Epub 2019 Mar 21.

a Departments of Cardiology and Medicine , Wexham Park Hospital, Frimley Health NHS Foundation Trust , Slough , UK.

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http://dx.doi.org/10.1080/15563650.2019.1588288DOI Listing
March 2019
2 Reads

QTc prolongation and Torsade de Pointes induced by extreme eperisone overdose.

Clin Toxicol (Phila) 2019 Mar 21:1-2. Epub 2019 Mar 21.

b Department of Pharmacy , Saitama Medical University Hospital , Saitama , Japan.

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http://dx.doi.org/10.1080/15563650.2019.1592186DOI Listing
March 2019
2 Reads

Tramadol, naloxone, and seizures.

Clin Toxicol (Phila) 2019 Mar 21. Epub 2019 Mar 21.

c Department of Emergency Medicine , Cook County Hospital (Stroger), Illinois Poison Center , Chicago , IL , USA.

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http://dx.doi.org/10.1080/15563650.2019.1591431DOI Listing
March 2019
2 Reads

Analytically confirmed 4-Methyl-N-ethylnorpentedrone (4-MEAP), a synthetic cathinone, in cases presenting to an emergency department.

Clin Toxicol (Phila) 2019 Mar 21:1-2. Epub 2019 Mar 21.

a Department of Emergency Medicine , National Taiwan University College of Medicine and National Taiwan University Hospital , Taipei , Taiwan.

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http://dx.doi.org/10.1080/15563650.2019.1591432DOI Listing
March 2019
1 Read

A review of 4652 exposures to liquid laundry detergent capsules reported to the United Kingdom National Poisons Information Service 2008-2018.

Clin Toxicol (Phila) 2019 Mar 20:1-8. Epub 2019 Mar 20.

a NPIS (Birmingham Unit) , City Hospital , Birmingham , UK.

Introduction: Liquid laundry detergent capsules contain concentrated liquid laundry detergent in a water-soluble polyvinyl alcohol membrane.

Objective: To review 4652 exposures reported to the United Kingdom National Poisons Information Service (NPIS) and to assess the impact of regulatory changes on potential toxicity.

Methods: Telephone enquiries to the NPIS and returned questionnaires for these products were analyzed for the period January 2008 to December 2018. Read More

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https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1
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http://dx.doi.org/10.1080/15563650.2019.1590586DOI Listing
March 2019
9 Reads

Medical outcomes of bromethalin rodenticide exposures reported to US poison centers after federal restriction of anticoagulants.

Clin Toxicol (Phila) 2019 Mar 20:1-6. Epub 2019 Mar 20.

a Wisconsin Poison Center , Milwaukee , WI, USA.

Background: Exposures to bromethalin rodenticides have increased since restrictions were placed on long acting anticoagulant rodenticide (LAAR) registrations in 2008. Bromethalin works, in part, by uncoupling mitochondrial oxidative phosphorylation. Toxicity in humans is not well characterized and no antidote is available. Read More

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http://dx.doi.org/10.1080/15563650.2019.1582776DOI Listing
March 2019
1 Read

Understanding the risk of seizure in tramadol overdose: still a long way to go.

Clin Toxicol (Phila) 2019 Mar 20. Epub 2019 Mar 20.

b National Egyptian Center of Environmental and Toxicological Research (NECTER), Faculty of Medicine, Cairo University , Cairo , Egypt.

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http://dx.doi.org/10.1080/15563650.2019.1591433DOI Listing
March 2019
1 Read

Epidemiology, toxicokinetics and biomarkers after self-poisoning with Gloriosa superba.

Clin Toxicol (Phila) 2019 Mar 19:1-7. Epub 2019 Mar 19.

a South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine , University of Peradeniya , Peradeniya , Sri Lanka.

Introduction: Gloriosa superba is a flowering plant that contains colchicine. Deliberate self-poisoning with this plant in Sri Lanka is common and potentially fatal. The objective of this study was to describe the epidemiology, toxicokinetics and selected biomarkers in these patients. Read More

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http://dx.doi.org/10.1080/15563650.2019.1581939DOI Listing
March 2019
2 Reads

Highly potent fentanyl analogs: apnea from exposure to small quantities of ß-hydroxyfentanyl and furanylfentanyl.

Clin Toxicol (Phila) 2019 Mar 19:1-3. Epub 2019 Mar 19.

c Clinical Toxicology and Environmental Biomonitoring Lab, University of California, San Francisco , San Francisco , CA, USA.

Context: Fentanyl analogs are synthetic opioids that bind to mu receptors with high potency. We report two cases where users developed apnea and required naloxone reversal after exposure to small quantities of the fentanyl analogs, furanylfentanyl and ß-hydroxyfentanyl.

Case Details: A 19 year-old woman reported insufflating a small number of granules of "fentanyl" powder and developed apnea. Read More

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http://dx.doi.org/10.1080/15563650.2018.1558233DOI Listing
March 2019
2 Reads

Analysis of blood lead levels of young children in Flint, Michigan before and during the 18-month switch to Flint River water.

Clin Toxicol (Phila) 2019 Mar 14:1-8. Epub 2019 Mar 14.

f Department of Microbiology, Biochemistry, and Molecular Genetics , Rutgers New Jersey Medical School , Newark , NJ , USA.

Background: The toxicity of lead, like any xenobiotic, is directly linked to the duration of exposure and toxin concentration in the body. The elevation in blood lead levels (BLLs) in young Flint, Michigan children noted in time-periods before, and during the 18-month exposure to Flint River water (FRW) from 25 April 2014 to 15 October 2015 is well-known internationally. The length of time BLLs were elevated is unknown, yet key in understanding the potential health impact of the event. Read More

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http://dx.doi.org/10.1080/15563650.2018.1552003DOI Listing
March 2019
2 Reads

A curious case of cannabinoid toxicity.

Clin Toxicol (Phila) 2019 Mar 12:1-2. Epub 2019 Mar 12.

c West Midlands Poisons Unit , City Hospital , Birmingham , UK.

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http://dx.doi.org/10.1080/15563650.2019.1587449DOI Listing
March 2019
1 Read

Impact of extra-corporeal membrane oxygenation on outcome of aluminium phosphide poisoning complicated with myocardial dysfunction.

Clin Toxicol (Phila) 2019 Mar 11:1-8. Epub 2019 Mar 11.

a Department of Cardiology , Dayanand Medical College and Hospital , Ludhiana , India.

Background: Aluminium phosphide (AlP) poisoning is associated with a high mortality rate when patients are complicated with myocardial dysfunction and refractory shock or severe metabolic acidosis. We studied the role of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) in patients of AlP poisoning induced myocardial dysfunction.

Methods And Results: This is a tertiary care, single-centre, retrospective study. Read More

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http://dx.doi.org/10.1080/15563650.2019.1584297DOI Listing
March 2019
3 Reads

Inadvertent ocular exposures secondary to e-liquid misuse.

Clin Toxicol (Phila) 2019 Mar 11:1-2. Epub 2019 Mar 11.

a Department of Emergency Medicine , Oregon Health and Science University , Portland , OR , USA.

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http://dx.doi.org/10.1080/15563650.2019.1577434DOI Listing

A case of accidental neonatal paracetamol overdose with prolonged half-life and measured metabolites.

Clin Toxicol (Phila) 2019 Mar 11:1-3. Epub 2019 Mar 11.

a Monash Toxicology Unit and Emergency Medicine Service, Monash Health , Victoria , Australia.

Introduction: Limited data exist regarding paracetamol metabolism after overdose in the neonate. We report a case of repeated supratherapeutic overdose in a neonate with paracetamol metabolite concentrations.

Case Report: A 10-day-old male neonate presented to hospital after repeated supratherapeutic dosing of paracetamol. Read More

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http://dx.doi.org/10.1080/15563650.2019.1587450DOI Listing
March 2019
2 Reads
3.122 Impact Factor

Potential uses of naltrexone in emergency department patients with opioid use disorder.

Clin Toxicol (Phila) 2019 Mar 4:1-7. Epub 2019 Mar 4.

a Department of Emergency Medicine, Division of Medical Toxicology , University of Massachusetts Medical School and Umass Memorial Medical Center , Worcester , MA , USA.

Introduction: Despite widespread recognition of the opioid crisis, opioid overdose remains a common reason for Emergency Department (ED) utilization. Treatment for these patients after stabilization often involves the provision of information for outpatient treatment options. Ideally, an ED visit for overdose would present an opportunity to start treatment for opioid use disorder (OUD) immediately. Read More

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https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1
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http://dx.doi.org/10.1080/15563650.2019.1583342DOI Listing
March 2019
6 Reads

Syrian rue seeds interacted with acacia tree bark in an herbal stew resulted in N,N-dimethyltryptamine poisoning.

Clin Toxicol (Phila) 2019 Mar 4:1-3. Epub 2019 Mar 4.

d Department of Emergency Medicine , Chang Gung Memorial Hospital , Keelung , Taiwan.

Introduction: Illicit substance use is an increasing problem all over the world, especially in adolescents and young adults. It is a challenge to make a definitive diagnosis of a specific substance in a poisoning case without toxicology laboratory confirmation. We confirmed the presence of N,N-dimethyltryptamine (DMT) by liquid chromatograph tandem mass spectrometer (LC/MS/MS) in biologic samples from two patients who presented with signs and symptoms consistent with sympathomimetic toxicity following the consumption of an herbal stew. Read More

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http://dx.doi.org/10.1080/15563650.2019.1576877DOI Listing
March 2019
5 Reads

Massive eucalyptus oil overdose leading to prolonged coma.

Clin Toxicol (Phila) 2019 Feb 26:1-2. Epub 2019 Feb 26.

c Austin Health, Clinical Toxicology Service and Victorian Poisons Information Centre , Heidelberg , Australia ;

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http://dx.doi.org/10.1080/15563650.2019.1578368DOI Listing
February 2019

A randomized controlled study comparing high-dose insulin to vasopressors or combination therapy in a porcine model of refractory propranolol-induced cardiogenic shock.

Clin Toxicol (Phila) 2019 Feb 26:1-7. Epub 2019 Feb 26.

b Department of Emergency Medicine , Regions Hospital , St. Paul , MN , USA.

Context: Although cerebral perfusion (CP) is preserved across a wide range of mean arterial pressures (MAP) through cerebral-vascular autoregulation, the relationship between MAP and CP in refractory poison-induced cardiogenic shock (PICS) has never been studied. We compared the effects of therapies used in PICS: high-dose insulin (HDI), HDI plus norepinephrine (NE), and vasopressors alone (NE plus epinephrine (Epi)) on cerebral tissue oxygenation (PO).

Methods: Fifteen swine were randomized to either HDI, HDI + NE, or NE + Epi. Read More

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http://dx.doi.org/10.1080/15563650.2019.1580372DOI Listing
February 2019
4 Reads

Psoriasiform eruption caused by teriflunomide in a patient with multiple sclerosis.

Clin Toxicol (Phila) 2019 Feb 26:1-3. Epub 2019 Feb 26.

b Istanbul University, Neurology Clinic , İstanbul , Turkey.

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http://dx.doi.org/10.1080/15563650.2019.1581940DOI Listing
February 2019
2 Reads

Deaths by poisoning in New Zealand, 2008-2013.

Clin Toxicol (Phila) 2019 Feb 26:1-8. Epub 2019 Feb 26.

a Best Practice Advocacy Centre New Zealand , Dunedin , New Zealand.

Introduction: While a number of developed countries have witnessed a decline in carbon monoxide (CO) deaths and increasing numbers of opioid-related fatalities, it is not known whether these or other trends have occurred in New Zealand. The aim of this study was, therefore, to review deaths due to poisoning in New Zealand, describe the causative substances, and identify any trends.

Methods: Retrospective study reviewing New Zealand's poison-related death findings recorded in the National Coronial Information System (NCIS) database over the 6-year period 2008-2013. Read More

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http://dx.doi.org/10.1080/15563650.2019.1582777DOI Listing
February 2019

Fatal intoxication with new synthetic cannabinoids AMB-FUBINACA and EMB-FUBINACA.

Clin Toxicol (Phila) 2019 Feb 26:1-6. Epub 2019 Feb 26.

a Institute of Forensic Research , Krakow , Poland.

Introduction: Synthetic cannabinoids are currently the largest group of new psychoactive substances. Those that have been subjected to legal control are replaced by newer uncontrolled substances, which causes constant and dynamic changes to the drug market. Some of the most recent synthetic cannabinoids that have appeared on the "legal highs" market are AMB-FUBINACA and EMB-FUBINACA. Read More

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http://dx.doi.org/10.1080/15563650.2019.1580371DOI Listing
February 2019
1 Read

The kiss of (cell) death: can venom-induced immune response contribute to dermal necrosis following arthropod envenomations?

Clin Toxicol (Phila) 2019 Feb 26:1-9. Epub 2019 Feb 26.

a Venom Systems and Proteomics Lab, School of Natural Sciences , Ryan Institute, National University of Ireland Galway , Galway , Ireland.

Introduction: Snakes, insects, arachnids and myriapods have been linked to necrosis following envenomation. However, the pathways involved in arthropod venom-induced necrosis remain a highly controversial topic among toxinologists, clinicians and the public. On the one hand, clinicians report on alleged envenomations based on symptoms and the victims' information. Read More

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http://dx.doi.org/10.1080/15563650.2019.1578367DOI Listing
February 2019
1 Read

Video delivery of toxicology educational content versus textbook for asynchronous learning, using acetaminophen overdose as a topic.

Clin Toxicol (Phila) 2019 Feb 26:1-5. Epub 2019 Feb 26.

c Department of Emergency Medicine , University of Colorado School of Medicine , Aurora , USA.

Objectives: Advances in technology have brought with them innovations in delivery of medical educational content; for example, audio and video podcasts, flipped classroom learning, and e-books. These new modalities may be useful for delivery of content asynchronously, as an adjunct to traditional lecture-based and bedside clinical teaching. Here, we measured the differences in knowledge acquisition between medical students using a video-based content delivery method and students using a traditional method of asynchronous content delivery (a textbook chapter). Read More

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http://dx.doi.org/10.1080/15563650.2019.1574974DOI Listing
February 2019
2 Reads

Loperamide induced cardiac arrhythmia successfully supported with veno-arterial ECMO (VA-ECMO), molecular adsorbent recirculating system (MARS) and continuous renal replacement therapy (CRRT).

Clin Toxicol (Phila) 2019 Feb 26:1-5. Epub 2019 Feb 26.

a Division of Critical Care Medicine , University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center , Baltimore , MD , USA.

Introduction: This case of Loperamide misuse had refractory ventricular arrhythmias and was successfully supported by VA ECMO. Loperamide is currently available without prescription and can be obtained in large quantities over the internet despite Food and Drug Administration (FDA) 2016 black box warning noting cardiac toxicity. This case illustrates the life-threatening toxicity of loperamide and suggests a supportive modality to provide clinical time while the drug is cleared endogenously or exogenously. Read More

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http://dx.doi.org/10.1080/15563650.2019.1580370DOI Listing
February 2019
5 Reads

Authors' reply to Comment on "A 29-year analysis of acute peak salicylate concentrations in fatalities reported to United States poison centers".

Clin Toxicol (Phila) 2019 May 26;57(5):378. Epub 2019 Feb 26.

b Children's Hospital of Michigan Regional Poison Center , Detroit , MI , USA.

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http://dx.doi.org/10.1080/15563650.2018.1554815DOI Listing

Human exposures to veterinary pharmaceutical products reported to Australia's largest poison information centre.

Clin Toxicol (Phila) 2019 Feb 21:1-12. Epub 2019 Feb 21.

a Translational Australian Clinical Toxicology (TACT) Research Group, Discipline of Pharmacology , Sydney Medical School, The University of Sydney , Camperdown , Australia.

Aim: To describe the epidemiology of veterinary pharmaceutical-related exposures based on telephone calls to Australia's largest poisons information centre.

Methods: A retrospective analysis of exposures to pharmaceutical products intended for animal use, managed by the New South Wales Poison Information Centre (NSWPIC, Australia's largest poisons information centre) from 2014 to 2016 inclusive, was conducted. Case narratives were reviewed and coded for exposure-related circumstances and intended species. Read More

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http://dx.doi.org/10.1080/15563650.2019.1572180DOI Listing
February 2019
3 Reads

The effect of a more strict 2014 DEA schedule designation for hydrocodone products on opioid prescription rates in the United States.

Clin Toxicol (Phila) 2019 Feb 21:1-9. Epub 2019 Feb 21.

a The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine , Dartmouth College , Hanover , NH , USA.

Background: From 1999 to 2010, the annual number of US deaths due to opioid overdose increased about 400% as the number of opioids prescribed yearly also increased by approximately 400%. Over this period, hydrocodone combination products drove the opioid epidemic, as they became the most frequently prescribed medication in the United States. Our objective was to determine if the Drug Enforcement Administration's (DEA) 2014 policy change - which made it more difficult to prescribe hydrocodone combination products by moving them from Schedule III to Schedule II - reduced the total amount of opioid prescriptions as intended. Read More

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http://dx.doi.org/10.1080/15563650.2019.1574976DOI Listing
February 2019
2 Reads

Retrospective evaluation of repeated supratherapeutic ingestion (RSTI) of paracetamol .

Clin Toxicol (Phila) 2019 Feb 21:1-9. Epub 2019 Feb 21.

c Department of Clinical Toxicology , Prince of Wales Hospital , Randwick , NSW , Australia.

Background: Repeated supratherapeutic ingestion (RSTI) of paracetamol can result in acute liver injury. Management guidelines vary worldwide and in Australia, acetylcysteine treatment is recommended in patients with a paracetamol concentration ≥20 mg/L and/or alanine transaminase (ALT) ≥50 U/L.

Objectives: To investigate patients with RSTI of paracetamol and determine whether admission ALT <50 U/L rules out those who develop hepatotoxicity (ALT >1000 U/L). Read More

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http://dx.doi.org/10.1080/15563650.2018.1547829DOI Listing
February 2019
1 Read
3.122 Impact Factor

Kratom exposures reported to United States poison control centers: 2011-2017.

Clin Toxicol (Phila) 2019 Feb 20:1-8. Epub 2019 Feb 20.

a Center for Injury Research and Policy , The Research Institute at Nationwide Children's Hospital , Columbus , OH , USA.

Context: Kratom, or Mitragyna speciosa, is a plant indigenous to Southeast Asia that has gained national attention in the United States for its increased use in the self-management of opioid withdrawal and pain, as well as for concerns about its safety.

Methods: This study analyzes exposures to kratom reported to poison control centers (PCCs) in the United States during 2011-2017 from the National Poison Data System (NPDS).

Discussion: From 2011 through 2017, 1807 kratom exposures were reported to United States PCCs. Read More

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http://dx.doi.org/10.1080/15563650.2019.1569236DOI Listing
February 2019
5 Reads

Is placing a victim in the left lateral decubitus position an effective first aid intervention for acute oral poisoning? A systematic review.

Clin Toxicol (Phila) 2019 Feb 20:1-14. Epub 2019 Feb 20.

a Centre for Evidence-Based Practice (CEBaP) , Belgian Red Cross, Mechelen , Belgium.

Introduction: In acute oral poisoning, any first aid intervention that limits or delays the uptake of the ingested substance, and which can be performed by bystanders as first responders, might assist in reducing morbidity if a toxic substance has been ingested. The current recommendation by the International Federation of Red Cross/Red Crescent Societies is to place a victim in the left lateral decubitus position.

Objective: The aim of this PRISMA compliant systematic review is to assess whether the current recommendation by the International Federation of Red Cross/Red Crescent Societies decreases or delays the absorption of an orally ingested poison. Read More

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https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1
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http://dx.doi.org/10.1080/15563650.2019.1574975DOI Listing
February 2019
4 Reads

The financial impact of the medical toxicology specialty code on a private practice.

Authors:
Jerrold B Leikin

Clin Toxicol (Phila) 2019 Feb 20:1-3. Epub 2019 Feb 20.

a NorthShore University HealthSystem - OMEGA, Glenbrook Hospital , Glenview , IL , USA.

Background: We describe the financial impact following the implementation of this unique specialty taxonomy code after October 1, 2017 on an established private medical toxicology practice.

Methods: Clinical financial data over a 1-year period (October 2016 through September 2017) prior to medical toxicology specialty CMS code implementation was compared to financial data (October 2017 through September, 2018) following implementation. The encounters were billed by current procedural terminology (CPT) codes through the same biller during these time periods. Read More

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http://dx.doi.org/10.1080/15563650.2019.1576878DOI Listing
February 2019
1 Read

What is the most appropriate dose of N-acetylcysteine after massive acetaminophen overdose?

Clin Toxicol (Phila) 2019 Feb 19:1-6. Epub 2019 Feb 19.

a Department of Emergency Medicine , Oregon Health and Science University , Portland , OR , USA.

While the traditional intravenous N-acetylcysteine (NAC) dosing regimen works well for the vast majority of acetaminophen overdoses, there may be cases of massive overdose where additional NAC may be necessary. Recent evidence suggests that patients with acetaminophen concentrations above the "300-line" develop hepatotoxicity at a higher rate than those below the 300-line, suggesting that an increase of dose may be beneficial at this cut-off. Additional clinical data suggest a further increase in doses at the 450-line and 600-lines. Read More

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http://dx.doi.org/10.1080/15563650.2019.1579914DOI Listing
February 2019
3 Reads

Delayed resolution of amitriptyline toxicity secondary to CYP2D6 deficiency.

Clin Toxicol (Phila) 2019 Feb 19:1-3. Epub 2019 Feb 19.

b Department of Emergency Medicine, Division of Medical Toxicology , Drexel University College of Medicine , Philadelphia , PA , USA.

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http://dx.doi.org/10.1080/15563650.2019.1567756DOI Listing
February 2019

Loperamide associated torsades de pointes, in the setting of complete heart block at marginally supratherapeutic dosing (20mg/day).

Clin Toxicol (Phila) 2019 Feb 19:1-2. Epub 2019 Feb 19.

b Department of Emergency Medicine , University of California San Francisco , San Francisco , CA , USA.

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http://dx.doi.org/10.1080/15563650.2019.1578369DOI Listing
February 2019
3 Reads

New synthetic opioid cyclopropylfentanyl together with other novel synthetic opioids in respiratory insufficient comatose patients detected by toxicological analysis.

Clin Toxicol (Phila) 2019 Feb 18:1-7. Epub 2019 Feb 18.

e Forensic Toxicological Laboratory , University Medical Center Göttingen, Georg-August-University , Göttingen , Germany.

Introduction: Fentanyl derivatives like cyclopropylfentanyl have recently appeared on the recreational drug market. Cyclopropylfentanyl is probably a highly potent opioid, but human toxicological data are not available so far. Similar to other fentanyl derivatives the most serious acute health risk due to the use of cyclopropylfentanyl is likely to be respiratory depression. Read More

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http://dx.doi.org/10.1080/15563650.2018.1554187DOI Listing
February 2019
5 Reads

MAGAM II - prospective observational multicentre poisons centres study on eye exposures caused by cleaning products.

Clin Toxicol (Phila) 2019 Feb 18:1-8. Epub 2019 Feb 18.

j Poisons Centre - Clinical Toxicology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany.

Objective: Local effects on the eye following cleaning product exposures are frequently reported. According to EU chemicals legislation many cleaning products are labelled with Hazard Phrase 318 indicating risk of irreversible eye damage. The objectives of this study were to identify cleaning products with potential for irreversible eye damage by collecting human exposure data from poisons centres (PC), and to clarify to what degree exact product identification is possible during a PC telephone call. Read More

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http://dx.doi.org/10.1080/15563650.2018.1560462DOI Listing
February 2019
3 Reads

Antivenom effect on lymphatic absorption and pharmacokinetics of coral snake venom using a large animal model.

Clin Toxicol (Phila) 2019 Feb 18:1-8. Epub 2019 Feb 18.

a Departamento de Biología Molecular y Bioprocesos , Instituto de Biotecnología Universidad Nacional Autónoma de México , Cuernavaca , México.

Context: Historically, administration and dosing of antivenom (AV) have been guided primarily by physician judgment because of incomplete understanding of the envenomation process. As demonstrated previously, lymphatic absorption plays a major role in the availability and pharmacokinetics (PK) of coral snake venom injected subcutaneously, which suggests that absorption from subcutaneous tissue is the limiting step for venom bioavailability, supporting the notion that the bite site is an ongoing venom depot. This feature may underlie the recurrence phenomena reported in viperid envenomation that appear to result from a mismatch between venom and AV PK. Read More

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http://dx.doi.org/10.1080/15563650.2018.1550199DOI Listing
February 2019
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Severe and prolonged flecainide intoxication treated by extracorporeal life support: possible role of cytochrome P450 2D6 polymorphism?

Clin Toxicol (Phila) 2019 Feb 13:1-2. Epub 2019 Feb 13.

c Department of Intensive Care , Cliniques Universitaires St-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium; Louvain Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain , Brussels , Belgium.

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http://dx.doi.org/10.1080/15563650.2018.1542703DOI Listing
February 2019
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Response to carpenter and colleagues.

Clin Toxicol (Phila) 2019 Feb 13:1-2. Epub 2019 Feb 13.

c Division of Emergency Medicine , Duke University School of Medicine , Durham , NC , USA.

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http://dx.doi.org/10.1080/15563650.2018.1554816DOI Listing
February 2019