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Tox Tunes #91: I Can’t Stand It (Memphis Jug Band)
What are you gonna do when your troubles get like mine Take a mouthful of sugar and drink a bottle of turpentine The Memphis Jug Band recorded in the 1920s and 1930s with an ever-changing lineup of musicians and instruments, usually including a liquor jug to provide the bass line. The 1960s blues-rock band Canned Heat obviously borrowed from this song for their own Turpentine Moan. Related post: Tox Tunes #20: Cocaine Habit Blues (Memphis Jug Band) (Source: The Poison Review)
Source: The Poison Review - December 22, 2014 Category: Toxicology Authors: Leon Tags: Medical i can't stand it memphis jug band tox tunes turpentine Source Type: news

Saturday with SMACC: Scott Weingart on Cutting Edge Intra-Arrest Care
The main theme of this extremely thought-provoking talk by Scott Weingart (@emcrit) is that CPR should not be limited to the cookbook algorithms taught in the American Heart Association’s ACLS course. Scott argues that ACLS teaches what can be done easily, not necessarily what’s needed to achieve an optimal outcome. He covers everything from the laryngeal mask airway to intra-arrest extracorporeal membrane oxygenation (ECMO.) You may not agree with all of Scott’s points, but this is a must-listen lecture. This talk was given at the 2014 SMACC Gold conference in Australia last March. I was there, and it w...
Source: The Poison Review - December 20, 2014 Category: Toxicology Authors: Leon Tags: Medical cardiopulmonary arrest Chicago cpr Medical conference resuscitation Scott Weingart SMACC Source Type: news

Surely the NEJM could do a better review of delirium tremens
2.5 out of 5 stars Recognition and Management of Withdrawal Delirium (Delirium Tremens). Schuckit MA. N Engl J Med 2014 Nov 27;371:2109-2113. No abstract available This is an amazingly inept paper, even by the traditionally low standards of the New England Journal‘s  “Review Article” section. It was written by a psychiatrist who — on the basis of this piece — seems not to deal with severe alcohol withdrawal or delirium tremens at all. At times, the author does not appear to appreciate the serious nature of DTs and the difficulty of treating the condition adequately. For instance, he states that ...
Source: The Poison Review - December 18, 2014 Category: Toxicology Authors: Leon Tags: Medical alcohol withdrawal delirium tremens DTs review article Source Type: news

Patient complains of bugs on her skin — could it be tox?
2.5 out of 5 stars Case 37-2014: A 35-Year-Old woman with Suspected Mite Infestation. Beach SR et al. N Engl J Med 2014 Nov 27;371:2115-2123. No abstract available This case — part of the Journal‘s “Case Records of the Massachusetts General Hospital” series — describes a 35-year-old woman had presented to the emergency department complaining of a parasitic skin infection: “During the 10 days before this presentation, she reported seeing white ‘granular balls,’ which she thought were mites or larvae, emerging from and crawling on her skin, sheets, and clothing and in her feces, apar...
Source: The Poison Review - December 13, 2014 Category: Toxicology Authors: Leon Tags: Medical amphetamine psychosis delusional parasitosis formication Source Type: news

Tox on the Web: deadly cocaine/fentanyl combination, the rising price of naloxone, and more
  Cocaine/Fentanyl Kills 3 in North Carolina: WTVD-ABC Eyewitness News in Raleigh, North Carolina reports that 3 people local Chatham County died over the weekend — and another 6 were taken to hospital — after using cocaine that had been surreptitiously adulterated with fentanyl. This is somewhat unusual, although many deaths in the past have been caused by fentanyl-laced heroin. A similar death occurred recently in Upstate New York. Naloxone Sticker Shock: The New York Times reported that with demand for intranasal naloxone increasing exponentially as take-home programs and use by police departments and oth...
Source: The Poison Review - December 8, 2014 Category: Toxicology Authors: Leon Tags: Medical cocaine fentanyl death. gastric lavage fatality robert hoffman tox on the web Source Type: news

Saturday SMACCdown: Should Real Airway Docs Use a Checklist?
In this verbal cage match from the 2014 SMACC Gold conference, Dr. Tim Leeuwenburg (@KangarooBeach) goes up against Dr. Minh Le Cong (@ketaminh) to debate the question: “Should real airway docs use checklists?” Very entertaining, and both sides make good points. Remember, SMACC Chicago takes place June 23-26, 2015. Many of the pre-conference workshops have already sold out, and registration for the conference itself has been brisk even at this early date. You can view the program and the amazing list of speakers lined up at the SMACC Chicago website. This is really the one conference in 2015 you won’t w...
Source: The Poison Review - December 7, 2014 Category: Toxicology Authors: Leon Tags: Medical checklist Le Cong Leeuwenburg patient safety SMACC Chicago SMACC Gold Source Type: news

Palytoxin: deadlier than fugu?
Palytoxin 3 out of 5 stars Hyperkalemia, Hyperphosphatemia, Acute Kidney Injury, and Fatal Dysrhythmias After Consumption of Palytoxin-Contaminated Goldspot Herring. Wu M: et al. Ann Emerg Med 2014 Dec;64:633-6. Abstract Palytoxin, a huge heat-stable molecule, is one of the most deadly of all the marine toxins. Fortunately, cases of severe palytoxin poisoning are relatively rare. This paper from Taiwan describes 4 patients from a single family who became symptomatic after eating fish soup made from the local catch. One person died. The presence of palytoxin was confirmed in samples of leftover fish. The following question...
Source: The Poison Review - December 5, 2014 Category: Toxicology Authors: Leon Tags: Medical fish poisoning Goldspot herring marine palytoxin Source Type: news

Best paper yet on screening suspected body packers
Body packer 4.5 out of 5 stars Body packing: a review of general background, clinical and imaging aspects. Bert FH et al. Radiol Med 2014 Oct 10 [Epub ahead of print] Abstract I’d say this is the best article on imaging suspected body packers we’re likely to see, but with the rapid evolution of radiological technology it will likely need to be updated every year or so. Nevertheless, it is the best review of the topic available, and has spectacular illustrations. The five authors rely on their experience as radiologists in major European cities, as well as published medical  literature, to review test character...
Source: The Poison Review - December 3, 2014 Category: Toxicology Authors: Leon Tags: Medical body packer body pusher cocaine drug smuggling heroin mule Source Type: news

Infants eliminate ethanol at rate comparable to that in adults
2.5 out of 5 stars Accidental Acute Alcohol Intoxication in Infants: Review and Case Report. Minera G, Robinson E.  J Emerg Med 2014;47:524-526 Abstract This case report describes a 9-week-old 9.5 kg boy who was brought to the emergency department when he was observed to be “acting strangely.”  He smelled of alcohol. History revealed that the grandmother had inadvertently prepared the infant’s formula with vodka instead of water. The child’s respiratory rate was 22/min and oxygen saturation 99% on room air. Fingerstick glucose was 167 mg/dL on admission and serum alcohol level was 330 mg/dL. Repe...
Source: The Poison Review - December 1, 2014 Category: Toxicology Authors: Leon Tags: Medical Alcohol ethanol elimination rate ethanol intoxication infant pediatric Source Type: news

Haff Time: fish-induced rhabdomyolysis
Buffalo fish (Ictiobus cyprinellus) 3 out of 5 stars Haff Disease: Rhabdomyolysis After Eating Buffalo Fish. Herman LL, Bies C. West J Emerg Med 2014 Sept;15:664-6. Abstract Haff Disease was first described in 1924 after an outbreak of acute muscle rigidity accompanied by dark  urine among patients living near the Königsberger Haff shores along the Baltic Coast.  Similar cases occurred in the following summers along the haff (a shallow lagoon.) Most victims gave a history of recently ingesting various fish — burbot, eel, pike, etc. Cases of rhabdomyolysis after ingesting fish were not reported in the United States u...
Source: The Poison Review - November 24, 2014 Category: Toxicology Authors: Leon Tags: Medical fish poisoning haff disease palytoxin rhabdomyolysis Source Type: news

Tox Tunes #90: Junco Partner (The Clash)
//www.youtube.com/watch?v=RZOPte4hlqE “Tox Tunes” has previously featured versions of “Junco Partner” by Dr. John and Professor Longhair. I love this reggae/punk take on the song from The Clash’s 1980 triple album Sandanista!. According to Dr. John, by the 1950s the song was known as an “anthem of the dopers, the whores, the pimps, the cons.” Joe Strummer of The Clash had already recorded “Junco Partner” with the previous band, the 101ers. By the way, the best use of the name “The Clash” in someone else’s song undoubtedly occurs in Richard Thompson&...
Source: The Poison Review - November 23, 2014 Category: Toxicology Authors: Leon Tags: Medical junco partner sandanista the clash tox tunes Source Type: news

Pop quiz: cardiac arrhythmia from an herbal medicine
3 out of 5 stars Life-threatening cardiovascular toxicity following ingestion of Chinese herbal medicine. Martinez A et al. Emerg Med Australas 2014 Oct;26:512-13. Abstract This case report describes a 46-year-old Chinese woman in Melbourne who presented with peri-oral and facial paresthesias, gastronintestinal disturbance (nausea, vomiting, diarrhea,  abdominal pain,) tachycardia and hypotension. She also had decreased level of consciousness and ventricular tachycardia. Symptoms started 30 minutes after ingesting a Chinese herbal medicine. The following is a pop quiz based on this presentation. Click on the question to r...
Source: The Poison Review - November 21, 2014 Category: Toxicology Authors: Leon Tags: Medical aconite cao wu cardiotoxicity Chinese herbal medicine chuan wu fu zi monkshood wolfsbane Source Type: news

What’s better for amatoxin poisoning: silibinin or leprechaun luck?
Amanita phalloides 2 out of 5 stars Survival Following Investigational Treatment of Amanita Mushroom Poisoning: Thistle or Shamrock? Gores KM et al. Chest 2014 Oct 1 [Epub ahead of print] Abstract Amatoxins are potent RNA inhibitors, shutting down protein synthesis and producing hepatonecrosis and, occasionally, renal injury. There is not generally accepted treatment for amatoxin-induced hepatotoxicity aside from supportive care, early multi dose activated charcoal, and liver transplant if indicated. There are, however, a number of unproven therapies that have been used and advocated in the past. This case report, from th...
Source: The Poison Review - November 18, 2014 Category: Toxicology Authors: Leon Tags: Medical amanita phalloides amatoxin milk thistle mushroom poisoning silibinin Source Type: news

Crayola toxicology: life-threatening causes of bluish vomiting
This article does serve to remind us of 3 important not-to-miss ingestions on the differential when a patient shows up barfing blue. Unfortunately, the authors misses an obvious mnemonic: Cerulean Blue Puke = Copper sulfate, Boric acid, Paraquat. Related posts: Green urine Propofol causes green urine An elderly woman with purple urine (Source: The Poison Review)
Source: The Poison Review - November 14, 2014 Category: Toxicology Authors: Leon Tags: Medical blue vomit boric acid copper sulfate crayola toxicology emesis paraquat Source Type: news

Snorting bupropion
2.5 out of 5 stars An 11-year review of bupropion insufflation exposures in adults reported to the California Poison Control System. Lewis JC et al. Clin Toxicol 2014 Nov;52:969-972. Abstract The abuse of bupropion by pulverizing and snorting the medication has been described at least as far back as 2002. Bupropion inhibits re-uptake of dopamine and norepinephrine, but apparently has little or no effect on serotonin. It is abused for its psychotropic effects that resemble those of amphetamine and cocaine.. A hallmark of overdose with sustained-release or extended-release bupropion formulations is delayed onset of seizures...
Source: The Poison Review - November 13, 2014 Category: Toxicology Authors: Leon Tags: Medical burpropion delayed seizures overdose toxicity Wellbutrin Zyban Source Type: news

Methoxphenidine: a designer dissociative drug
3 out of 5 stars Acute toxicity associated with the recreational use of the novel dissociative psychoactive substance methoxphenidine. Hofer KE et al. Clin Toxicol 2014 Oct 28 [Epub ahead of print] Abstract Methoxphenidine  (MXP) is a dissociative drug with actions apparently similar to those of phencyclidine (PCP), ketamine, and methoxetamine (MXE). It is often sold as a “research chemical” and labelled as “Not for Human Consumption.” The pharmacology and toxicology of MXP has not been well studied. Anecdotal reports on some drug forums describe anterograde amnesia and prolonged duration of effe...
Source: The Poison Review - November 12, 2014 Category: Toxicology Authors: Leon Tags: Medical case report designer drug dissociative ketamine methoxetamine pcp phencyclidine Source Type: news

Ban the Words: should the phrase “should be considered” be banished from the toxicology literature?
Interventions such as gastric lavage and whole bowel irrigation are labor intensive and associated with significant adverse effects. In addition, they have never been proven to improve clinical outcomes. Are we now at a point where we can stop discussing them, easing them into a dignified retirement along with ipecac-induced emesis? Many texts and review articles suggest that these interventions “should be considered” in selected toxicology cases. Should this phrase be banned from the literature? I will be hosting a Twitter chat with @EM_News tomorrow from noon – 1 pm EST to talk about my November column ...
Source: The Poison Review - November 10, 2014 Category: Toxicology Authors: Leon Tags: Medical ban the words Emergency Medicine News gastric lavage whole bowel irrigation Source Type: news

Saturday with SMACC: Weingart on sepsis in New York City
In this brilliant talk from smaccGOLD last March in Australia, Scott Weingart talks about lessons from the STOP Sepsis Collaborative project in New York City based on their experience with 15,000 severe sepsis patients. In brief, the Collaborative achieved a 22% reduction of in-patient mortality in these patients by relatively simple measures that did not involve early goal-directed therapy or fancy invasive monitoring. The key steps in their protocol involved: early recognition of the septic patient source control reasonable but not massive fluid administration inotropes early antibiotics meticulous intubation (if indica...
Source: The Poison Review - November 9, 2014 Category: Toxicology Authors: Leon Tags: Medical Paul Marik Scott Weingart septic shock SMACC Chicago smaccGold STOP sepsis collaborative Source Type: news

Sun Tzu and the Art of Focusing in Medical Toxicology
The philosophy expressed in Sun Tzu’s classic The Art of War has been applied to everything from military strategy to business management. But what does it have to teach practitioners of emergency medicine and medical toxicology? In my current column for Emergency Medicine News I discuss a very important lesson from the book that will completely change the way you read recommendations about gastric lavage and whole bowel irrigation still included in many textbook chapters and review articles. The read the column, click here. By the way, EM News will be hosting a Twitter Chat about the column to take place on Tuesday,...
Source: The Poison Review - November 7, 2014 Category: Toxicology Authors: Leon Tags: Medical gastric lavage should be considered sun tzu whole bowel irrigation Source Type: news

There is no real evidence on treating calcium channel blocker overdose
2.5 out of 5 stars Treatment of calcium channel blocker poisoning: A systematic review. St-Onge M et al. Clin Toxicol 2014 Nov;52:926-944. Abstract This systematic review is massive, intimidating, and all but unreadable. As a prelude to establishing a clinical guideline for treatment of calcium channel blocker (CCB) overdose, the 14 Canadian authors systematically searched and evaluated relevant literature. They initially identified 15,577(!) citations, from which two reviewers selected 216 for analysis. These included case reports, case series, animal trials, and observational studies. No eligible controlled trials were ...
Source: The Poison Review - November 7, 2014 Category: Toxicology Authors: Leon Tags: Medical calcium channel blocker overdose evidence systematic review therapy Source Type: news

Use of alkyl nitrite “poppers” can cause permanent visual impairment
Some poppers are sold as “Leather Cleaner” or “Acetone-free nail polish remover” 3.5 out of 5 stars Poppers maculopathy. Gruener AM et al. Lancet 2014;384:1606 Full Text This case report describes a 30-year-old man who developed central visual impairment after using alkyl nitrite “poppers” as a sexual aid. Eye exam revealed diminished visual acuity bilaterally, yellow foveal spots and damage to the retinal photoreceptors. Six months later, the visual impairment had not resolved. Previous cases of visual damaged associated with the use of alkyl nitrite poppers have been reported. (See,...
Source: The Poison Review - November 5, 2014 Category: Toxicology Authors: Leon Tags: Medical alkyl nitrite eye damage isobutyl nitrite isopropyl nitrite maculopathy poppers visual impairment Source Type: news

Position statement on bystander naloxone
4 out of 5 stars Position Statement: Expanding access to naloxone in the United States. Doyon S et al Clin Toxicol 2014 Oct 15 [Epub ahead of print] Reference This position statement was endorsed by the American Academy of Clinical Toxicology, the American College of Medical Toxicology, and the American Association of Poison control Centers. The authors start off by noting the marked increase in overdose deaths that have tripled over the last 30 years, and resulted in what the CDC calls an epidemic. They point out that in 2010 there were over 15,000 deaths from prescription opioid overdose. They also state — without cit...
Source: The Poison Review - November 5, 2014 Category: Toxicology Authors: Leon Tags: Medical bystander naloxone intranasal narcan narcotic opiate opioid overdose Source Type: news

Saturday with SMACC: Motorbike Mayhem
The lecture by John Hinds (@DocJohnHinds) last March at SMACC Gold in Brisbane was one of the most fascinating and unusual presentations I’ve ever seen at a medical conference. Hinds, a consultant anesthesiologist and intensivist at Craigavon Area Hospital in Northern Ireland, is also a motor bike racing enthusiast. His riveting account of the types of injuries that can occur in this sport — and how to manage them — should not be missed. To hear the lecture and access the slide set, click here. And that brings us to breaking, very exciting news. The brochure for SMACC CHICAGO has just been released, with just an ...
Source: The Poison Review - November 1, 2014 Category: Toxicology Authors: Leon Tags: Medical john hinds motor bike injury SMACC Gold smack chicago Source Type: news

Tox Tunes #89: Strange Brew (Cream)
http://www.youtube.com/watch?v=rGvfm7eEFSw   “Strange brew — killin’ what’s inside of you”   It always seemed to me that the subtext of this song was about drugs, although the lyrics don’t explicitly reference psychedelics or any other recreational pharmaceuticals. The song, found on Cream’s second album Disraeli Gears, is a reworking of Buddy Guy’s and Junior Wells’ version of an early blues song “Hey Lawdy Mama” that was in Cream’s early repertoire: http://www.youtube.com/watch?v=cj0_D5IGtfM Yesterday, Jack Bruce, Cream’s bass play...
Source: The Poison Review - October 26, 2014 Category: Toxicology Authors: Leon Tags: Medical cream disraeli gears eric clapton ginger baker jack bruce strange brew tox tunes Source Type: news

Saturday with SMACC: Evidence-Based Education — What Works
Victoria Brazil Evidence-Based Education — What Works– from Social Media and Critical Care on Vimeo. From SMACC Gold: Victoria Brazil asks what educational modalities and interventions are effective in medical education, what does “effectiveness” really mean and how do we measure it. Here are links to some of the studies and resources she mentions: The Great Dr. Fox Lecture: A Vintage Academic Hoax Hunt et al: Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training Best Evidence Medical Education (BEME) Collaboration BondVH: virtual hospital app (Sou...
Source: The Poison Review - October 11, 2014 Category: Toxicology Authors: Leon Tags: Medical dr. myron l. fox lecture medical education SMACC victoria brazil Source Type: news

More than you ever wanted to know about synthetic cannabinoids
This article is not really readable, but I’m not sure it was meant to be read. Rather, it’s a reference paper with (by my count) 228 citations through the year 2014. It will be invaluable for anyone surveying the medical literature on synthetic cannabinoids The authors’ goals was to review comprehensively the pharmacology and toxicology of various chemicals found in synthetic cannabinoid products such as “Spice,” “K2,” and “Crazy Clown.” Their extensive literature search identified 215 relevant articles. Because of the multiple substances covered and mix of laboratory, ...
Source: The Poison Review - October 9, 2014 Category: Toxicology Authors: Leon Tags: Medical crazy clown K2 literature review spice synthetic cannabinoid Source Type: news

TPR Podcast Episode #6: I’m tripping and I can’t get down
TPR Podcast Episode 6: I’ve Tripped and I Can’t Get Down Written by Theresa Kim, MD   Outline   1)     Synthetic cathinones 2)     Piperazine compounds 3)     Gamma-hydroxybutyric acid (GHB) 4)     25C-NBOMe     This month’s podcast was inspired by the New York Times article “A Year After Drug Deaths, the Electric Zoo Music Festival Tries Again” which covered designer drug related deaths associated with summer music festivals     Synthetic Cathinones   Derivatives of the Catha edulis (khat) plant’s psychoactive alkaloid (cathinone) o   examples: mephedrone, methedrone, MD...
Source: The Poison Review - October 7, 2014 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news

Rosary pea ingestion: no testing needed
A. precatorius seeds 2.5 out of 5 stars A Case of Abrin Toxin Poisoning, Confirmed via Quantitation of L-Abrine (N-Methyl-L-Tryptophan) Biomarker. Wooten JV et al. J Med Toxicol 2014 Feb 13 [Epub ahead of print] Abstract The decorative rosary pea or jequirity pea (Abrus precatorius) contains the toxin abrin, a protein that inhibits the function of mRNA, leading to impaired protein synthesis and cell death. The mechanism is quite similar to that of the toxin ricin, found in castor beans. This case report describes a 22-month-old girl who ingested approximately 20 rosary peas. She appeared asymptomatic until she started vom...
Source: The Poison Review - October 4, 2014 Category: Toxicology Authors: Leon Tags: Medical abrin jequirity pea rosary pea Source Type: news

Must-listen podcast: anti-NMDA receptor encephalitis
  < As part of its “Best Case Ever” series, the Emergency Medicine Cases podcast has a superb discussion by Dr. David Carr of anti-NMDA receptor encephalitis, a relatively new but important diagnosis that is generally under-recognized and often missed. To listen to it, click here. The reason this diagnosis is of interest to toxicologists is that during the early psychotic stage of the disease patients may be treated with a neuroleptic agent. During later stages when movement disorders and autonomic instability supervene, it is easy to misdiagnose the condition as neuroleptic malignant syndrome. The tele...
Source: The Poison Review - September 29, 2014 Category: Toxicology Authors: Leon Tags: Medical anti-NMDA receptor encephalitis Source Type: news

Tox on the web: narcotic noodles, intranasal narcan, and much more!
The Antidote: A long piece in the  The New Yorker by Ian Frazier describes the epidemic of overdoses from both prescription opiate analgesics and heroin, how that epidemic affects the New York City borough of Staten Island, and the potential role of intranasal naloxone in reducing the number of deaths. A little superficial regarding the origins of the epidemic and the medical use of naloxone, but well worth reading nevertheless. It is superb at portraying the human dimension of what Frazier justifiably calls an “iatrogenic disaster.” By the way, the versatile Frazier is the author of one of the funniest parodi...
Source: The Poison Review - September 29, 2014 Category: Toxicology Authors: Leon Tags: Medical ian frazier intranasal naloxone medical overtreatment mind-altering plants narcan opium noodles tox on the web Source Type: news

Review: cobalt toxicity and artificial metal hips
4.5 out of 5 stars Systemic toxicity related to metal hip prostheses. Bradberry SM et al. Clin Toxicol 2014;52:837-847. Abstract As TPR has reported before, cobalt poisoning can cause hypothyroidism, cardiomyopathy, and neurotoxicity. Neurological manifestations include: optic nerve damage and retinopathy with reduced visual acuity bilateral nerve deafness and tinnitus polyneuropathy (sensory and motor) cognitive impairment and memory loss A number of papers and case reports have described clinical cobalt toxicity related to metal-on-metal hip prostheses or revision of a failed ceramic prosthesis with metal parts. Al...
Source: The Poison Review - September 25, 2014 Category: Toxicology Authors: Leon Tags: Medical cardiomyopathy cobalt toxicity hip replacement hypothyroidism neurotoxicity prosthesis Source Type: news

Avoid couchlock! Four things to know about cannabis pharmacology
  With medical marijuana now legal in 23 states and the District of Columbia — and recreational weed available in Colorado and Washington State — knowing the pharmacokinetics of THC has never been more important, both for consumers and the physicians who must counsel and treat them. Recently, the New York Times’ Pulitzer Prize-winning columnist Maureen Dowd got into trouble in Denver when she overdosed on a cannabis candy bar and experienced 8 hours of paranoia and couchlock. My recent Emergency Medicine News column describing 4 things Maureen should have known about weed before venturing to the “mi...
Source: The Poison Review - September 18, 2014 Category: Toxicology Authors: Leon Tags: Medical cannabis edibles marijuana overdose pharmacokinetcis pharmacokinetics Source Type: news

Tox on the Web: sarin, lithium, strychnine, and much more!
  Toxicologist as Man on Couch with Laptop: This video shows a short presentation by Larissa Laskowski a first year fellow at the NYC Poison Control Center, describing the work of Eliot Higgins and the Brown Moses blog. Higgins — an unemployed finance worker several years ago with no knowledge about weapons of warfare — started blogging about the use of different weapons in Syria, and posting online videos appearing on sites such as YouTube that demonstrated use of these weapons. He is now an acknowledge expert in the field. His work led to the identification of sarin as the agent used in the Ghouta chemical at...
Source: The Poison Review - September 18, 2014 Category: Toxicology Authors: Leon Tags: Medical albert hoffman brown moses eliot higgins lithium LSD nicotine sarin strychnine syria toledo ohio tox on the web toxic algae Source Type: news

Case Report: Synthetic Cannabinoid K2 and Myocardial Infarction
This article describes 16-year-old male who presented to hospital with 1 day of substernal chest pressure associated with nausea, vomiting, and dyspnea that started 2 hours after he smoked the synthetic cannabinoid K2. Workup revealed elevated ST segments in the inferolateral leads and elevated troponin that peaked at 8.29 ng/ml (normal 0-0.3 ng/ml). Echocardiogram and cardiac catheterization were unremarkable. Urine drug screen was positive only for opiates and benzodiazepines, both of which the patient received in the hospital before the specimen was obtained. Specimens for additional toxicology tests were sent to an out...
Source: The Poison Review - September 17, 2014 Category: Toxicology Authors: Leon Tags: Medical coronary syndrome K2 myocardial infarction synthetic cannabinoid Source Type: news

Conservative treatment for asymptomatic body packers?
Body packer 2 out of 5 stars Asymptomatic body packers should be treated conservatively. Glovinski PV et al. Dan Med J 2013 Nov;60:A4723 Abstract Kudos to the authors for putting their general conclusion in the title. Unfortunately, there’ s less here than meets the eye. This is a retrospective review of 57 patients suspected of body packing, seen at Hvidovre Hospital in Denmark. However, actual body packing was confirmed in only a little over half of these cases, meaning this is really a study of only 29 patients. All confirmed body packers were admitted, given a laxative and “monitored using a scope.”...
Source: The Poison Review - September 10, 2014 Category: Toxicology Authors: Leon Tags: Medical body packers CT imaging Source Type: news

Do pediatric patients require endoscopy after ingesting a laundry pod?
3 out of 5 stars Laundry Detergent Pod Ingestions: Is There a Need for Endoscopy? Smith E et al. J Med Toxicol 2014 Sep;10(3):286-91 Abstract The authors never answer their title question definitively, but you wouldn’t expect that they’d be able to on the basis of this small case series and the limited data published to date. Ingestion of laundry detergent pod (LDP) ingredients can present with manifestations affecting a number of systems: Gastrointestinal Pulmonary Neurological Metabolic The paper presents 3 cases of pediatric LDP ingestion in patients ages 13 months to 3 years. Presenting signs and sympt...
Source: The Poison Review - September 8, 2014 Category: Toxicology Authors: Leon Tags: Medical caustic ingestion esophageal stricture laundry pod detergent Source Type: news

Tox Tunes #88: Junco Partner (Professor Longhair)
http://www.youtube.com/watch?v=DG6gPe1plWQ   Professor Longhair (Henry “Roy” Byrd, 1918-1980) combined classic New Orleans rhythm and blues piano with Afro-Cuban funk to produce music that was exciting and utterly original. Many years ago, I was working in a research lab in New York City, living in a West Village studio that rented for $78 a month. (Yes, it was that long ago.) I hated killing rabbits for their prostaglandin, and it was sort of a bleak time. But during that period I came across an oddly compelling record — New Orleans Piano by Professor Longhair. It was magical, and taught me that the ...
Source: The Poison Review - September 8, 2014 Category: Toxicology Authors: Leon Tags: Medical henry byrd junco partner junko partner professor longhair tox tunes Source Type: news

Saturday with SMACC: The Art and Science of Fluid Responsiveness
Haney Mallemat – The Art and Science of Fluid Responsiveness from Social Media and Critical Care on Vimeo. From SMACC Gold: In a great talk, Haney Mallemat from the University of Maryland discusses the limitations of static indices of fluid responsiveness such as blood pressure and respiratory-induced changes in inferior vena cava diameter. He argues persuasively that dynamic indices — such as change in stroke volume with passive leg raise — are more accurate and precise, although measurement is technically more difficult.   (Source: The Poison Review)
Source: The Poison Review - September 7, 2014 Category: Toxicology Authors: Leon Tags: Medical dynamic indices fluid responsiveness haney mallemat SMACC ultrasound Source Type: news

Must-read: consider hemodialysis in cases of massive acetaminophen overdose
4 out of 5 stars Extracorporeal treatment of acetaminophen poisoning: Recommendations from the EXTRIP workgroup. Gosselin S et al. Clin Toxicol 2014 Aug 18:1-12. [Epub ahead of print] Abstract These recommendations come from the Extracorporeal Treatments in Poisoning (EXTRIP) workgroup, a project established to provide some guidance on the use of hemodialysis and other techniques in toxicology cases, an area where high-quality evidence simply does not exist. Although there has been some disagreement among toxicologists about the value of this effort, I have found the papers that come from EXTRIP extremely interesting a...
Source: The Poison Review - September 6, 2014 Category: Toxicology Authors: Leon Tags: Medical acetaminophen enhanced elimination extracorporeal treatment extracorporeal treatments in poisoning workgroup extrip massive overdose N-acetylcysteine paracetamol tylenol Source Type: news

Synthetic cannabinoid XLR-11 and driving
XLR-11 3 out of 5 stars Driving Under the Influence of Synthetic Cannabinoid Receptor Agonist XLR-11. Lemos NP. J Forensic Sci  2014 Aug 3. doi: 10.1111/1556-4029.12550. [Epub ahead of print] Abstract XLR-11 is one of the many different synthetic cannabinoid compounds found in samples of smokeable herbs sometimes sold as “Spice” or “Legal Marijuana.” Exposure to XLR-11 has been associated with cases of acute kidney injury. This case report describes a 22-year-old male who appeared “really high on weed” after being involved in a traffic accident. The man admitted to using “Blueb...
Source: The Poison Review - September 4, 2014 Category: Toxicology Authors: Leon Tags: Medical driving synthetic cannabinoid xlr-11 Source Type: news

Severed snake head bites, kills chef in China
Indonesian spitting cobra USA Today reports that a chef in China died recently after being bitten by the decapitated head of an Indonesian spitting cobra, possibly Naja sputatrix. Chef Peng Fan beheaded the snake in preparation for making traditional cobra soup at his restaurant in Guangdong province. Ten to twenty minutes later, when he was disposing of the head, it bit him. “We did not know what was happening” one diner said, “but could hear screams coming from the kitchen.”  The chef was dead before medical help could arrive. Cobra venom is predominantly neurotoxic and cardiotoxic. Death could ...
Source: The Poison Review - September 1, 2014 Category: Toxicology Authors: Leon Tags: Medical chef China fatal injury peng fan spitting cobra Source Type: news

Tox Tunes #87: Cocaine Blues (Bob Dylan 1961)
http://www.youtube.com/watch?v=x8a6eRME6po   This version of “Cocaine Blues” by a very young Bob Dylan was recorded in 1961, possibly shortly before he left Minnesota for New York City. It’s hard to believe that this was over half a century ago.   Related posts: Cocaine Blues (Dave Van Ronk) Cocaine Blues (Roy Hogsed) Cocaine Blues (Nick Drake) Cocaine Blues (Townes Van Zandt) Cocaine Blues (Luke Jordan) Cocaine Habit Blues (Memphis Jug Band) Cocaine Blues (Keith Richards) (Source: The Poison Review)
Source: The Poison Review - August 31, 2014 Category: Toxicology Authors: Leon Tags: Medical bob dyland cocaine blues tox tunes Source Type: news

Saturday with SMACC: Resuscitation Dogmalysis
Reid, Cliff — Resuscitation Dogmalysis from Social Media and Critical Care on Vimeo. From SMACC Gold 2014: Cliff Reid demonstrates that everything you thought you knew about treating critically ill patients may not be true. (Source: The Poison Review)
Source: The Poison Review - August 31, 2014 Category: Toxicology Authors: Leon Tags: Medical dogmalysis resuscitation SMACC Gold Source Type: news

Treating digoxin toxicity: is less more?
3 out of 5 stars Digoxin-specific antibody fragments in the treatment of digoxin toxicity. Chan BSH, Buckley NA. Clin Toxicol 2014 Aug 4 [Epub ahead of print] Abstract This long detailed paper seems to be a manifesto masquerading as a review article. It is quite informative and well worth reading. But I’d keep in mind that the authors appear to have a (not so) hidden agenda: to decrease the dose of digoxin-specific antibody fragments administered in most cases of acute and chronic digoxin toxicity. The authors state their objective up front: To review the pharmacology, efficacy, effectiveness, indications, safety an...
Source: The Poison Review - August 29, 2014 Category: Toxicology Authors: Leon Tags: Medical digibind digifab digoxin specific antibody fragments digoxin toxicity Source Type: news

Hydrogen peroxide ingestion: can bedside ultrasound help?
http://www.youtube.com/watch?v=ed6mpRKmx14 3 out of 5 stars Young Woman With Epigastric Pain and Vomiting. Manning EP et al. Ann Emerg Med 2014 Sep;64:330. Full Text This brief case is part of the Annals of Emergency Medicines‘s series “Image of the Month.” A 23-year-old woman develops epigastric pain and vomiting after investing a cleaning agent. Abdominal exam was unremarkable. a CT of the abdomen demonstrated gas in the portal veins. The cleaning agent was hydrogen peroxide, which causes injury by two mechanisms: 1) corrosive tissue injury, and 2) gas formation. A previous case report indicated that...
Source: The Poison Review - August 29, 2014 Category: Toxicology Authors: Leon Tags: Medical bedside emergency ultrasound gas in portal vein hydrogen peroxide ingestion overdose Source Type: news

Blowguns, poison darts, and tajem
This interesting short film illustrates the meticulous care that goes into making a poison dart blowgun. The poison mentioned in the video — tajem — is made from latex obtained from the bark of a specific tree. I was not able to find out details about how it acts, but it appears to be cardiotoxic and produce fatal arrhythmias. One source mentions that there are several natural antidotes. Hunting with tajem-tipped poison darts is practiced by the Penan people in Borneo. (Source: The Poison Review)
Source: The Poison Review - August 27, 2014 Category: Toxicology Authors: Leon Tags: Medical blowgun cardiotoxicity pen an people poison darts Source Type: news

Blowguns, poison darts, and tajem poison
This interesting short film illustrates the meticulous care that goes into making a poison dart blowgun. The poison mentioned in the video — tajem — is made from latex obtained from the bark of a specific tree. I was not able to find out details about how it acts, but it appears to be cardiotoxic and produce fatal arrhythmias. One source mentions that there are several natural antidotes. Hunting with tajem-tipped poison darts is practiced by the Penan people in Borneo. (Source: The Poison Review)
Source: The Poison Review - August 27, 2014 Category: Toxicology Authors: Leon Tags: Medical blowgun cardiotoxicity pen an people poison darts Source Type: news

Body packers: can CT determine the number of drug packets?
Body packer 2.5 out of 5 stars Sensitivity and specificity of CT scanning for determining the number of internally concealed packages in ‘body-packers.’ Asha SE et al. Emerg Med J 2014 Feb 19. doi: 10.1136/emermed-2013-203389. [Epub ahead of print] Abstract Although the abdominal CT scan has been shown to be relatively accurate for determining the presence or absence of drug packets in suspected body packers, there is no good data as whether or not the test is accurate in determining the number of such packets. The abstract of this paper suggests that the authors — from Sydney’s St. George Hospital — ...
Source: The Poison Review - August 26, 2014 Category: Toxicology Authors: Leon Tags: Medical body packer CT mule radiography Source Type: news

CPC: salicylate toxicity
Discussion of salicylate toxicity misses several key points Pearl: falsely normalized anion gap in salicylate overdose Excellent guidelines for managing salicylate overdose Salicylate toxicity can present with a normal-anion-gap metabolic acidosis Salicylate toxicity: the great masquerader       (Source: The Poison Review)
Source: The Poison Review - August 25, 2014 Category: Toxicology Authors: Leon Tags: Medical aspiring poisoning case records of the massachusetts general hospital salicylate toxicity Source Type: news

Tox Tunes #86: Let’s Go Get Stoned (Big Mama Thornton)
http://www.youtube.com/watch?v=spkcAjt-TKU Big Mama Thornton (1926-1984) was a powerful rhythm and blues singer who recorded and/or wrote a number of songs that were big hits for other artists. “Let’s Go Get Stoned” — written by Nickolas Ashford, Valerie Simpson, and Josephine Armstead — went to the top of th eR&B charts when Ray Charles released his version in 1966. Thornton recorded Leiber and Stoller’s song “Hound Dog” in 1952. It was popular, but not the monster hit Elvis Presley had with the song in 1956. Thornton recorded her own song “Ball and Chain” in the ear...
Source: The Poison Review - August 25, 2014 Category: Toxicology Authors: Leon Tags: Medical big mama thornton let's go get stoned tox tunes Source Type: news