Tox Tunes #100: Rehab (Amy Winehouse)
TPR started the series “”Tox Tunes” on January 3, 2010 with Keith Richards’ cover of Reverend Gary Davis classic “Cocaine Blues.” Our stated goal was to highlight selections “culled from the long tradition of popular songs about drugs, toxins, and poisoning.”
Amy Winehouse’s “Rehab” — sometimes called the most ironic song in history — is our one-hundredth selection. Of course, Winehouse died of alcohol intoxication in July 2011; the coroner’s report listed her blood alcohol level as 416 mg/dL.
As a look back, we will post a list of — and links to...
Source: The Poison Review - August 24, 2015 Category: Toxicology Authors: Leon Tags: Medical Alcohol amy winehouse ethanal rehab tox tunes Source Type: news
Make the Diagnosis, Sherlock!
A 24-year-old man is brought to the emergency room with altered mental status. He was found wearing only his undershorts and shouting “I am God!” A friend reports that 3 hours before presentation the patient had been seen smoking marijuana. Can you make the diagnosis?
This case is part of the New England Journal of Medicine‘s “Interactive Medical Case” series. It is not behind the Journal‘s firewall and costs nothing to play. Subscribers can earn CME or MOC credit. To work through the case, click here. (Source: The Poison Review)
Source: The Poison Review - August 19, 2015 Category: Toxicology Authors: Leon Tags: Medical agitated delirium hyperthyroidism interactive medical case new england journal of medicine thyroid storm Source Type: news
Google Glass in toxicology: there may be less here than meets the eye(glasses)
Google Glass
3 out of 5 stars
The Feasibility and Acceptability of Google Glass for Teletoxicology Consults. Chai PR et al. J Med Toxicol 2015 Aug 6 {Epub ahead of print]
Abstract
This paper takes up a fascinating subject — it has already received a fair amount of attention in the media — but I think there is somewhat less here than meets the eye.
Google Glass is an optical head-mounted device (OHMD) that looks like a a pair of eyeglasses with an extra do-dad placed in front of one lens. This structure contains a camera and a display. The Glass is connected to the internet through a wi-fi network. In addition, the G...
Source: The Poison Review - August 18, 2015 Category: Toxicology Authors: Leon Tags: Medical consultation Google Glass head-mounted device medical toxicology Source Type: news
Ten cases of suspected palytoxin poisoning
This report describes the investigation by the Alaska Section of Epidemiology into at least 10 cases of palytoxin poisoning over a 2 year period. The index case, a middle-aged man, presented to the emergency department complaining of a “bitter metallic taste,” fever, weakness, headache, cough, as well as arthralgias and myalgias. Approximately 7-8 hours before presentation, live zoanthid coral was placed in his home aquarium. On presentation, he was tachycardic (135/min,) tachypnic, and febrile (103oF.) Two other persons who lived with the index case presented with milder symptoms.
The authors point out that th...
Source: The Poison Review - August 15, 2015 Category: Toxicology Authors: Leon Tags: Medical aquarium colonial coral palytoxin zoanthid Source Type: news
Candiru: a catfish that’s small, eel-like, and penetrates the urethra
3.5 out of 5 stars
Candiru — A Little Fish With Bad Habits: Need Travel Health Professionals Worry? A Review. Bauer IL J Travel Med 2013 Mar-Apr;20:119-124.
Abstract
Don’t know how I missed this paper when it was published 2 years ago. The author searched medical literature to answer the pressing question: Is there really a catfish native to the Amazon River that can swim up — and become embedded in — a man’s urethra?
TPR has posted on this subject before. The candiru (Vandellia cirrhosa) — a tiny eel-like catfish — is a blood-sucking parasite that preys on larger fish, following the stream of water a...
Source: The Poison Review - August 12, 2015 Category: Toxicology Authors: Leon Tags: Medical candiru catfish penis urethral penetration urology Source Type: news
Early metabolic acidosis and coma in massive acetaminophen overdose
3.5 out of 5 stars
Coma and Severe Acidosis: Remember to Consider Acetaminophen. Villano JH et al. J Med Toxicol 2015 July 8 [Epub ahead of print]
Reference
This paper, from UC-San Diego, contains an excellent case discussion that makes numerous important points about a patient who presents with decreased mental status and high-anion-gap metabolic acidosis.
The patient was a 28-year-old male who was brought to the emergency department because he was found to be unresponsive in his jail cell 16 hours after being arrested for murder. Initial evaluation revealed tachycardia (111/min,) mild hypothermia (95.5oF,) and a depresse...
Source: The Poison Review - August 7, 2015 Category: Toxicology Authors: Leon Tags: Medical acetaminophen overdose APAP elevated anion gap metabolic acidosis Source Type: news
Review: liquid nicotine toxicity
2.5 out of 5 stars
Liquid Nicotine Toxicity. Kim JW, Baum CR. Pediatr Emer Care 2015;31:517-524.
Abstract
This review of liquid nicotine toxicity is part of the continuing medical education series in Pediatric Emergency Care.
While there are a few good clinical nuggets buried in this review, they are surrounded by so many distracting and unnecessary epidemiological facts that the whole paper — though relatively short — is a chore to read. In addition, some of the “facts” are wrong. For example::
A study found that the proportion of calls that poison control centers received regarding e-cigarettes and cigare...
Source: The Poison Review - July 30, 2015 Category: Toxicology Authors: Leon Tags: Medical e-cigarettes electronic cigarettes liquid nicotine toxicity Source Type: news
Venlafaxine abuse
2.5 out of 5 stars
Venlafaxine as the ‘baby ecstasy’? Literature overview and analysis of web-based misusers’ experiences. Francesconi G et al. Hum Psychopharmacol Clin Exp 2015 Jul;30:255-261.
Abstract
In 2003, Sattar et al published a case report of venlafaxine abuse in a 38-year-old man. The patient had been prescribed 225-mg extended-release venlafaxine daily. He found that increasing his dose by 50% — to 337.5-mg per day — initially produced a “sudden, amphetamine-like ‘high'” that he did not re-experience even after increasing the dose to 450-mg.
He subsequently discovered ...
Source: The Poison Review - July 30, 2015 Category: Toxicology Authors: Leon Tags: Medical abuse effexor overdose venlafaxine Source Type: news
Case series: anxiety and agitation following exposure to the synthetic cannabinoid ADB-PINACA
3 out of 5 stars
A Common Source Outbreak of Severe Delirium Associated with Exposure to the Novel Synthetic Cannabinoid ADB-PINACA. Schwartz MD et al. J Emerg Med 2015 May;48:573-80.
Abstract
As noted in a recent survey of synthetic cannabinoid exposures in the New England Journal of Medicine, the synthetic cannabinoid (SC) ADB-PINACA was associated with outbreaks in August and September 2013, both in Brunswick GA (22 cases) and Denver CO (> 220 exposures).
This paper reports on 7 cases from the outbreak in Georgia. All patients tested positive for ADB-PINACA or its metabolic ADB-PINACA-5-Pentoic Acid in plasma a...
Source: The Poison Review - July 29, 2015 Category: Toxicology Authors: Leon Tags: Medical ADB-PINACA agitation anxiety black mamba case series crazy clown delirium synthetic cannabinoid Source Type: news
Death after consuming a marijuana edible
This report describes the investigation by the Colorado Department of Public Health and Environment (CDPHE) into a well-publicized fatality that occurred shortly after recreational marijuana became available in that state.
In March 2014, a 19-year-old man ingested one piece of a marijuana cookie purchased by his 23-year-old friend. (Note: at that time as well as now, the legal age for using marijuana in Colorado was 21.) When he felt no effects after 30-60 minutes, he ingested the remainder of the cookie:
“During the next 2 hours, he reportedly exhibited erratic speech and hostile behaviors. Approximately 3.5 hours a...
Source: The Poison Review - July 23, 2015 Category: Toxicology Authors: Leon Tags: Medical 11-OH-THC death fatality edible marijuana pot Source Type: news
5F-ADB-PINACA and other extremely potent new synthetic cannabindoids
3.5 out of 5 stars
Pharmacology of Indole and Indazole Synthetic Cannabinoid Designer Drugs AB-FUBINACA, ADB-FUBINACA, AB-PINACA, ADB-PINACA, 5F-AB-PINACA, 5F-ADB-PINACA, ADBICA, and 5F-ADBICA. Banister SD et al. ACS Chem Neurosci 2015 July 17 [Epub ahead of print]
Abstract
As TPR noted in a recent post, many recently reported cases of severe toxicity or death associated with exposure to synthetic cannabinoids (SCs) involved relatively new and unfamiliar chemicals such as MAB-CHMINACA, AB-PINACA, and ADB-PINACA.
These new compounds incorporate either an indole or an indazole group, and have structured that can be altered...
Source: The Poison Review - July 22, 2015 Category: Toxicology Authors: Leon Tags: Medical 5F-ADB-PINACA FUBINACA indazole indole synthetic cannabinoid Source Type: news
Serious toxicity and fatalities from synthetic cannabinoids
3.5 out of 5 stars
Synthetic Cannabinoid—Related Illnesses and Deaths. Trecki J et al. N Engl J Med 2015 Jul 9;373:103-107.
Reference
As the authors point out in this interesting article, there has been a recent surge in reports of fatalities and severe toxicity from synthetic cannabinoids (SCs). This is likely from a combination of increased incidence and more diligent surveillance.
The most interesting part of the paper is the Table, that lists recent cases involving severe toxic effects from SCs, including 20 deaths. The specific SCs involved in the fatal cases include MAB-CHMINACA, AB-PINACA, XLR-11, ADB-PINACA, and...
Source: The Poison Review - July 20, 2015 Category: Toxicology Authors: Leon Tags: Medical death fatality MAB-CHMINACA synthetic cannabinoids Source Type: news
Tox Tunes #99: Casey Jones (Grateful Dead)
The critical response to the final 3 performances of the Grateful Dead’s “Fare Thee Well” tour has been decidedly mixed. In the New York Times, Jon Pareles reported that “Even with a handful of the Dead’s inevitable stumbles, the music was strong.”
On the other hand, Greg Kot’s review in the Chicago Tribune was headlined “Grateful Dead pay slack tribute to legacy.”
This time around, as the Times cleverly notes, its “as much about today as yesterday, more hashtags than hash, less Summer of Love than summer of ‘likes.'” Some fans are coming not in psych...
Source: The Poison Review - July 5, 2015 Category: Toxicology Authors: Leon Tags: Medical casey jones grateful dead tox tunes Source Type: news
Tox Tunes #98: Truckin’ (The Grateful Dead)
Surprisingly, “Tox Tunes” has featured only one Grateful Dead song so far. This weekend seemed a good time to catch up, as the remnants of The Dead play their farewell concerts at Soldier Field in Chicago in the biggest festival the Windy City has seen since smaccUS.
There are, of course, a number of drug references in the song, which relates the autobiography of the band through the early 1970s. On January 31, 1970, 19 members of the band and its touring party — including their live-in street chemist and sound engineer Owsley Stanley — were arrested in New Orleans for possession of marijuana:
Sitting and s...
Source: The Poison Review - July 3, 2015 Category: Toxicology Authors: Leon Tags: Medical grateful dead tox tunes truckin' Source Type: news
Recommendations for starting hemodialysis in salicylate toxicity
3.5 out of 5 stars
Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Juurlink D et al. Ann Emerg Med 2015 May 8 [Epub ahead of print]
Abstract
Aspirin is an especially dangerous poison for a number reasons:
• It’s easy to purchase over-the-counter in large quantities
• Even after a life-threatening acute ingestion of salicylate, a patient can present looking deceptively stable only to deteriorate catastrophically several hours later
• In chronic salicylate toxicity, the diagnosis can be easily missed
Ask many toxicologists about the poisons the...
Source: The Poison Review - July 1, 2015 Category: Toxicology Authors: Leon Tags: Medical aspirin enhanced elimination extracorporeal treatment extrip hemodialysis indications salicylate toxicity Source Type: news
