Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater.
CONCLUSION: Wastewater-based epidemiology with smart sewer selection and robotic wastewater collection is feasible to detect the presence of specific opioids, naloxone, methadone, and buprenorphine within a city. These results suggest that wastewater epidemiology could be used to detect patterns of opioid exposure and may ultimately provide information for opioid use disorder (OUD) treatment and harm reduction programs. PMID: 31919800 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - January 9, 2020 Category: Toxicology Authors: Endo N, Ghaeli N, Duvallet C, Foppe K, Erickson TB, Matus M, Chai PR Tags: J Med Toxicol Source Type: research

Do Patients Die with or from Metformin-Associated Lactic Acidosis (MALA)? Systematic Review and Meta-analysis of pH and Lactate as Predictors of Mortality in MALA.
CONCLUSION: Our review found higher mortality from MALA than seen in recent studies. This may be due to variation in standard medical practice both geographically and across the study interval, sample size, misidentification of MALA for another disease process and vice versa, confounding by selection and reporting biases, and treatment intensity (e.g., hemodialysis) influenced by degree of pH and lactate derangement. The ROC curves showed poor predictive power of either lactate or pH for mortality in MALA. With the exception of patients with acute metformin overdose, patients with MALA usually have coexisting precipitating...
Source: Journal of Medical Toxicology - January 6, 2020 Category: Toxicology Authors: Blumenberg A, Benabbas R, Sinert R, Jeng A, Wiener SW Tags: J Med Toxicol Source Type: research

The Global Educational Toxicology Toolkit  (GETKIT): A 1-Day Course for Teaching Poisoning Essentials in Low- and Middle-Income Countries (LMIC): Course Development and Pilot Data Analysis.
The Global Educational Toxicology Toolkit (GETKIT): A 1-Day Course for Teaching Poisoning Essentials in Low- and Middle-Income Countries (LMIC): Course Development and Pilot Data Analysis. J Med Toxicol. 2020 Jan 02;: Authors: Kopec KT, Vohra R, Santos C, Kazzi Z, Wong A Abstract INTRODUCTION: Worldwide an estimated one million deaths occur annually as a result of poisoning. Internationally there is a lack of toxicology training programs, especially in resource poor settings. We developed a one-day, interactive toxicology curriculum for healthcare practitioners in countries lacking clinical toxic...
Source: Journal of Medical Toxicology - January 2, 2020 Category: Toxicology Authors: Kopec KT, Vohra R, Santos C, Kazzi Z, Wong A Tags: J Med Toxicol Source Type: research

Buprenorphine Initiation in the Emergency Department: a Thematic Content Analysis of a #firesidetox Tweetchat.
CONCLUSIONS: A tweetchat can be used to disseminate and discuss the adoption of buprenorphine in the ED. Importantly, the tweetchat provides a forum for experts to share narratives and expertise on implementation and barriers and successes in operationalizing buprenorphine administration in emergency departments. PMID: 31898154 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - January 2, 2020 Category: Toxicology Authors: Chenworth M, Perrone J, Love JS, Greller HA, Sarker A, Chai PR Tags: J Med Toxicol Source Type: research

Evaluating Effectiveness of Online Learning Modules in Pediatric Environmental Health Education.
Abstract OBJECTIVE: Content and training about pediatric environmental health are lacking in healthcare professionals' education. In an initiative to improve pediatric environmental health education, the Pediatric Environmental Health Specialty Unit (PEHSU) program offers free, interactive, web-based ("eLearning") modules on environmental health topics. The aim of this study is to determine the effectiveness of PEHSU eLearning modules in increasing knowledge about pediatric and reproductive environmental health. METHODS: This is a retrospective analysis of 994 users who had completed at least one of...
Source: Journal of Medical Toxicology - December 23, 2019 Category: Toxicology Authors: Wong KH, Allen A, Durrani TS Tags: J Med Toxicol Source Type: research

Leadership Roles in Opioid Stewardship and the Treatment of Patients with Opioid Use Disorder Among Medical Toxicologists.
CONCLUSIONS: Medical toxicologists can serve as leaders to promote safe opioid prescribing practices through both institutional and governmental opioid task forces and opioid stewardship programs. They also provide important addiction-related clinical care to patients with OUD. PMID: 31863312 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - December 20, 2019 Category: Toxicology Authors: Carpenter JE, Murray BP, Mazer-Amirshahi M, Laes JR, Nacca N, Nelson LS, Perrone J, Schwarz ES, Wiegand TJ, Wax PM Tags: J Med Toxicol Source Type: research

National Institutes of Health (NIH) Executive Meeting Summary: Developing Medical Countermeasures to Rescue Opioid-Induced Respiratory Depression (a Trans-Agency Scientific Meeting)-August 6/7, 2019.
This report briefly summarizes the information presented throughout the meeting, which was also webcast live in its entirety to registered remote attendees. PMID: 31853736 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - December 18, 2019 Category: Toxicology Authors: Yeung DT, Bough KJ, Harper JR, Platoff GE Tags: J Med Toxicol Source Type: research

Imperfect but important: a fellow's perspective on journal peer review.
PMID: 31853737 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - December 18, 2019 Category: Toxicology Authors: Neumann N Tags: J Med Toxicol Source Type: research

Urine Bisphenol A and Arsenic Levels in Residents of the Cheyenne River Sioux Tribe, South Dakota, with and without Diabetes.
CONCLUSION: The results of this study are consistent with others that have reported no association between diabetes and exposure to BPA or As. PMID: 31848906 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - December 17, 2019 Category: Toxicology Authors: Chang A, Ridpath A, Carpenter J, Kieszak S, Sircar K, Espinosa-Bode A, Nelson D, Martin C Tags: J Med Toxicol Source Type: research

Single-Agent Bupropion Exposures: Clinical Characteristics and an Atypical Cause of Serotonin Toxicity.
CONCLUSION: Bupropion overdose is primarily associated with seizures, tachycardia, and agitation; bupropion may be an atypical cause of serotonin toxicity. PMID: 31823333 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - December 10, 2019 Category: Toxicology Authors: Murray B, Carpenter J, Dunkley C, Moran TP, Kiernan EA, Rianprakaisang T, Alsukaiti WS, Calello DP, Kazzi Z, Toxicology Investigators Consortium (ToxIC) Tags: J Med Toxicol Source Type: research

Circulating microRNA Profiles in Acetaminophen Toxicity.
CONCLUSIONS: Severe cases of acetaminophen toxicity showed two distinct patterns of microRNA elevation which were similar to previous work, while less severe cases were difficult to distinguish from non-acetaminophen-associated cases. Further work is needed to incorporate microRNA profiles into the diagnostic algorithm of acetaminophen toxicity. PMID: 31792846 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - December 2, 2019 Category: Toxicology Authors: Carreiro S, Marvel-Coen J, Lee R, Chapman B, Ambros V Tags: J Med Toxicol Source Type: research

Cardiac Collapse Secondary to Phenytoin Toxicity in a Neonate Treated with Extracorporeal Membrane Oxygenation Support (ECMO).
We describe the case of a 3-day-old male infant who developed cardiovascular collapse secondary to severe phenytoin toxicity (max phenytoin level 86 μg/mL) and was placed on extracorporeal membrane oxygenation support (ECMO). Several ancillary treatments were utilized in an attempt to decrease serum phenytoin concentrations and limit toxicity including albumin boluses, phenobarbital administration, intravenous lipid infusion, and folic acid supplementation. DISCUSSION: Although uncommon, drug toxicity should be considered in patients with acute changes who are exposed to medications with potential toxicity. With el...
Source: Journal of Medical Toxicology - November 26, 2019 Category: Toxicology Authors: Knecht M, LaRochelle J, Barkemeyer B, Gupta R, Brumund M, Mumphrey C Tags: J Med Toxicol Source Type: research

The Effect of 4-Methylpyrazole on Oxidative Metabolism of Acetaminophen in Human Volunteers.
CONCLUSIONS: These results show 4-MP effectively reduced oxidative metabolism of APAP in human volunteers ingesting a supratherapeutic APAP dose. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03878693. PMID: 31768936 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - November 25, 2019 Category: Toxicology Authors: Kang AM, Padilla-Jones A, Fisher ES, Akakpo JY, Jaeschke H, Rumack BH, Gerkin RD, Curry SC Tags: J Med Toxicol Source Type: research

Lessons Learned Through the Journey of a Medical Toxicologist While Characterizing Lead Hazards in the Republic of Georgia.
PMID: 31728957 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - November 14, 2019 Category: Toxicology Authors: Kazzi Z, Gabelaia L, Shengelia L, Sturua L, Ericson B, Giorgobiani A, Nadiradze A, Gamkrelidze A Tags: J Med Toxicol Source Type: research

ACMT/IST 2019 American-Israeli Medical Toxicology Conference Abstracts-Haifa, Israel.
PMID: 31721040 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - November 13, 2019 Category: Toxicology Authors: American College Of Medical Toxicology Tags: J Med Toxicol Source Type: research

Pediatric Bupropion Ingestions in Adolescents vs. Younger Children-a Tale of Two Populations.
Abstract BACKGROUND: Bupropion is a unique class of antidepressant. In overdose, it is associated with tachycardia, altered mental status, and a dose-dependent risk of seizures, which can be delayed. Despite being a common medication, there is a paucity of data comparing toxicity in younger versus older children with bupropion exposures. The primary purpose of this study is to examine bupropion toxicity in pediatric patients and assess for toxicity differences between younger and older (teenaged) groups. METHODS: This single-center, observational cohort study reviewed pediatric patients presenting to a toxico...
Source: Journal of Medical Toxicology - November 11, 2019 Category: Toxicology Authors: Offerman S, Levine M, Gosen J, Thomas SH Tags: J Med Toxicol Source Type: research

Kratom Adulterated with Phenylethylamine and Associated Intracerebral Hemorrhage: Linking Toxicologists and Public Health Officials to Identify Dangerous Adulterants.
CONCLUSION: Medical toxicologists should form working relationships with laboratories and public health officials to aid in early identification of adulterated products that carry risk to the general population. PMID: 31713176 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - November 11, 2019 Category: Toxicology Authors: Nacca N, Schult RF, Li L, Spink DC, Ginsberg G, Navarette K, Marraffa J Tags: J Med Toxicol Source Type: research

Assessment of the Utility of the Oral Fluid and Plasma Proteomes for Hydrocodone Exposure.
CONCLUSIONS: We present an assessment of the oral fluid and plasma proteome following hydrocodone administration, which demonstrates the potential of oral fluid as a noninvasive sample that may reveal features of hydrocodone in opioid use, and with additional study, may be useful for other opioids and in settings of misuse. PMID: 31677050 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - November 1, 2019 Category: Toxicology Authors: Deatherage Kaiser BL, Jacobs JM, Schepmoes AA, Brewer HM, Webb-Robertson BM, Valtier S, Bebarta VS, Adkins JN Tags: J Med Toxicol Source Type: research

The Toxicology Investigators Consortium Case Registry-the 2018 Annual Report.
The objective of this ninth annual report is to summarize the Registry's 2018 data and activity with its additional 7043 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2018. Detailed data was collected from these cases and aggregated to provide information which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. A total of 51.5% of cases were female, 48% were male, and 0.6% tr...
Source: Journal of Medical Toxicology - October 22, 2019 Category: Toxicology Authors: Spyres MB, Farrugia LA, Kang AM, Calello DP, Campleman SL, Pizon A, Wiegand T, Kao L, Riley BD, Li S, Wax PM, Brent J, Toxicology Investigators Consortium (ToxIC) Study Group Tags: J Med Toxicol Source Type: research

Moving Towards Gender Equality in Medical Toxicology.
PMID: 31529316 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - September 16, 2019 Category: Toxicology Authors: Spyres MB, Moore EC, Ruha AM, O'Connor AD Tags: J Med Toxicol Source Type: research

Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment.
CONCLUSIONS: Male victims of copperhead snake envenomation demonstrate slightly better recovery than females, but response to Fab antivenom overall is similar across all subgroups studied. PMID: 31482319 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - September 3, 2019 Category: Toxicology Authors: Lavonas EJ, Burnham RI, Schwarz J, Quackenbush E, Lewis B, Rose SR, Greene S, Toschlog EA, Charlton NP, Mullins ME, Schwartz R, Denning D, Sharma K, Kleinschmidt K, Bush SP, Anderson VE, Ginde AA, Gerardo CJ Tags: J Med Toxicol Source Type: research

Severe Toxicity to the New Psychoactive Substances 3-Hydroxyphencyclidine and N-Ethylhexedrone: an Analytically Confirmed Case Report.
We describe an analytically confirmed case of acute toxicity related to the use of both 3-hydroxyphencyclidine and N-ethylhexedrone. CASE REPORT: A 56-year-old male was brought to the Emergency Department by ambulance with hyperthermia (39.9 °C), sinus tachycardia (150 beats per minute), reduced consciousness, ocular clonus, and vertical nystagmus. He was treated with cooled intravenous (IV) fluids and IV benzodiazepines. Following 1 hour of treatment, his temperature fell to 37.7 °C, he developed rhabdomyolysis (creatine kinase peaked at 5999 IU (normal range
Source: Journal of Medical Toxicology - September 3, 2019 Category: Toxicology Authors: Dunlop LC, Wood D, Archer J, Hudson S, Dargan P Tags: J Med Toxicol Source Type: research

Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl.
CONCLUSION: Our findings refute the notion that high potency synthetic opioids like illicitly manufactured fentanyl require increased doses of naloxone to successfully treat an overdose. There were no significant differences in the dose of naloxone required to treat opioid overdose patients with UDS evidence of exposure to fentanyl, opiates, or both. Further evaluation of naloxone stocking and dosing protocols is needed. PMID: 31471760 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - August 30, 2019 Category: Toxicology Authors: Carpenter J, Murray BP, Atti S, Moran TP, Yancey A, Morgan B Tags: J Med Toxicol Source Type: research

Correction to: Adverse Effects of Physostigmine.
Abstract In "Adverse Effects of Physostigmine" by Arens et al in the July 2019 issue of JMT, reference #27 contains an error. PMID: 31414401 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - August 14, 2019 Category: Toxicology Authors: Arens AM, Kearney T Tags: J Med Toxicol Source Type: research

ACMT Position Statement: Remove the Waiver Requirement for Prescribing Buprenorphine for Opioid Use Disorder.
PMID: 31414402 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - August 14, 2019 Category: Toxicology Authors: Marino R, Perrone J, Nelson LS, Wiegand TJ, Schwarz ES, Wax PM, Stolbach AI Tags: J Med Toxicol Source Type: research

Patch Problems? Characteristics of Transdermal Drug Delivery System Exposures Reported to the National Poison Data System.
CONCLUSION: Overall, single-substance TDDS exposures decreased over the duration of this study and typically resulted in no or mild effects. However, exposures involving fentanyl resulted in higher rates of major or moderate medical outcomes and were associated with multiple deaths. PMID: 31410729 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - August 13, 2019 Category: Toxicology Authors: Thornton SL, Darracq MA Tags: J Med Toxicol Source Type: research

Thromboelastography with Platelet Studies (TEG ® with PlateletMapping®) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis.
CONCLUSIONS: Inhibition of ADP-induced platelet aggregation and fibrinolysis occurred independent of hypofibrinogenemia and thrombocytopenia, indicating fibrinogen concentration (or protime) and platelet count monitoring alone is insufficient to assess the extent of hematologic toxicity in rattlesnake envenomation. Crotalidae polyvalent immune Fab (ovine) reversed platelet inhibition in one case, suggesting platelet inhibition could also be used in treatment decisions. Fibrinolysis could also be reversed, although the timing to antivenom administration was less clear. PMID: 31407209 [PubMed - as supplied by publisher]...
Source: Journal of Medical Toxicology - August 12, 2019 Category: Toxicology Authors: Kang AM, Fisher ES Tags: J Med Toxicol Source Type: research

Crataegus mexicana (Tejocote) Exposure Associated with Cardiotoxicity and a Falsely Elevated Digoxin Level.
We describe a case of tejocote exposure from a weight-loss supplement resulting in severe cardiotoxicity. CASE REPORT: A healthy 16-year-old girl presented to an emergency department after ingesting eight pieces of her mother's tejocote root weight-loss supplement. At arrival, she was drowsy, had active vomiting and diarrhea, and had a heart rate of 57 with normal respirations. Her initial blood chemistries were unremarkable, except for an elevated digoxin assay of 0.7 ng/mL (therapeutic range 0.5-2.0 ng/mL). All other drug screens were negative. She later developed severe bradycardia and multiple episodes o...
Source: Journal of Medical Toxicology - August 12, 2019 Category: Toxicology Authors: Palmer KG, Lebin JA, Cronin MT, Mazor SS, Burns RA Tags: J Med Toxicol Source Type: research

Nitrous Oxide Toxicity: Case Files of the Carolinas Medical Center Medical Toxicology Fellowship.
PMID: 31388940 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - August 6, 2019 Category: Toxicology Authors: Shah K, Murphy C Tags: J Med Toxicol Source Type: research

Development and Feasibility of a Porcine Model of Amlodipine Toxicity.
CONCLUSION: This study demonstrates a potentially repeatable model of amlodipine-induced toxic shock using intravenous administration of amlodipine and several methodological considerations for researchers undertaking similar work. PMID: 31385194 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - August 5, 2019 Category: Toxicology Authors: Boley SP, Mackenzie RB, LeRoy JM, Engebretsen KM, Stellpflug SJ Tags: J Med Toxicol Source Type: research

JMT's  Research Concepts Section: a 5-Year Evaluation.
JMT's Research Concepts Section: a 5-Year Evaluation. J Med Toxicol. 2019 Aug 05;: Authors: Jang DH, Love JS, Mycyk MB PMID: 31385195 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - August 5, 2019 Category: Toxicology Authors: Jang DH, Love JS, Mycyk MB Tags: J Med Toxicol Source Type: research

Self-Analysis: How to Engage with Social Media. A Fellow's Perspective.
PMID: 31342446 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - July 24, 2019 Category: Toxicology Authors: McCabe D Tags: J Med Toxicol Source Type: research

Adverse Drug Events and Reactions Managed by Medical Toxicologists: an Analysis of the Toxicology Investigators Consortium (ToxIC) Registry, 2010-2016.
CONCLUSIONS: 4.2% of cases managed at the bedside by a consulting toxicologist and reported to the ToxIC registry between 2010 and 2016 had ADE/ADR as the reason for consultation. Agents most commonly involved in ADE/ADR included cardiovascular medications, antipsychotic medications, and antidepressants. PMID: 31313221 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - July 16, 2019 Category: Toxicology Authors: Beauchamp GA, Amaducci A, Greenberg MR, Meyers M, Cook M, Cannon RD, Katz KD, Finkelstein Y, Toxicology Investigators Consortium (ToxIC) Tags: J Med Toxicol Source Type: research

Adverse Drug Events and Reactions Managed by Medical Toxicologists: an Analysis of the Toxicology Investigators Consortium (ToxIC) Registry, 2010-2016.
CONCLUSIONS: 4.2% of cases managed at the bedside by a consulting toxicologist and reported to the ToxIC registry between 2010 and 2016 had ADE/ADR as the reason for consultation. Agents most commonly involved in ADE/ADRs included cardiovascular medications, antipsychotic medications, and antidepressants. PMID: 31309522 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - July 15, 2019 Category: Toxicology Authors: Beauchamp GA, Amaducci A, Greenberg MR, Meyers M, Cook M, Cannon RD, Katz KD, Finkelstein Y, Toxicology Investigators Consortium (ToxIC) Tags: J Med Toxicol Source Type: research

Lacosamide: a Study of Exposures Reported to US Poison Centers over a 9-Year Period.
CONCLUSION: Lacosamide exposures infrequently cause death or disability; however, a considerable proportion of the study population required intensive care. Exposed patients with symptoms require healthcare evaluation. PMID: 31286429 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - July 8, 2019 Category: Toxicology Authors: Teijido J, Kempf D, Laubach E, Zosel A, Borys D Tags: J Med Toxicol Source Type: research

A New Way Forward in the Emergency Department.
PMID: 31278586 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - July 5, 2019 Category: Toxicology Authors: Schwarz ES, Laes JR, Wiegand TJ Tags: J Med Toxicol Source Type: research

Human Errors and Adverse Hemodynamic Events Related to "Push Dose Pressors" in the Emergency Department.
CONCLUSIONS: Human errors and adverse hemodynamic events were common with the use of push dose pressors in the emergency department. Adverse hemodynamic events were more common than in previous studies. Future research should determine if push dose pressors improve outcomes and if so, how to safely implement them into practice. PMID: 31270748 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - July 3, 2019 Category: Toxicology Authors: Cole JB, Knack SK, Karl ER, Horton GB, Satpathy R, Driver BE Tags: J Med Toxicol Source Type: research

Does Lidocaine Cause False Positive Results on Cocaine Urine Drug Screen?
CONCLUSION: The present study found no evidence that lidocaine or norlidocaine are capable of producing false positive results on standard cocaine urine immunoassays. PMID: 31264143 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - July 1, 2019 Category: Toxicology Authors: Kim E, Murray BP, Salehi M, Moran TP, Carpenter JE, Koch DD, Ritchie JC, Schindler JM, Morgan BW Tags: J Med Toxicol Source Type: research

Opioid Use Disorder and Prescribed Opioid Regimens: Evidence from Commercial and Medicaid Claims, 2005-2015.
CONCLUSIONS: Most enrollees with OUD in the data had current opioid prescriptions, suggesting that continuing efforts to reduce misuse of prescribed opioids among patients with prescriptions may be effective. However, a substantial percentage of enrollees with OUD may be obtaining opioids via other, likely illegitimate, channels, particularly younger people, which suggests an opportunity for targeted efforts to reduce opioid diversion. PMID: 31152355 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - May 31, 2019 Category: Toxicology Authors: Ali MM, Cutler E, Mutter R, Henke RM, O'Brien PL, Pines JM, Mazer-Amirshahi M, Diou-Cass J Tags: J Med Toxicol Source Type: research

Gadolinium Aspiration Following Inadvertent Endotracheal Tube Cuff Injection in a Pediatric Patient.
CONCLUSION: This case of pulmonary aspiration secondary to inadvertent GBCA injection in a pediatric patient demonstrated no acute  side effects or complications within the first 24 hours. With the wide range of adverse effects attributed to gadolinium use in the medical literature, it is difficult to predict potential future adverse effects. PMID: 31119526 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - May 22, 2019 Category: Toxicology Authors: Mostafa AMT, Ershad M, Dela Cruz M, McKeever RG, Vearrier D, Greenberg MI Tags: J Med Toxicol Source Type: research

ACMT Position Statement: Buprenorphine Administration in the Emergency Department.
PMID: 31087272 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - May 13, 2019 Category: Toxicology Authors: Wax PM, Stolbach AI, Schwarz ES, Warrick BJ, Wiegand TJ, Nelson LS Tags: J Med Toxicol Source Type: research

Self-Analysis: Do I Comprehend Case Series and Cohort Studies? A Fellow's Perspective.
PMID: 31065888 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - May 7, 2019 Category: Toxicology Authors: McCabe DJ Tags: J Med Toxicol Source Type: research

Hydrogen Sulfide Toxicity: Mechanism of Action, Clinical Presentation, and Countermeasure Development.
CONCLUSION: H2S exists in two main pools in vivo after exposure. While several countermeasures are being studied for H2S intoxication, a need exists for a small-volume, safe, highly effective antidote with a long shelf life to treat acute toxicity as well as prevent long-term effects of exposure. PMID: 31062177 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - May 6, 2019 Category: Toxicology Authors: Ng PC, Hendry-Hofer TB, Witeof AE, Brenner M, Mahon SB, Boss GR, Haouzi P, Bebarta VS Tags: J Med Toxicol Source Type: research

Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease.
We present a case report of coagulopathy from BSS poisoning in a patient with underlying cirrhosis. The patient's high prothrombin time suggests inhibition of vitamin K-dependent coagulation factors. The patient had decreased factor V activity, which is responsible for converting prothrombin to thrombin. Patients with cirrhosis often have hypoprothrombinemia which may be exacerbated by salicylate-induced coagulopathy. Given the widespread use of BSS products, physicians should recognize coagulopathy as a possible manifestation of toxicity especially in patients with underlying liver disease. PMID: 31062178 [PubMed - a...
Source: Journal of Medical Toxicology - May 6, 2019 Category: Toxicology Authors: Yu C, Eustaquio N, Calello DP, Ruck BE, Nelson LS, Santos C Tags: J Med Toxicol Source Type: research

The Relationship Between Circulating Acetaminophen-Protein Adduct Concentrations and Alanine Aminotransferase Activities in Patients With and Without Acetaminophen Overdose and Toxicity.
Abstract INTRODUCTION: Measurement of serum acetaminophen-protein adducts (APAP-CYS) has been suggested to support or refute a diagnosis of acetaminophen (APAP)-induced hepatotoxicity when ingestion histories are unreliable or unavailable and when circulating APAP concentrations are low or undetectable. Non-APAP overdose patients commonly have used APAP products in non-toxic quantities and, thus, will have measurable APAP-CYS concentrations, even when hepatic injury results from other causes, such as ischemic hepatitis. The relationship between alanine aminotransferase (ALT) activity and APAP-CYS concentration mig...
Source: Journal of Medical Toxicology - April 12, 2019 Category: Toxicology Authors: Curry SC, Padilla-Jones A, Ruha AM, O'Connor AD, Kang AM, Wilkins DG, Jaeschke H, Wilhelms K, Gerkin RD, Acetaminophen Adduct Study Group Tags: J Med Toxicol Source Type: research

ACMT Position Statement: Addressing Pediatric Cannabis Exposure.
PMID: 30945126 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - April 3, 2019 Category: Toxicology Authors: Amirshahi MM, Moss MJ, Smith SW, Nelson LS, Stolbach AI Tags: J Med Toxicol Source Type: research

Ten Years of Robotripping: Evidence of Tolerance to Dextromethorphan Hydrobromide in a Long-Term User.
We report a patient with persistent dextromethorphan hydrobromide abuse at escalating doses whose mean serum chloride concentration increased, on average, by 0.00232 mEq/L every day over a 110-month period. This case demonstrates progressive spurious hyperchloremia secondary to bromide interference in hospital-based chloride assays, supporting the patient's reported need to dose escalate to the same desired effect. Although this artefactual laboratory finding is a well-documented result of bromide ingestion, it may be useful in identifying patterns of dextromethorphan hydrobromide use that suggest tolerance. PMID...
Source: Journal of Medical Toxicology - March 22, 2019 Category: Toxicology Authors: Olives TD, Boley SP, LeRoy JM, Stellpflug SJ Tags: J Med Toxicol Source Type: research

The Recommendation and Use of Extracorporeal Membrane Oxygenation (ECMO) in Cases Reported to the California Poison Control System.
CONCLUSIONS: ECMO is being recommended more often for treatment of acute poisoning cases by the CPCS. All caregivers involved in the treatment of poisoning should gain a working knowledge of the potentially lifesaving technology of ECMO, its indications for use, adverse effects, and drug or poison interactions. PMID: 30895517 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - March 20, 2019 Category: Toxicology Authors: Lewis J, Zarate M, Tran S, Albertson T Tags: J Med Toxicol Source Type: research

A Swine Model of Severe Propranolol Toxicity Permitting Direct Measurement of Brain Tissue Oxygenation.
CONCLUSION: We report a pilot study swine model of propranolol toxicity with hypotension despite HDI, in which physiologic measures including PbrO2 are achieved. Our toxicity model can be used in the future, and the hemodynamic and brain monitoring model may prove important for subsequent research in various contexts. PMID: 30895518 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - March 20, 2019 Category: Toxicology Authors: Orozco BS, Engebretsen KM, Holger JS, Stellpflug SJ Tags: J Med Toxicol Source Type: research

In Response to "Impact of Targeted Temperature Management on ED Patients with Drug Overdose-Related Cardiac Arrest".
In Response to "Impact of Targeted Temperature Management on ED Patients with Drug Overdose-Related Cardiac Arrest". J Med Toxicol. 2019 Mar 08;: Authors: Fountain JH, Eggleston W Abstract PMID: 30850943 [PubMed - as supplied by publisher] (Source: Journal of Medical Toxicology)
Source: Journal of Medical Toxicology - March 8, 2019 Category: Toxicology Authors: Fountain JH, Eggleston W Tags: J Med Toxicol Source Type: research