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 considered...
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

Hallucinogenic stimulant PMMA found in “Superman” pills that killed 4 in Britain
The Guardian (U.K.) reported yesterday that the deaths of 4 men in Britain over the holidays were associated with a drug — purported to be MDMA (ecstasy) — that actually contained the hallucinogenic stimulant PMMA, a far more dangerous drug. The deaths all seemed to be related to a 5-sided pill that reproduced the famous Superman logo. PMMA is related to PMA, a drug so lethal it has been marketed under the name “Dr. Death.” Some data indicates that PMMA (para-methoxymethamphetamine) is metabolized to PMA (para-methamphetamine.) Both PMA and PMMA cause increased release of serotonin along with decreased re...
Source: The Poison Review - January 8, 2015 Category: Toxicology Authors: Leon Tags: Medical dr. death ecstasy mdma paramethoxyamphetamine paramethoxymethamphetamine pma PMMA serotonin syndrome superman Source Type: news

Pop Quiz: Tox in the News 2014
2014 was quite an interesting year for toxicology stories in the news. There was the bizarre death of a chef in China’s Guangdong province, the discovery that a chemical warfare agent may be commonly found in swimming pools, the case of multiorgan failure after playing a video game . . . and that’s not even including the crowning of the new record holder for world’s hottest pepper. (It’s the Carolina Reaper, grown by the PuckerButt Pepper Company.) My new column in Emergency Medicine News will test your knowledge of these current poisoning events. To take the quiz, click here. (Source: The Poison Review)
Source: The Poison Review - January 6, 2015 Category: Toxicology Authors: Leon Tags: Medical 2014 quiz toxicology in the news Source Type: news

Tetrodotoxin poisoning from dried “globefish”
This report presents 2 cases of tetrodotoxin poisoning seen at Hennepin County Medical Center in June, 2014. The patients, a 30-year-old man and his 33-year-old sister, both presented with symptoms typical of puffer fish poisoning that began 30 minutes after ingesting dried “globefish” originally purchased from a street vendor in New York City. Symptoms included: numbness around the mouth and tongue paresthesias and weakness in the extremities fatigue dyspnea Each patient is described as stating that “my teeth can’t feel themselves.” Physical exam findings, including strength and respirator...
Source: The Poison Review - January 6, 2015 Category: Toxicology Authors: Leon Tags: Medical fish poisoning globefish lagocephalus lunaris puffer fish seafood poisoning tetrodotoxin Source Type: news

The 5th Annual Alexander Awards: The Best Tox Reading of 2014
Alexander Gettler The distinguished Alexander Awards go to the best writings related to toxicology topics that have appeared in the previous year. To be eligible to win an Alexander, an article or paper must be freely available on the web, not locked up behind some paywall or subject to restricted access. The awards are named for Alexander Gettler (1883-1968,) the chief toxicologist with the Office of the Chief Medical Examiner of the City of New York during the first half of the 20th century. Gettler’s work was crucial in the development of modern forensic toxicology. In a must-read piece from New York magazine, Stev...
Source: The Poison Review - January 2, 2015 Category: Toxicology Authors: Leon Tags: Medical alexander award alexander gentler best toxicology reading 2014 Source Type: news

Death after injecting alpha-PVP
3 out of 5 stars Death due to intravenous use of α-pyrrolidinopentiophenone. Sellors K et al. Med J Aust 2014 Nov 17;201:601-3. Full Text  α-pyrrolidinopentiophenone (α-PVP) is a synthetic cathinone stimulant with structural similarities to MDPV. Like MDPV, α-PVP contains a pyrrolidine ring, a 5-sided nitrogen-containing component that enables the molecule to effectively block reuptake of dopamine and norepinephrine, with much weaker effects at the serotonin transporter. This dramatic case report describes a 44-year-old man who injected a product labelled “Smokin’ Slurries Scrubba” (α-PVP) intrave...
Source: The Poison Review - December 31, 2014 Category: Toxicology Authors: Leon Tags: Medical agitted delirium alphya-PVP death fatality MDPV Source Type: news

Nicotine poisoning from an asparagus look-alike
This report, from the University of Wisconsin in Madison, describes two patients who developed symptoms consistent with nicotinic poisoning after ingesting foraged B australis. Patient 1 was an 85-year-old woman developed nausea, vomiting, diarrhea, abdominal distress, and dizziness within 15 minutes of ingesting what she took to be “wild asparagus.” Patient 2, her 48-year-old daughter, developed similar symptoms plus vertigo within a similar time frame after ingestion. Each patient was described as having severe truncal ataxia and was not able to stand unassisted. The patients were treated with fluids, anti...
Source: The Poison Review - December 30, 2014 Category: Toxicology Authors: Leon Tags: Medical asparagus baptisia look alike nicotine toxicity Source Type: news

Deaths and severe toxicity at an electronic dance-music festival in NYC
This report — from the CDC and the New York City Department of Health — describes the full investigation into adverse medical events associated with the 3-day Labor Day weekend electronic dance-music (EDM) festival. (After the 2 deaths, the third day was cancelled.) The authors identified 22 adverse medical events requiring transfer to an emergency room. Nine cases were severe — defined as involving seizure, intubation, ICU admission, or death. Specimens for toxicology testing were available from 17 patients. The following were the key findings: Five patients were admitted to the ICU. One patient who died tested...
Source: The Poison Review - December 23, 2014 Category: Toxicology Authors: Leon Tags: Medical death ecstasy electronic dance-music festival fatality mdma methamphetamine methylone new york Source Type: news

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

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

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

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

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

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

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