Tox Tunes #106: Mountain Dew (The Stanley Brothers)
Long before there was the soft drink, the term “mountain dew” referred to bootleg whiskey. Actually, the use of the term may have been brought over from Ireland. According to the Merriam-Webster dictionary, the use of the term to denote illegal alcohol goes back to the 1800s. When I went to camp as a teenager, this was one of our favorite songs to sing around the campfire. (Yes, it was that kind of camp.) My favorite version by far is that recorded by the great bluegrass duo Ralph and Carter Stanley — The Stanley Brothers. (Source: The Poison Review)
Source: The Poison Review - February 15, 2016 Category: Toxicology Authors: Leon Tags: Medical mountain dew stanley brothers tox tunes Source Type: news
Saturday with SMACC: Ho v Bellezzo debate — ECMO is a step too far
One of my favorite sessions from SMACC Chicago last year was the the debate between Chris Ho and Joe Bellezzo — both from Sharp Memorial Hospital in San Diego. Dr. Ho — on the resolution: ECPR (extracorporeal cardiopulmonary resuscitation) is a step to far. Dr. Ho took the affirmative side, arguing that ECPR (with is the same as ECMO) was not backed by any evidence of efficacy, horrendously expensive, resource-intensive, fraught with complications, and unethical. Dr. Bellezzo countered that all of his opponents objections were “bullshit.” The session was entertaining but also dead serious. To listen, click ...
Source: The Poison Review - February 14, 2016 Category: Toxicology Authors: Leon Tags: Medical Chris Ho ECMO ECPR extracorporeal cardiopulmonary resuscitation extracorporeal membrane oxygenation Joe Bellezzo saturday with smack SMACC Source Type: news
Severe bupropion overdose and ECMO: two great saves
ChaNaWiT/shutterstock.com 3.5 out of 5 stars Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrance Oxygenation. Heise CW et al. J Med Toxicol 2016 Feb 8 [Epub Ahead of Print] Abstract This awesome, exciting paper from Banner University Medical Center in Phoenix describes two teenagers with severe bupropion overdose who survived refractory cardiac arrest after veno-arterial extracorporeal membrane oxygenation (VA-ECMO): Case 1: A 15-year-old girl was brought to hospital after ingesting up to 90 150-mg bupropion tablets. She had a seizure en route...
Source: The Poison Review - February 12, 2016 Category: Toxicology Authors: Leon Tags: Medical burpropion ECMO extracorporeal membrane oxygenation 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 of A muscaria producin...
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
W-18, a synthetic opiate 100 times more potent than fentanyl
W-18 Last August, Canadian police seized 110 illegal fentanyl pills at a home in Alberta province. Yesterday, Global News reported that some of the pills have tested positive for an extremely potent opioid called W-18. This is certainly a disturbing development, since W-18 is a μ-receptor agonist 100 times more potent than fentanyl. According to B.C. Centre for Disease Control, W-18 is one of a series of 32 synthetic opioids discovered in the 1980s at the University of Alberta. W1 thru W19 are pure μ-receptor agonists; W20 thru W32 are agonist-antagonists (as is buprenorphine.) W-18 seems to be the most powerful agonis...
Source: The Poison Review - February 4, 2016 Category: Toxicology Authors: Leon Tags: Best of TPR Medical fentanyl opiate opioid w-18 Source Type: news
Coronary artery vasospasm induced by cocaine (maybe)
2.5 out of 5 stars Cocaine-Induced Coronary Artery Vasospasm. Almaddah N, Ajayi TO. N Engl J Med 2016 Feb 4;374:e5 Full Text with video In a series of amazing studies that are now about three decades old, Richard Lange and his colleagues at Parkland Hospital in Dallas investigated the cardiovascular effects of administering intranasal cocaine to patients to patients during cardiac catheterization for routine workup of chest pain. In an initial study, the group demonstrated that cocaine produced coronary artery vasoconstriction that was relieved by nitroglycerin and exacerbated by smoking a cigarette and also by ad...
Source: The Poison Review - February 4, 2016 Category: Toxicology Authors: Leon Tags: Medical cardiovascular effects cocaine coronary artery vasospasm Source Type: news
Tox Tunes #105: How Can a Poor Man Stand Such Times and Live (Ry Cooder)
Well the doctor comes around with a face all bright, And he says in a little while you’ll be all right. All he gives is a humbug pill, A dose of dope and a great big bill — Tell me how can a poor man stand such times and live? “How Can a Poor Man Stand Such Times and Live” was written by Blind Alfred Reed (1880-1956), who recorded it about a month after the stock market crash in 1929 that heralded the Great Depression. This great cover by Ry Cooder features a first-rate band including the legendary Flaco Jiménez on accordion. This cut was taken from a 1987 concert at The Catalyst in Santa Cruz. Th...
Source: The Poison Review - February 1, 2016 Category: Toxicology Authors: Leon Tags: Medical blind alfred reed flaco jimenez how can a poor man stand such times and live ry cooder tox tunes Source Type: news
Saturday with SMACC: Strayer on how to use opioids (and how not to use opioids)
The 3rd (and final) release of registrations for the 2016 Social Media and Critical Care (SMACC) conference in Dublin (June 13-16) will take place on February 3 at 09:00 Sydney time — or 4 pm Tuesday February 2 Chicago time. The 2nd release early December sold out in just one hour (!) after being posted, so if you’re interested in attending plan accordingly. The program and registration details for the conference can be accessed at the smaccDUB website. To get a taste of what’s in store for Dublin, here’s a talk from last year’s smaccCHICAGO — Reuben Strayer’s excellent talk o...
Source: The Poison Review - January 31, 2016 Category: Toxicology Authors: Leon Tags: Medical addiction dublin epidemic opiate opioid SMACC smaccdub social media and critical care Source Type: news
Cannabis psychopharmacology: it’s more complex than you might imagine
Yarygin/shuttershock.com 3.5 out of 5 stars The Cannabis sativa Versus Cannabis indica Debate: An Interview with Ethan Russo, MD. Cannabis and Cannabinoid Research 2016 Jan;1:44-46 Full Text This short interview with Ethan Russo MD should be of interested to toxicologists and other clinicians who might counsel patients on issues regarding medical marijuana. It contains some interesting information about the different biologically active chemicals contained in cannabis plants, and their effects. These chemicals include: Δ9-tetrahydrocannabinol (THC) – main psychoactive chemical in Cannabis cannabinol – bre...
Source: The Poison Review - January 29, 2016 Category: Toxicology Authors: Leon Tags: Medical cannabidiol cannabinol cannabis cannabis indica cannabis sativa marijuana myrcene pinene THC Source Type: news
Extracorporeal treatment for digoxin toxicity: just say no
3 out of 5 stars Extracorporeal treatment for digoxin poisoning: systematic review and recommendations from the EXTRIP Workgroup. Mowry JB et al. Clin Toxicol 2016 Feb;54:103-14. Abstract “Forced diuresis, and hemodialysis are ineffective in enhancing the elimination of digoxin because of its large volume of distribution (4-10 L/kg), which makes it relatively inaccessible to these techniques.” Goldfrank’s Toxicologic Emergencies (Tenth Edition, 2015) That one sentence from the latest edition of Goldfrank’s tells you all you need to know about the use of extracorporeal treatment (ECTR) in digoxin...
Source: The Poison Review - January 28, 2016 Category: Toxicology Authors: Leon Tags: Medical digoxin toxicity extracorporeal treatment extrip Fab fragment hemodialysis hemoperfusion Source Type: news
Tox on the Web: deadly French drug trial, fatal food, and more!
Must-read post about the catastrophic phase 1 French drug trial: In a superb must-read post at the Forbes magazine website, David Kroll discusses what we know about the disastrous drug safety trial in France that left 1 subject dead and 4 others with varying degrees of neurological damage.The drug in question — named BIA 10-2474 — is an inhibitor of the enzyme fatty acid amide hydrolase (FAAH) that was being developed as a new oral analgesic. As Kroll explains: What’s so important about FAAH? Our bodies make several fatty acid amides that include anandamide, a natural stimulator of the cannabinoi...
Source: The Poison Review - January 23, 2016 Category: Toxicology Authors: Leon Tags: Medical bia 10-2474 fatty acid amide hydrolase inhibitor litvenenko polonium-210 putin tox on the web Source Type: news
Happy Birthday, Wilbur Scoville! (1865-1942)
Pass the Carolina Reaper! (Source: The Poison Review)
Source: The Poison Review - January 22, 2016 Category: Toxicology Authors: Leon Tags: Medical Source Type: news
Definitive paper on phenytoin/phosphenytoin-associated purple glove syndrome
Purple glove syndrome (fda.gov) 4.5 out of 5 stars Purple Glove Syndrome after Phenytoin or Fosphenytoin Administration: Review of Reported Cases and Recommendations for Prevention. Garbovsky LA et al. J Med Toxicol 2015 Dec;11:445-459. Abstract Purple glove syndrome (PGS) is an uncommon adverse drug reaction to parenteral administration of phenytoin or fosphenytoin marked by severe progressive soft tissue discoloration, swelling and pain in the distal extremity into which the drug was infused. This extremely well done and comprehensive paper will tell you all you need to know (well, probably more than you need to know) ...
Source: The Poison Review - January 22, 2016 Category: Toxicology Authors: Leon Tags: Medical adverse drug reaction dilantin phenytoin phosphenytoin purple glove syndrome soft tissue Source Type: news
Review of synthetic cannabinoids out-of-date as soon as it’s published
3 out of 5 stars A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment. Tait RJ et al. Clin Toxicol 2016 Jan;54:1-13. Abstract This paper review clinical literature related to use of synthetic cannabinoids (SCs) through the end of 2015. Although it seems comprehensive, and cites 108 references, it is of course already at least 18 months out-of-date. The number of cases involving exposure to SC surged during 2015. For example, although the authors of this paper identified 22 deaths associated with SCs, according to CDC data in the first 6 months of 2015 alone ...
Source: The Poison Review - January 20, 2016 Category: Toxicology Authors: Leon Tags: Medical K2 spice synthetic cannabinoids systematic review Source Type: news
Must-read: combination acetaminophen-opioid formulations should be abandoned
4 out of 5 stars The prescription paradox of acetaminophen safety. Dart RC, Green JL. Pharmacoepidemiol Drug Saf 2015 Dec 29 [Epub ahead of print] Reference Last week, we pointed out that the American College of Medical Toxicology (ACMT) had issued a position statement on prescribing opioids that had missed a good opportunity to call for abandoning use of pharmaceutical products that combined strong opioids such as hydrocodone with acetaminophen. I just discovered that a recent editorial by Richard Dart and Jody Green from the Rocky Mountain Poison and Drug Center agree with my take on this matter. They point out that a re...
Source: The Poison Review - January 13, 2016 Category: Toxicology Authors: Leon Tags: Medical acetaminophen adverse effects hepatotoxicity opioid Source Type: news