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Rant: ultrasound visualization of pills in the stomach will never make sense
Konstantin Shevtsov/shutterstock.com 2 out of 5 stars Accuracy of Trans-Abdominal Ultrasound in a Simulated Massive Acute Overdose. Sullivan S et al.  Am J Emerg Med 2016 Apr 23 [Epub ahead of print] Abstract As soon as emergency portable bedside ultrasound became feasible approximately three decades ago, toxicologists wondered if it would be a useful modality for visualizing pills in the stomach of overdose patients. The answer, clearly, is no it would not. This misguided paper illustrates why. This randomized study had a study group (N=10) and a control group (N=10) ingest 50 enteric-coated placebo capsules plu...
Source: The Poison Review - May 25, 2016 Category: Toxicology Authors: Leon Gussow Tags: Medical activated charcoal acute ingestion gastric lavage sonography ultrasound whole bowel irrigation Source Type: news

Case report: Amanita muscaria (fly agaric) poisoning
Mikhail Kochlev/shutterstock.com 2 out of 5 stars Coma in the course of severe poisoning after  consumption of red fly agaric (Amanita muscaria). Mikaszewska-Sokolewicz MA et al. Acta Biochim Pol 2016 Feb 1 [Epub ahead of print] Full Text Probably the most recognizable mushroom in the world is Amanita muscaria (the “fly agaric”), This striking red-and-white fungus contains several distinct neurotoxins: ibotenic acid:  this toxin is structurally similar to the excitatory neurotransmitter glutamic acid muscimol: structurally similar to GABAA  this is the main psychoactive component...
Source: The Poison Review - February 9, 2016 Category: Toxicology Authors: Leon Tags: Medical amanita muscaria fly agaric isotonic acid muscimol mushroom poisoning Source Type: news

Case report: veno-venous ECMO as a bridge to lung transplantation in paraquat poisoning
3 out of 5 stars Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning. Tang X et al.  Clin Toxicol 2015 Aug 28 [Epub ahead of print] Abstract Conceptually, extracorporeal membrane oxygenation (ECMO) seems a perfect technique for treating some of the sickest toxicology patients,  buying time until failing vital functions can recover. With severe cardiotoxins — for example, calcium channel blockers, beta blockers or bupropion — veno-arterial ECMO can provide complete cardiopulmonary bypass, replacin...
Source: The Poison Review - September 9, 2015 Category: Toxicology Authors: Leon Tags: Medical ECMO extracorporeal membrane oxygenation lung transplantation paraquat poisoning Source Type: news

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2.5 out of 5 stars Evaluation of Residual Toxic Substances in the Stomach Using Upper Gastrointestinal Endoscopy for Management of Patients With Oral Drug Overdose on Admission. Miyauchi M et al. Medicine 2015 Jan;94:e463 Abstract Despite many flaws, this paper has some interesting data that the authors use to come to exactly the wrong conclusion. The authors studied patients presenting with oral non-liquid drug overdose. Using endoscopy they classified the contents of the stomach as: 1) tablet/food phase; 2) soluble/fluid phase; and 3) reticular/empty phase.(I’m not clear on the precise meaning of a “tabl...
Source: The Poison Review - February 24, 2015 Category: Toxicology Authors: Leon Tags: Medical gastric empyting gastric lavage gastrointestinal decontamination Source Type: news

News flash: dead overdose victims can have drugs in the GI tract
1.5 out of 5 stars Retained drugs in the gastrointestinal tracts of deceased victims of oral drug overdose. Livshits Z et al. Clin Toxicol 2014 Dec 30:1-6 [Epub ahead of print] Abstract This is certainly one of the more bizarre medical papers I’ve seen for quite some time. The main objective of the study was to determine the presence of “undigested or partially digested” tablets found at autopsy in the GI tracts of oral drug overdose fatalities. Why would they be interested in this question? Apparently to argue that aggressive gastrointestinal decontamination may have benefit even late after oral ing...
Source: The Poison Review - February 6, 2015 Category: Toxicology Authors: Leon Tags: Medical activated charcoal cadaver study gastric emptying gastric lavage gastrointestinal decontamination ingestion intoxication overdose whole bowel irrigation Source Type: news

Whole bowel irrigation? Don’t just do something, stand there!
3.5 out of 5 stars Position paper update: Whole bowel irrigation for gastrointestinal decontamination of overdose patients. Thanacoody R et al. Clin Toxicol 2015 Jan;53:5-12. Abstract In 1997 the American Academy of Clinical Toxicology (AACT) and the Euroopean Association of Poisons Centre and Clinical Toxicologists (EAPCCT) published a position paper regarding the use of whole bowel irrigation (WBI) for gastrointestinal decontamination in the poisoned patient. The key conclusions were that no evidence existed showing that WBI improved clinical outcome, and that it should not be used routinely but “may be consid...
Source: The Poison Review - January 13, 2015 Category: Toxicology Authors: Leon Tags: Medical gastrointestinal decontamination overdose poisoning polyethylene glycol position paper whole bowel irrigation 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 b...
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

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

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

Ten hyped highs, the poison squad, and Lyme disease: Weekly Web Review in Toxicology
Thefix.com interviews medical toxicologist Dr. Jeff Lapoint for a “Straight look at 10 Hyped Highs.” Topics include salvia, methoxetamine (“Mexxy”), Benzo Fury (6-APB), kratom, and Bromo Dragonfly. Worth reading. At Esquire, Bruce Watson writes about “The Poison Squad: An Incredible HIstory.” This piece tells the story of a project, run by Dr. Harvey Washington Wiley in the very early years of the twentieth century, to investigate the potential health hazards of various food additives. Officially called the “hygienic table trials”, the were quickly— and more accura...
Source: The Poison Review - July 1, 2013 Category: Toxicology Authors: Leon Tags: Medical designer drugs legal highs lyme disease poison square weekly web review in toxicology Source Type: news

Gastric lavage? Fuggedaboutit!
4 out of 5 stars Position paper update: gastric lavage for gastrointestinal decontamination. Benson BE et al. Clin Toxicol 2013 Feb18 [Epub ahead of print] Abstract The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists published their initial position paper on gastric lavage in 1997, concluding that their was no good evidence supporting the use of the procedure in poisoned patients. A 2004 update  reached the same conclusion. This paper reviewed medical literature appearing since 2003 and found there was no need to alter the grou...
Source: The Poison Review - February 23, 2013 Category: Toxicology Authors: Leon Tags: Medical american academy of clinical toxicology decontamination european association of poisons centers and clinical toxicologists gastric lavage position paper Source Type: news

Excellent lectures giving introduction to medical toxicology
http://www.youtube.com/watch?v=RTKj-hgFhE0 At Academic Life in Emergency Medicine, Dr. Rahul Patwari has posted a very good series of whiteboard lectures that can serve as a basic introduction to medical toxicology for rotating medical students or interns. The four lectures — about 10 minutes each — cover general supportive management, toxidromes, laboratory testing, and gastrointestinal decontamination. I especially appreciated Dr. Patwari’s uncompromising approach to gastric lavage: “We don’t do that anymore”. The entire lecture series is full of common sense advice. There are som...
Source: The Poison Review - February 7, 2013 Category: Toxicology Authors: Leon Tags: Medical academic life in emergency medicine decontamination patwari toxicology toxidromes Source Type: news