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Sriracha, Zohydro, and more: tox on the web
http://www.youtube.com/watch?v=U2DJN0gnuI8 The science of Sriracha: The American Chemical Society has a must-see video on Sriracha hot sauce — it goes well with everything — including disquisitions about the origin of the Scoville scale and the physiology of capsaicinoids. (HT @ToxTalk) Early ads for sedatives: The Milwaukee Journal-Sentinel — which is doing some of the best reporting in the country on drugs and the pharmaceutical industry — has a great collection of medical journal ads for tranquilizers from the 1950s and 60s. This post accompanies their story on the deadly interaction between sedat...
Source: The Poison Review - March 5, 2014 Category: Toxicology Authors: Leon Tags: Medical amphetamine drug screen capsaicin did she kill him Florence Maybrick gravel Kate Coloquhoun PVP pyrrolidinopentiophenone scoville scale sedative sriracha tox on the web tranquilizer advertisement zohydro Source Type: news
Central pontine myelinolysis associated with ethylene glycol intoxication
central pontine myelinolysis, MRI 3.5 out of 5 stars Massive Ethylene Glycol Poisoning Triggers Osmotic Demyelination Syndrome. Ahmed A et al. J Emerg Med 2014 Mar;46(3):369-74 Abstract Central pontine myelinolysis has long been associated with too rapid correction of subacute hyponatremia. Although the pathophysiologic mechanism has not yet been fully elucidated, it appears to involve stress from relative serum hyperosmolality and loss of water from brain cells. Endothelial damage and injury to the blood-brain barrier may also play a role. Recently, this process has been renamed osmotic demyelination syndrome (ODS) with ...
Source: The Poison Review - March 4, 2014 Category: Toxicology Authors: Leon Tags: Medical central pontine myelinolysis ethylene glycol toxicity osmolality osmotic demyelination syndrome toxic alcohol Source Type: news
Tox Tunes #79: Muggles (Louis Armstrong)
http://www.youtube.com/watch?v=qY6Yo6lE-Jg In the Harry Potter series, a “muggle” refers to a person without any magical power whatsoever. I’m quite sure Louis Armstrong had something else in mind when he recorded this track in 1928. It features some magnificent playing, especially by Armstrong on trumpet and Earl Hines on piano. Back in the 1920s, “muggles” was common slang for marijuana, especially among jazz musicians. (Source: The Poison Review)
Source: The Poison Review - March 2, 2014 Category: Toxicology Authors: Leon Tags: Medical earl hines louis armstrong muggles tox tunes Source Type: news
Hyperbaric oxygen for gas emboli following hydrogen peroxide ingestion
Discussion” section of the paper: As little as “one sip” (1-5 ml) of hydrogen peroxide can cause problems. Imaging and endoscopy are appropriate for patients who have ingested solutions > 10% and those who have “significant symptoms.” including persistent abdominal pain, neurologic deficits, or hematemesis. HBO should be considered in patients with gas emboli after ingestion of hydrogen peroxide. The paper is possibly most valuable for its 2 tables, that summarize reported cases of hydrogen peroxide ingestions treated with and without HBO. (Source: The Poison Review)
Source: The Poison Review - February 27, 2014 Category: Toxicology Authors: Leon Tags: Medical gas emboli hydrogen peroxide hyperbaric oxygen Source Type: news
The Dark Side of Acetaminophen, and more: Tox on the Web
The Dark Side of Acetaminophen: The Toronto Star has a long article this weekend about the hepatotoxicity of acetaminophen, both when taken in deliberate overdose as a suicidal gesture or attempt, or ingested in supra-therapeutic (or even therapeutic) doses. It was put together with the help of the investigative unit ProPublica and goes over much of the material covered in the recent “This American Life” episode but with a Canadian twist. The piece states that a 2009 report “found a dozen cases in Health Canada’s adverse drug events database where people suffered liver injury or damage aft...
Source: The Poison Review - February 23, 2014 Category: Toxicology Authors: Leon Tags: Medical acetaminophen amitriptyline cyclobenzaprine ethylene glycol hepatotoxicity nasal naloxone tox on the web Source Type: news
TPR Podcast Episode #2: Chinese Restaurant Toxicology
Conclusion: patients with renal dysfunction should be cautious of how much durian they ingest Summary of Soy Sauce Induced 19 year old male came in comatose after being dared to ingesting a quart of soy sauce 2 hrs prior to arrival Peak sodium 196 The patient received very aggressive fluid hydration 6L D5W Soy sauce is 17-18% NaCl A quart of soy sauce has 160-170gm ~ 10tbsp of NaCl The only critique of the paper is that the use of very aggressive fluid hydration and lowering of sodium should not be generalized to all cases given the risk of central pontine myelinolysis In this case extreme measures and aggressi...
Source: The Poison Review - February 22, 2014 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news
Why is cocaine adulterated with an animal dewormer? Mystery solved?
3.5 out of 5 stars Aminorex, a metabolic of the cocaine adulterant levamisole, exerts amphetamine like actions at monoamine transporters. Hofmaier T et al. Neurochem Int 2013 Dec 1 [Epub ahead of print] Abstract During the last decade, many shipments of cocaine seized by U.S. drug authorities have been found to be adulterated with levamisole, a veterinary anti-worming medicine. The drug in the past has been used to treat various medical conditions in humans, but was withdrawn from the market because of significant adverse reactions. Levamisole has also been associated with the occurrence of agranulocytosis and dermal ...
Source: The Poison Review - February 21, 2014 Category: Toxicology Authors: Leon Tags: Medical adulterated aminorex cocaine levamisole Source Type: news
Driving under the influence (of marijuana)
How safe is driving under the influence of marijuana? For forensic purposes, are there tests that can establish impairment from THC? If so, how can they be used fairly and accurately. These are important questions now — especially in the states of Washington and Colorado — and they are explored in a very interesting article by Maggie Koerth-Baker in this morning’s New York Times science section. One can argue about the use of roadside field sobriety tests and Breathalyzer results to demonstrate driving under the influence of alcohol — lawyers hash out these issues in coatrooms every day — but the science b...
Source: The Poison Review - February 19, 2014 Category: Toxicology Authors: Leon Tags: Medical automobile cannabis driving marijuana THC Source Type: news
Asystole shortly after intravenous fat emulsion for overdose: causation or coincidence?
3 out of 5 stars Asystole Immediately Following Intravenous Fat Emulsion for Overdose. Cole JB et al. J Med Toxicol 2014 Feb 12. [Epub ahead of print] Abstract This case paper describes 2 patients who developed asystolic within 60 seconds of being given intravenous fat emulsion (IFE) bolus for treatment of severe cardiotoxicity. Both patients had return of spontaneous circulation (ROSC) after several minutes of cardiopulmonary resuscitation. Unfortunately, both patients died days after admission from multisystem organ failure. Patient A, a 50-year-old woman, had ingested an undetermined about of metoprolol and bupropion...
Source: The Poison Review - February 18, 2014 Category: Toxicology Authors: Leon Tags: Medical asystole bupropion cardiac arrest diltiazem intralipid intravenous fat emulsion therapy metoprolol propranolol Source Type: news
Source: The Poison Review - February 17, 2014 Category: Toxicology Authors: Leon Tags: Medical Source Type: news
Tox Tunes #78: Needle of Death (Neil Young)
http://www.youtube.com/watch?v=kfxNkhrJqSM This beautiful cover version of Bert Jansch’s “Needle of Death” by Neil Young is from a concert at Carnegie Hall’s Isaac Stern auditorium this past January. The visuals and the sound aren’t much — the clip was recorded from the balcony seats — but I find the performance moving anyway, especially at this time when the number of heroin overdose deaths are increasing dramatically. This song is a fitting companion to Young’s own “The Needle and the Damage Done.” (Source: The Poison Review)
Source: The Poison Review - February 16, 2014 Category: Toxicology Authors: Leon Tags: Medical bert jansch needle of death neil young tox tunes Source Type: news
6 Pearls About Metformin and Lactic Acidosis
3.5 out of 5 stars Metformin accumulation: Lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy. Vecchio S et al. Clin Toxicol 2014 Feb;52:129-135. Abstract Metformin is frequently used alone or in combination to treat type 2 diabetes. It lowers blood glucose by decreasing hepatic gluconeogenesis, predominantly by inhibiting mitochondrial respiratory chain complex I. The drug is eliminated mainly by the kidneys, and acute or chronic renal insufficiency may allow accumulation of the drug with increasing levels. A small percentage of patients on metformin devel...
Source: The Poison Review - February 13, 2014 Category: Toxicology Authors: Leon Tags: Medical glucophage lactic acidosis MALA metabolic acidosis metformin Source Type: news
You don’t need Dr. House to suspect cobalt toxicity in a patient with an artificial hip
Dr. Gregory House 3 out of 5 stars Cobalt intoxication diagnosed with the help of Dr. House. Dahms K et al. Lancet 2014 Feb 8;383:574. Full text This is a neat short case report that can fix in the mind the features of cobalt toxicity. A 55-year-old man came to clinic with a history of: severe heart failure (ejection fraction = 25%) decreased hearing acuity decreased visual acuity fever of unknown origin hypothyroidism abdominal discomfort lymphadenopathy All signs and symptoms seemed to have developed over the year before presentation. Further history revealed that the patient had undergone bilateral hip replacement. ...
Source: The Poison Review - February 12, 2014 Category: Toxicology Authors: Leon Tags: Medical artificial hip prosthesis cobalt toxicity dr. gregory house Source Type: news
Tox on the Web: the resurgence of heroin abuse, and more
The death of actor Philip Seymour Hoffman last week prompted a slew of articles about the related problems of prescription opioid abuse and heroin addiction. In the Washington Post, Joel Achenbach points out that despite the recent spike in deaths from heroin overdose, recent data indicated that “[p]rescription opioids are killing Americans at more than five times the rate that heroin is.” Achenbach also notes that use of heroin is increasing as individuals addicted to opioid pain relievers turn to the cheaper and more available street drug. CBCNews reported on a similar trend in Canada (clip above). ...
Source: The Poison Review - February 10, 2014 Category: Toxicology Authors: Leon Tags: Medical azodiacarbonamide buprenorphine butane oil cannabis dab giant hornet hash oil helium heroin overdose hyperthermia marijuana methadone naloxone opiate pain relievers oxycodone philip seymour hoffman serotonin syndr Source Type: news
Maybe Pradaxa (dabigatran) does need blood monitoring after all
2.5 out of 5 stars The Effect of Dabigatran Plasma Concentrations and Patient Characteristics on the Frequency of Ischemic Stroke and Major Bleeding in Atrial Fibrillation Patients. Reilly PA et al. J Am Coll Cardiol 2014 Feb 4;63:321-8. Abstract A must-read article in yesterday’s New York Times described the internal battle at Boehringer Ingelheim, the maker of Pradaxa (dabiagtran etexilate), concerning the publication of this study. A major marketing point posited in favor of dabigatran over warfarin for the prevention of stroke in patients with atrial fibrillation was that it did not require monitoring with reg...
Source: The Poison Review - February 7, 2014 Category: Toxicology Authors: Leon Tags: Medical bleeding blood testing boehringer ingelheim dabigatran pradaxa stroke Source Type: news
Episode #1 Addendum
Discussion of the reappearance of the krokodil report as a letter to the editor Critique of the revised report Definition of a case report Critique of the Revised Krokodil Report Revision has improved grammar and sentence structure Content, however, still flawed: Unsupported claim that krokodil is rapidly spreading across Europe Krokodil loosely called “homemade heroin” — it’s actually desomorphine or the product formed from the attempt to manufacture desomorphine from codeine and caustic reagents Use of sensationalized terms such as “flesh eating” which are more appropriate for non-medical journa...
Source: The Poison Review - February 5, 2014 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news
The money and influence behind “Pain: the 5th vital sign”
“Last year, [Philip Seymour Hoffman] checked into a rehabilitation program for about 10 days, a move that came after a reliance on prescription pills led to a return to heroin, after what he said had been a clean period spanning two decades.” New York Times February 4, 2014 The death of actor Philip Seymour Hoffman from a drug overdose earlier this week brings into focus not only the recent resurgence of heroin use, but also the dangers of prescription opioid pain relievers. It seems an appropriate time to rerun this post from December 2012. A must-read article in the Wall Street Journal this weekend focus...
Source: The Poison Review - February 5, 2014 Category: Toxicology Authors: Leon Tags: Medical heroin opiate opioid opioid pain relievers pain the 5th vital sign philip seymour hoffman Source Type: news
Bud Light commercial too toxic for the Super Bowl
http://www.youtube.com/watch?v=cYIN-b8qjmo This toxicology-themed Bud Light commercial was banned from airing during the 2007 Super Bowl. (Source: The Poison Review)
Source: The Poison Review - February 2, 2014 Category: Toxicology Authors: Leon Tags: Medical blowfish bud light fugu super bowl Source Type: news
Breaking Dab: a potent and explosive form of THC
A few weeks ago, NPR’s news show All Things Considered reported on “wax” or “butane hash oil” or “dab”, a highly concentrated form of tetrahydrocannabinol (THC) extracted from marijuana in a process using butane as a solvent. Butane is, of course, highly flammable, and there have been an increasing number of reported explosions caused by individuals trying to make this stuff at home: http://www.youtube.com/watch?v=34GlKQwMFJU This situation has obvious analogy to the dangers involved in meth labs. (“Breaking Dab”?) Aside from creating a danger during manufacture of ...
Source: The Poison Review - February 1, 2014 Category: Toxicology Authors: Leon Tags: Medical butane butane hash oil dab honey marijuana tetrahydrocannabinol THC wax Source Type: news
Ethylene glycol intoxication can cause falsely elevated lactate levels
3 out of 5 stars The importance of the osmolality gap in ethylene glycol intoxication. Oostvogels R et al. BMJ 2013 Dec 7;347:31-33. Reference – no abstract available This brief case report teaches a key lesson. A 32-year-old woman on multiple sedative and antipsychotic medications presented to the emergency department with decreased mental status. Initially, the treating physicians suspected overdose from one or more of the patients prescription medications. However, they noted an elevated anion gap (23) and an serum lactate level of 25.9 mmol/L (reference 0.0-2.2) for which there was no obvious explanation. The...
Source: The Poison Review - January 31, 2014 Category: Toxicology Authors: Leon Tags: Medical ethylene glycol toxicity lab error lactate lactic acid oxalate Source Type: news
Bruce Springsteen on Pete Seeger
http://www.youtube.com/watch?v=B4i8ziSHkNA Wonderful tribute by The Boss at Seeger’s 90th birthday celebration. Pete’s and his music were a lifelong inspiration for me, from “Goodnight, Irene” to “The Weavers at Carnegie Hall” to his environmental work with the Hudson River Sloop Clearwater Foundation. And there was, always, his unwavering and indomitable political courage. This incredible performance was aired on CBS’s The Smothers Brothers Comedy Hour in 1968, in the midst of the war in Vietnam: http://www.youtube.com/watch?v=uXnJVkEX8O4 When Toshi Seeger, whom Pete married in 19...
Source: The Poison Review - January 28, 2014 Category: Toxicology Authors: Leon Tags: Medical Source Type: news
Epidemic of heroin/fentanyl overdose deaths in Western Pennsylvania
KDKA-TV, the local CBS station in Pittsburgh, reported yesterday that at least 22 people have died recently from narcotic overdoses in Western Pennsylvania. Authorities believe the deaths are related to products containing heroin and/or fentanyl sold on the street and derived from supplies stamped with the labels “Theraflu,” “Bud Ice,” or “Income Tax.’ This outbreak is reminiscent of previous events. In the early 1990s, fentanyl-laced heroin sold as “Tango and Cash” killed dozens of victims. In 2006, the Philadelphia Medical Examiner’s Office reported 252 overdose dea...
Source: The Poison Review - January 28, 2014 Category: Toxicology Authors: Leon Tags: Medical fentanyl heroin western pennsylvania Source Type: news
Case series: toxicity from a new synthetic cannabinoid
3.5 out of 5 stars An Outbreak of Exposure to a Novel Synthetic Cannabinoid. Monte AA et al. New Engl J Med 2014 Jan 23;370:389-390. Full Text Last month, TPR posted about an MMWR report describing a markedly increased number of visits to Colorado emergency departments by patients related to smoking synthetic cannabinoid products. This spike in visits occurred in August-September 2013. This letter to the editor describes this same outbreak as seen at 2 teaching hospitals in the Denver area. These institutions saw a combined total of 76 patients. Presenting symptoms included altered mental status, tachycardia (followed by ...
Source: The Poison Review - January 27, 2014 Category: Toxicology Authors: Leon Tags: Medical black mamba colorado crazy clown spice synthetic cannabinoid Source Type: news
Tox Tunes #77: Cooksferry Queen (Richard Thompson)
http://www.youtube.com/watch?v=fGKkhUkxvc4 The narrative of this song is somewhat murky, but seems to involve a gangster or politician (Mulvaney) in a dingy town “with no future” who gets turned on by psychedelic drugs given to him by his “Cooksferry Queen” She gave me one pill to get bigger She gave me one pill to get small I saw snakes dancing all around her feet And dead men coming through the wall According to some online commenters, Cook’s Ferry was a club that Thompson frequented in the 1960s. In this clip, I believe Danny Thompson (no relation) — formerly with the folk-rock group Pe...
Source: The Poison Review - January 26, 2014 Category: Toxicology Authors: Leon Tags: Medical cooksferry queen richard thompson tox tunes Source Type: news
Justin Bieber arrest refocuses spotlight on “sizzurp”
Visit NBCNews.com for breaking news, world news, and news about the economy [In the video above, the Today show's Jeff Rossen explains why "sizzurp" — a drug favored by some rap music and pop stars — is so dangerous.] Reports describing the arrest of pop star Justin Bieber, 19, this week for driving under the influence — after he was stopped while apparently drag racing his Lamborghini in Miami Beach — often mentioned that one of his favorite drinks is “sizzurp“, a potentially lethal mix of prescription cough syrup (codeine and promethazine), soda pop, and hard candy. TPR wrote about this con...
Source: The Poison Review - January 24, 2014 Category: Toxicology Authors: Leon Tags: Medical codeine jolly roger justin beiber promethazine purple drank sizzurp today show Source Type: news
Drug overdose deaths surge in Rhode Island: Tox on the Web
http://www.youtube.com/watch?v=d05jOFCV3jE Overdose deaths spike in Rhode Island: The Providence Journal reported that during the first 13 days of this year, 22 people in Rhode Island died of drug overdose. Tests on 13 victims revealed the presence of fentanyl — but not acetylfentanyl, a potent analog that 1n 2013 caused at least 14 overdose deaths in the state over the course of just 3 months. One official suggested that the increased number of OD deaths might be related to the push to fight prescription opioid overdose: Michelle McKenzie, senior project director at The Miriam Hospital, who has done extensive ...
Source: The Poison Review - January 23, 2014 Category: Toxicology Authors: Leon Tags: Medical 4-methylcyclohexane anion gap metabolic acidosis elk river fentanyl overdose deaths recast rhode island rob roman sean nordt west virginia Source Type: news
Dabigatran-related bleeding: a case series
2 out of 5 stars Clinical Experience of Life-threatening Dabigatran-Related Bleeding at a Large, Tertiary Care, Academic Medical Center: a Case Series. Ross B et al. J Med Toxicol 2014 Jan 3 [Epub ahead of print] Abstract The authors retrospectively reviewed patients on dabigatran (Pradaxa) admitted to UMass Memorial Medical Center (Worcester) for bleeding. They identified 7 patients with intracranial hemorrhage (ICH) and 4 patients with gastrointestinal bleeding. Although they present copious information regarding baseline characteristics, treatment modalities and outcomes, with a study population this small and non-...
Source: The Poison Review - January 21, 2014 Category: Toxicology Authors: Leon Tags: Medical bleeding case series dabigatran gastrointestinal bleeding hemorrhage intracranial hemorrhage pradaxa recombinant factor VIIa Source Type: news
The Poison Review Podcast
The Poison Review is pleased to announce that the long-planned TPR podcast has finally arrived. Actually, this is a resurrection of a project that began back in 1992, when TPR was a hard-copy newsletter with an accompanying audio program that was sent out on cassette tape. We were, of course, inspired by the masters of innovative medical education — Drs. Rick Bukata and Jerry Hoffman — whose Emergency Medical Abstracts project had started in the mid-1970s, and demonstrated to all that continuing medical education need be neither boring nor gullible. For a (very) fanciful history of the old TPR, see this post f...
Source: The Poison Review - January 18, 2014 Category: Toxicology Authors: Leon Tags: Medical podcast the poison review theresa kim Source Type: news
Methylene blue and poison-induced hypotension
3 out of 5 stars Methylene blue used in the treatment of refractory shock resulting from drug poisoning. Fisher J et al. Clin Toxicol 2014 Jan;52:63-65 Abstract Refractory shock in drug overdose results mainly from myocardial depression and/or vasodilatation. Bedside echocardiography can be very helpful in sorting out these two mechanisms, each of which might require somewhat different therapy. The best example of this is calcium channel blocker overdose. With myocardial depression, high-dose insulin/euglycemic therapy (HIT) should be considered early on. However, HIT would not be expected to produce significant vasoco...
Source: The Poison Review - January 16, 2014 Category: Toxicology Authors: Leon Tags: Medical antidoate distributive shock hypotension methylene blue nitric oxide quetiapine Source Type: news
Episode 1: What is ‘Krokodil’
Written by Theresa Kim MD Outline Introduction of the podcast Summary of American Journal of Medicine’s published case report on krokodil Hypotheses as to the cause of the disappearance this article Review of the current literature on krokodil Overview of krokodil history, production, and its chemical profile Confirmatory testing for krokodil? Introduction Podcast presenters: Dr. Leon Gussow-medical editor of the Poison Review Dr. Steve Aks-Toxikon Director, fellowship director and faulty at Cook County Emergency Medicine Dr. Jenny Lu-Toxikon Consortium and Cook County Emergency Medicine faculty Dr. Theresa Kim-Cook...
Source: The Poison Review - January 16, 2014 Category: Toxicology Authors: LeonThe Poison Review Tags: Podcast Source Type: news
Toxic Spill in West Virginia: Tox on the Web
Chemical Leak in West Virginia: On her Wired Science blog Elemental, @deborahblum tries to track down information about 4-methylcyclohexane methanol (MCHM), a “detergent” (foaming agent) used for washing coal that leaked from a storage tank into West Virginia’s Elk River on Thursday. Not much is known about the toxicology and risk of MCHM, except that it is an irritant. In the meantime, hundreds of thousands of West Virginia residents have been advised to stop drinking and bathing in tap water. Blum makes the important point that, although at this point MCHM does not seem to be overwhelmingly toxic, not...
Source: The Poison Review - January 12, 2014 Category: Toxicology Authors: Leon Tags: Medical amiodarone carbon monoxide toxicity child abuse dolphins elk river hyperbaric oxygen methylcyclohexane puffer fish toxic leak west virginia Source Type: news
“The Poisoner’s Handbook”: must-see TV
I just got a chance to watch “The Poisoner’s Handbook,” the superb 2-hour PBS documentary — based on Deborah Blum’s book of the same name — that describes the development of forensic toxicology in the early part of the twentieth century. Grisly and fascinating, this is absolutely must viewing for anyone interested in toxicology, or the application of science to law. In the early 1900s, death investigations were the responsibilities of coroners, who were generally corrupt and untrained political hacks. Forensic science had not developed to the point where it could be at all convincing in a court ...
Source: The Poison Review - January 10, 2014 Category: Toxicology Authors: Leon Tags: Medical american experience deborah blum documentary forensic toxicology pbs poisoner's handbook public broadcasting system Source Type: news
Make the diagnosis: 16-month-old child with irritability
3 out of 5 stars A 16-Month-Old Girl with Irritability After Ingesting White Pills. Jones MA et al. Pediatr Emerg Care 2014 Jan;30:69-71. Reference – no abstract available This short diagnostic puzzle was presented as part of Pediatric Emergency Care‘s “Pick Your Poison” series. A 16-month-old girl is brought to the emergency department with irritability, diaphoresis, tachycardia (152 bpm, resistant to fluids), hypokalemia (3.7 mmol/L) and an anion-gap metabolic acidosis (gap = 24). The father reports that the child was found ingesting “white pills” contained in her grandmother’s...
Source: The Poison Review - January 9, 2014 Category: Toxicology Authors: Leon Tags: Medical caffeine toxicity diet pills dimethylamylamine dmaa pediatric poisoning sympathomimetic toxidrome Source Type: news
Was Alexander the Great poisoned?
Alexander the Great 3 out of 5 stars Was the death of Alexander the Great due to poisoning? Was it Veratrum album? Schep LJ et al. Clin Toxicol 2013 Dec 26 [Epub ahead of print] Abstract Although accounts of the events leading up to the death of Alexander the Great (356-323 BC) vary, many versions describe a sudden onset of abdominal pain following a banquet featuring abundant amounts of wine. This was followed by weakness and trouble walking or speaking. He may or may not have developed fever. Symptoms persisted for 11 or 12 days before he died. Since that time, historians and commentators have debated about what cause...
Source: The Poison Review - January 7, 2014 Category: Toxicology Authors: Leon Tags: Medical alexander the great death poisoning toxicology history veratrum album Source Type: news
Into the Wild: did a neurotoxin kill Chris McCandless?
http://www.youtube.com/watch?v=4ZaRxPsk_M0 In April 1992, Chris McCandless, aka “Alexander Supertramp,” hiked into the Alaskan wilderness with no map, no compass, and no means of communicating with the outside world. A 24-year-old from Fairfax, Virginia, he had graduated with honors with a double major (history, anthropology) from Emory University in Atlanta. However, as chronicled in Jon Krakauer’s book Into the Wild, he then took off on an odyssey of self-discovery that led to Alaska. Four months later, his body was discovered by hunters who came across the abandoned bus that served as his shelter. He ...
Source: The Poison Review - January 6, 2014 Category: Toxicology Authors: Leon Tags: Best of TPR Medical Alaska alexander supertramp chris mccandless hedysarum mackenzii into the wild jedysarum alpinum jon krakauer lathyrism neurotoxicity odap wild sweet pea Source Type: news
Quiz: toxicology in the news, 2013
Rob Ford The year 2013 was filled with spectacular news events related to toxicology. How well were you following events over the past 12 months. My current Emergency Medicine News column tests your knowledge of the year in poisons. To take the quiz, click here. [Photograph of Rob Ford from wikipedia.org.] (Source: The Poison Review)
Source: The Poison Review - January 2, 2014 Category: Toxicology Authors: Leon Tags: Medical 2013 Emergency Medicine News quiz toxicology in the news Source Type: news
“Krokodil” paper reappears on American Journal of Medicine website
2 out of 5 stars ‘Krokodil’ — A Designer Drug from Across the Atlantic, with Serious Consequences. Thekkemuriyi DV et al. Am J Med 2013 Oct 15 [Epub ahead of print] Reference – no abstract available This paper, which was posted in manuscript form and then temporarily withdrawn from the American Journal of Medicine website, has reappeared as a “Clinical Communication to the Editor” prior to publication. As @ForensicToxGuy points out in a thorough analysis on his blog, the journal, the new version of the case report has been edited to eliminate some of the horrendous grammar and sentence...
Source: The Poison Review - January 2, 2014 Category: Toxicology Authors: Leon Tags: Medical american journal of medicine desomorphine krokodil Source Type: news
The 4th Annual Alexander Awards: Best Tox Reading of 2013
Alexander Gettler The coveted Alexander award is named in honor of Alexander Gettler (1883-1968), the chief toxicologist with the Office of the Medical Examiner of the City of New York during the first half of the 20th century. Gettler was a key figure in the development of modern forensic toxicology. By the way, Gettler will certainly be a key figure when a documentary based on Deborah Blum’s book The Poisoner’s Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York is broadcast in early January on the PBS series “American Experience.” To be eligible to win an Alexander, an artic...
Source: The Poison Review - December 31, 2013 Category: Toxicology Authors: Leon Tags: Medical long form journalism medical toxicology Source Type: news
The Top 7 Tox Articles of 2013
As we celebrate the year just ending, and welcome in 2014, let’s pause and remember some of the articles in the field of medical toxicology that most impressed TPR during 2013. The following 7 papers are listed in chronological order (links connect to TPR‘s discussion of each article): Pediatric Marijuana Exposures in a Medical Marijuana State. Wang GS et al. JAMA Pediatr 2013 July;167:630-3 With several states legalizing recreational marijuana — and many more allowing medical marijuana — cases of inadvertent pediatric exposure to cannabis will undoubtedly increase, and it is important for emergency practi...
Source: The Poison Review - December 31, 2013 Category: Toxicology Authors: Leon Tags: Medical 2013 medical toxicology top articles Source Type: news
Tox Tunes #76: Cocaine Blues (Dave Van Ronk)
http://www.youtube.com/watch?v=CGVqfX4ys4M A snippet of “Cocaine Blues” shows up in Inside Llewyn Davis, a film based partly on Dave Van Ronk’s book The Mayor of MacDougal Street: A Memoir. Van Ronk’s memoir is a fiercely intelligent and level-headed reminiscence of the music scene in Greenwich Village in the 1950s and 60s — what Van Ronk called the “Great American Folk Scare.” That the Coen Brothers made such a grim and bloodless movie out of it is, to my mind, a cultural tragedy. “Cocaine Blues” — a song closely associated with Van Ronk — was actually written by the...
Source: The Poison Review - December 30, 2013 Category: Toxicology Authors: Leon Tags: Medical cocaine blues coen brothers dave van ronk inside llewyn davis mayor of macdougal street tox tunes Source Type: news
Case Conference: agitated delirium from snorting “bath salts”
This article is part of the New England Journal of Medicine‘s “Case Records of the Massachusetts General Hospital” series. There is a very good discussion of the initial approach and differential diagnosis for a patient who presents with “agitation, delirium abnormal vital signs, and reports he had taken a toxic substance.” However, I find some of the management decisions puzzling. The patient was initially treated with fomepizole and sodium thiosulfate. Although toxic alcohols and cyanide are certainly in the differential for metabolic acidosis, that seems to me a case of treating the lab val...
Source: The Poison Review - December 27, 2013 Category: Toxicology Authors: Leon Tags: Medical agitated delirium bath salts case records of the massachusetts general hospital methcathinone Source Type: news
Painful Priapism, ADHD Drugs, and other News of Tox on the Web
This article is essential reading. (For more on tramadol, click here.) [HT @DavidJuurlink] Carbon Monoxide Toxicity: Over at Academic Life in Emergency Medicine, there is an excellent review of carbon monoxide toxicity by Dr. Dan Repplinger, with expert peer review by Dr. David Juurlink. The review focuses on the indications for hyberbaric oxygen therapy. Dr. Juurlink summation reflects my opinion on the matter exactly: ” . . .there are no absolute indications for HBO on patients with CO poisoning. Don’t let anyone tell you otherwise.” Another must-read. Liver toxicity and dietary supplements: The New...
Source: The Poison Review - December 24, 2013 Category: Toxicology Authors: Leon Tags: Medical ADHD atomoxetine attention deficit hyperactivity disorder carbon monoxide poisoning cyanide deborah blum dietary supplements hepatotoxicity hyperbaric oxygen lead toxicity liver injury strattera tox on the web tramadol Source Type: news
Do we need to change the dosing regimen for IV N-acetylcysteine
1.5 out of 5 stars Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomized controlled trial. Bateman DM et al. Lancet 2013 Nov 28 [Epub ahead of print] Abstract The authors argue that since there is a high incidence of adverse events — nausea and vomiting, anaphylactoid reactions — associated with the standard protocol for administering intravenous N-acetylcysteine (IV-NAC), a different dosing regimen might be safer and just as effective. In this somewhat complicated trial from Great Britain, subjects were randomized to 4 groups: Standard (in the U.K.) IV-...
Source: The Poison Review - December 22, 2013 Category: Toxicology Authors: Leon Tags: Medical acetaminophen adverse events N-acetylcysteine NAC rumack-matthew nomogram Source Type: news
Eight cases of botulism from home-made prison hooch
Clostridium botulinum 4 out of 5 stars Emergency Department Identification and Critical Care Management of a Utah Prison Botulism Outbreak. Williams BT et al. Ann Emerg Med 2013 Dec 12 [Epub ahead of print] Abstract Pruno (aka “hooch” or “white lightning”) is a home-brewed alcoholic beverage made by prisoners out of readily available ingredients. Typically, some combination of fruits. water, sugar, and bread are enclosed in an airtight plastic bag and allowed to ferment for several weeks. The resulting concoction has been described as tasting like “vomit-flavored wine-cooler.” This...
Source: The Poison Review - December 17, 2013 Category: Toxicology Authors: Leon Tags: Medical botulism hooch prison pruno utah Source Type: news
Toxicology comic books and cartoons: Tox on the Web
Best Tox on the Web This Week: In anticipation of its January 7 broadcast of a documentary based on Deborah Blum’s The Poisoner’s Handbook as part of the “American Experience” series, the Public Broadcasting System has posted an interactive comic book “Tales from the Poisoner’s Handbook” highlighting some cases crucial to the history of forensic toxicology. Great fun! By the way, on NPR’s Science Friday, you can hear Deborah Blum (@deborahblum) and Maria Popova (@brainpicker) discuss their choices for the best science books of 2013. alpha fentanyl: In Emergency Medicine N...
Source: The Poison Review - December 16, 2013 Category: Toxicology Authors: Leon Tags: Medical alpha fentanyl american experience anticholinergic syndrome brian kloss deborah blum jim roberts maria popova science friday tales from the poisoner's handbook the poisoners handbook Source Type: news
Must-read: The NY Times on the marketing of ADHD drugs
This article, although it really doesn’t feature a smoking gun, is important reading. Highly recommended. (Source: The Poison Review)
Source: The Poison Review - December 16, 2013 Category: Toxicology Authors: Leon Tags: Medical adderall ADHD attention deficit hyperactivity disorder concerta intuniv marketing new york times Ritalin Source Type: news
Emergency department visits in Colorado associated with smoking synthetic cannabinoids
3 out of 5 stars Severe Illness Associated with Reported Use of Synthetic Marijuana — Colorado, August-September 2013. MMWR 2013 Dec 13;62:1016-1017. Full Text In August and September of this year, it became apparent to the Colorado Department of Public Health and Environment (CDPHE) that there was a significant increase in the number of patients visiting emergency departments after smoking synthetic marijuana products. Therefore, the Department sent out a request to all EDs in the state to report patients seen on or after August 21 with altered mental status after using any form of synthetic marijuana. To study this pr...
Source: The Poison Review - December 13, 2013 Category: Toxicology Authors: Leon Tags: Medical colorado crazy clown denver spice synthetic cannabinoid Source Type: news
Twitter for Toxicologists
My recent Emergency Medicine News column described why I think everyone with an interest in medical toxicology should be on Twitter, along with my suggestions about some prolific tox tweeters who are worthwhile following. To read the column, click here. (Source: The Poison Review)
Source: The Poison Review - December 12, 2013 Category: Toxicology Authors: Leon Tags: Medical Emergency Medicine News medical toxicology twitter Source Type: news
Stroke in a young patient? Ask about synthetic cannabinoids
3 out of 5 stars Ischemic stroke after use of synthetic marijuana “spice”. Freeman MJ et al. Neurology 2013;81:1-4. Abstract This interesting paper, from the University of South Florida in Tampa, describes a brother and sister who at different times both developed ischemic strokes shortly after smoking a synthetic marijuana product. The 26-year-old brother presented with dysarthria, expressive aphasia, and right-sided weakness after smoking “Spice” a few hours previously. Head CT showed a clot in the proximal middle cerebral artery. His symptoms resolved after treatment with thrombolytics. The 19-y...
Source: The Poison Review - December 11, 2013 Category: Toxicology Authors: Leon Tags: Medical cerebral ischemia jwh-018 spice stroke synthetic cannabinoid Source Type: news