Case series: 9 patients with acute kidney injury after smoking a synthetic cannabinoid
This article is a very complete and finely done description both of the clinical syndrome of AKI associated with use of synthetic cannabinoids, and the related public health investigation. [HT @DougBorys] Related posts: Four (really three) cases of acute kidney injury associated with us of synthetic cannabinoids MMWR: synthetic pot suspect in cases of kidney failure Blueberry “spice” in Wyoming linked to cases of renal failure (Source: The Poison Review)
Source: The Poison Review - August 22, 2014 Category: Toxicology Authors: Leon Tags: Medical acute kidney injury clown loyal renal toxicity spice synthetic cannabinoid Source Type: news

Methoxetamine: a ketamine analog that is NOT bladder friendly
3.5 out of 5 stars Methoxetamine — a novel recreational drug with potent hallucinogenic properties. Zawilska JB. Toxicol Lett 2014 Aug 13. pii: S0378-4274(14)01298-3. doi: 10.1016/j.toxlet.2014.08.011. [Epub ahead of print] Abstract Methoxetamine (MXE) is a structural analog of ketamine, with effects that are similar but more intense and longer-lasting. Street names include: MXE Mexxy  M-ket MEX Kmax Special M MA “Legal ketamine” Minx Jipper Roflcoptr Since chronic exposure to ketamine is known to cause ulcerative cystitis, MXE is sometimes touted as “bladder friendly.” However, lack of clini...
Source: The Poison Review - August 20, 2014 Category: Toxicology Authors: Leon Tags: Medical bladder toxicity genitourinary toxicity ketamine methoxetamine MXE Source Type: news

On the internet, nobody knows if it’s 25C-NBOMe (“N-bomb”)
This article uses both published scientific literature and discussions on Web bulletin boards and chat groups in an attempt to define the effects of this drug. The authors argue that since the internet is a crucial factor in marketing and disseminating novel psychoactive substances and since peer-reviewed articles about these substances are scarce, using unconfirmed anecdotal reports on sites like Bluelight and Drugs-Forum is justified. I don’t buy it. However, the authors do reference several medical papers about N-bomb. for example,  a recent article by Grautoff and Kahler described a 19-year-old man who suppose...
Source: The Poison Review - August 18, 2014 Category: Toxicology Authors: Leon Tags: Medical 25C-NBOME n-bomb Source Type: news

Tox Tunes #85: Goodnight, Irene (Jerry Lee Lewis and Van Morrison) “Goodnight, Irene” was introduced by the folksinger and blues musician Lead Belly (Huddie Ledbetter, 1888-1949) and became a big hit for The Weavers in 1950. This fascinating song tells a somewhat murky story about unrequited passion and suicidal fantasies. The Weavers, however, left out the reference to opiates in Lead Belly’s original lyrics: I love Irene I swear I do I love her ’til the sea runs dry If Irene turns her back on me I’m gonna take morphine and die. Jerry Lee Lewis and Van Morrison keep this verse in their version. Lead Belly’s ...
Source: The Poison Review - August 18, 2014 Category: Toxicology Authors: Leon Tags: Medical drug references goodnight irene jerry lee lewis lead belly leadbelly morphine popular song the weavers tox tunes van morrison Source Type: news

Iron poisoning: Tox on the Web
Academic Life in Emergency Medicine has a very nice review of iron toxicity by Mary A. Wittler and David Manthey from Wake Forest University Baptist Medical Center. Also, in a recent post at Life in the Fast Lane, Chris Nickson discusses “The Toddler with the Iron Gut” in a Q&A format. (Source: The Poison Review)
Source: The Poison Review - August 12, 2014 Category: Toxicology Authors: Leon Tags: Medical deferoxamine iron toxicity pediatric poisoning Source Type: news

Review of scorpion envenomation
Asian forest scorpion 3 out of 5 stars Scorpion Envenomation. Isbister GK, Bawaskar HS. N Engl J Med 2014 Jul 31;371:457-463. Reference With over 1700 species of scorpions found all over the world, this brief review article is much too short and unfocused to provide more than a superficial overview of its topic. The authors point out that most scorpion stings cause, at most, minor toxicity with pain and other local effects only. Most serious envenomations are associated with the Buthidae family, which include the genus Centruroides, several of which are found in North America and commonly cause neuromuscular excitation...
Source: The Poison Review - August 12, 2014 Category: Toxicology Authors: Leon Tags: Medical antivenom centruroides Review scorpion envenomaton Source Type: news

MIcrocystin: the hepatotoxin that shut down Toledo’s water supply
  Microcystin-LR 3.5 out of 5 stars The Toxicology of Microcystins. Dawson RM. Toxicon 1998;36:953-962. Abstract Just when you thought it was safe to go back to the faucet . . . While I was on vacation, the big toxicology story involved contamination of the water supply to Toledo Ohio. As a result almost half a million people in the area were warned not to drink — or even shower with — water from Lake Erie. The cause was a bloom of freshwater cyanobacteria, resulting from increased levels of phosphates and fertilizer. These cyanobacteria product microcystin, a heat-stable hepatotoxin. Microcystin can cause 3 clin...
Source: The Poison Review - August 8, 2014 Category: Toxicology Authors: Leon Tags: Medical acute liver failure algae cyanobacteria hepatoxicity microcystin toledo ohio Source Type: news

Nicotine liquid fatality — but was it from intravenous injection?
2.5 out of 5 stars Fatal Intravenous Injection of Electronic Nicotine Delivery System Refilling Solution. Thornton SL et al. J Med Toxicol 2014;10:202-204. Reference Well, any case report of a fatality following exposure to e-cigarette nicotine  refill liquid is interesting, but this one has problems. Lately, TPR has been whinging about the BuzzFeed-ificiation of the medical literature, especially with regard to titles of published papers. In this process, nuanced topics and cases are simplified to produce a misleading title that serves better as clickbait. This case report describes  29-year-old male who was found at ...
Source: The Poison Review - July 31, 2014 Category: Toxicology Authors: Leon Tags: Medical e-cigarette fatality nicotine liquid Source Type: news

N-Bomb: a potent psychedelic stimulant
3.5 out of 5 stars 2C-I-NBOMe, an “N-bomb” that kills with “Smiles”. Toxicological and legislative aspects. Nikolaou P et al. Drug Chem Toxicol 2014 May 1 [Epub ahead of print] Abstract Despite the confusing title, this is a well done comprehensive review of 2C-I-NBOMe, an extremely  potent hallucinogenic stimulant that has been associated with deaths and severe toxicity. The NBOMe structure drugs have a 2-methoxybenzyl group attached to the nitrogen of a 2C psychedelic phenethylamine:   This substitution gives the drug enhanced activity at the 5-HT2A  serotonin receptor, a main target of m...
Source: The Poison Review - July 29, 2014 Category: Toxicology Authors: Leon Tags: Medical 25I 2C-I-NBOME hallucinogenic stimulant n-bomb smiles substituted phenethylamine Source Type: news

Must-read: marketing vs. medicine in the case of Pradaxa (dabigatran)
4 out of 5 stars Dabigatran: how the drug company withheld important analyses. Cohen D. BMJ 2014 Jul 23;349:g4670. doi: 10.1136/bmj.g4670. Full Text As TPR has reported before, there has long been reason to doubt the claim that the anticoagulant dabigatran (Pradaxa) can be safely and effectively used for prevention of strokes in patients with non-valvular atrial fibrillation without laboratory monitoring. This must-read investigative report uses internal company documents released in association with a lawsuit — recently settled for $650 million — to suggest that Boehringer Ingelheim, the drug’s manufacturer, sup...
Source: The Poison Review - July 28, 2014 Category: Toxicology Authors: Leon Tags: Medical adverse drug event anticoagulant bleeding boehringer ingelheim dabigatran hemorrhage pradaxa Source Type: news

Bedside ultrasound in tox cases: an idea whose time has come?
Is there a role for point-of-care bedside ultrasound imaging in overdose cases? Quite possibly. My recent column in Emergency Medicine News discussed this question. To read it, click here. Related post: Ultrasound visualization of ingested tablets: good idea or wild-goose chase? (Source: The Poison Review)
Source: The Poison Review - July 23, 2014 Category: Toxicology Authors: Leon Tags: Medical calcium channel blockers salicylate toxicity toxicology cases ultrasound Source Type: news

Fatal caffeine overdose: useful paper despite BuzzFeed-worthy title
This article is classic example of scientific bait and switch, a deceptive tactic not dissimilar to the use of “click bait” by websites like BuzzFeed. The subtitle promises “Fatal Caffeine Intoxication: A Series of Eight Cases . . .” But by the end of the introduction this has been walked to back “eight fatal cases of caffeine intoxication-related deaths,” a concept that is hopelessly vague and undefined. The way the authors use the term, a man who gets hit by a truck leaving Starbucks after drinking two Vente cappuccinos could be considered a caffeine-related death. The authors’ a...
Source: The Poison Review - July 20, 2014 Category: Toxicology Authors: Leon Tags: Medical caffeine toxicity cardiotoxicity fatality Source Type: news

Two cases of laboratory-confirmed exposure to 25B-NBOMe
25I-NBOMe blotter paper 3 out of 5 stars Two cases of severe intoxication associated with analytically confirmed use of the novel psychoactive substances 25B-NBOMe and 25C-NBOMe. Tang MHY et al. Clin Toxicol 2014 Jun;52:561-565. Abstract The NBOMe series of drugs are substituted phenethylamines. They act as agonists at both the 5-HT2A receptors and the α-receptors. Because of these actions, they can cause both hallucinations (5-HT2A  effects) and sympathomimetic toxidrome (α effects.) Since these drugs are so potent, they are often sold in the form of impregnated blotter paper. This paper, from Hong Kong, describes ...
Source: The Poison Review - July 18, 2014 Category: Toxicology Authors: Leon Tags: Medical 25B-NBOMe 25C-NBOME 25I-NBOMe blotter paper hallucinogenics sympathomimetic toxidrome Source Type: news

Case report: guanfacine overdose
Intuniv (Guanfacine) 3 out of 5 stars Prolonged Bradycardia and Hypotension Following Guanfacine Extended Release Overdose. Walton J et al. J Child Adolesc Physcopharmacol 2014 Jul 10 [Epub ahead of print] Reference  Guanfacine is a central α2-agonist with a mechanism of action similar to that of clonidine. Originally marketed as an antihypertensive agent, it is now available as an extended-release preparation (Imtuniv) for treating children ages 6-17 with attention-deficit hyperactivity disorder (ADHD). It is thought the mechanism of action in that condition may involve stimulation of α2-receptors in the prefrontal c...
Source: The Poison Review - July 18, 2014 Category: Toxicology Authors: Leon Tags: Medical ADHD attention deficit hyperactivity disorder clonidine guanfacine Source Type: news

Review of cannabinoid hyperemesis syndrome
3 out of 5 stars A hot mess: A case of hyperemesis. Cheung E et al.  Can Fam Physician 2014 Jul;60:633-637. Full Text With medical marijuana now legal in 23 states plus the District of Columbia, and recreational marijuana legal in 2 states, it is essential that all emergency and primary care physicians become familiar with the adverse effects that can ensue from regular use of cannabis. One of the most striking and unexpected complications of chronic cannabis exposure is violent cyclic vomiting. This has been called “cannabinoid hyperemesis syndrome” (CHS). In this review article, the authors propose the foll...
Source: The Poison Review - July 17, 2014 Category: Toxicology Authors: Leon Tags: Medical cannabinoid hyperemesis syndrome cannabis cyclic vomiting marijuana THC Source Type: news