Review: recreational marijuana use
Stanimir G. Stoev/Shutterstock.com
3 out of 5 stars
Recreational cannabis use: Pleasures and pitfalls. Rella JG. Cleve Clin J Med 2015 Nov;82:765-72.
Full Text
This somewhat superficial but relatively well done review article gets extra credit for being available via open access. The author covers the history, pharmacology, toxicology, and acute and chronic effects of cannabis use, as well as withdrawal and the cannabinoid hyperemesis syndrome.
My main problem with this paper involves the author’s casual use of references. For example, he states that previous literature had reported “a fivefold increased risk ...
Source: The Poison Review - November 10, 2015 Category: Toxicology Authors: Leon Tags: Medical recreational marijuana Review THC Source Type: news
Therapeutic plasma exchange in poisoned patients
1 out of 5 stars
Therapeutic plasma exchange in poisoning: 8 years’ experience of a university hospital. Disel NR et al. Am J Emerg Med 2015 Oct;33:1391-1395.
Abstract
In therapeutic plasma exchange (TPE), blood is removed from the body, and plasma is separated from components such as RBCs, WBCs, and platelets. Those components are re-infused along with a replacement fluid such as fresh-frozen plasma or albumin. This procedure is usually used to removed pathological immunoglobulins in various conditions such as thrombotic thrombocytopenic purpura.
There have been some case reports and small case series on the us...
Source: The Poison Review - November 8, 2015 Category: Toxicology Authors: Leon Tags: Medical apheresis plasma exchange poisoned patient toxicology Source Type: news
Use of flumazenil and naloxone in poisoned patients
4 out of 5 stars
Flumazenil, naloxone and the ‘coma cocktail’ Sivilotti MLA Br J Clin Pharmacol 2015 Aug 7 [Epub ahead of print]
Abstract
This very smart paper reviews factors affecting the clinical use of two antidotes that reliably reverse coma caused by two major classes of poisons: flumazenil for benzodiazepines, and naloxone for opiates.
Both these antidotes are specific, rapid-acting, short-lived, and titratable. However, significant adverse effects have been associated with each of them. Unwise or overly aggressive administration of flumazenil can cause acute benzodiazepine withdrawal, agitation, seiz...
Source: The Poison Review - November 3, 2015 Category: Toxicology Authors: Leon Tags: Medical antidote benzodiazepine coma cocktail flumazenil naloxone opiate Source Type: news
Hemodialysis in lithium poisoning: there is no evidence. Full stop.
3.5 out of 5 stars
Hemodialysis for lithium poisoning. Lavonas EJ, Buchanan J. Cochrane Database Sys Rev 2015 Sep 16 [Epub ahead of print]
Abstract
At a session at the ACEP Scientific Assembly last year, Jerry remarked: “Guidelines should regularly conclude that there is no evidence. Full stop.”
I really like this Cochrane review of hemodialysis in lithium poisoning because [SPOILER ALERT] that is exactly what the authors conclude. They note that although hemodialysis undoubtedly increases clearance of lithium, there is no agreement as to whether this enhanced elimination actually improves clinical outcome.
In...
Source: The Poison Review - September 29, 2015 Category: Toxicology Authors: Leon Tags: Medical cochrane review extracorporeal treatment hemodialysis lithium poisoning Source Type: news
Tox Tunes #102: Jake Leg Blues (The Mississippi Sheiks, 1930)
“Jake Leg Blues” by the Mississippi Sheiks is another song form the 1930s that describes the ravages wrought by Jamaica Ginger extract, an alcohol-containing patent medicine that was deliberately contaminated with the organophosphate compound tricresyl phosphate (TOCP) during prohibition. For a more complete description of this tragic episode of mass poisoning, and for references, see our previous post.
“Limber leg” refers both to the leg weakness and foot drop caused by TOCP, and also to the impotence that affected many victims.
The blog Vernacular:Shellac has a great post about Jake Leg...
Source: The Poison Review - September 28, 2015 Category: Toxicology Authors: Leon Tags: Medical jake leg mississippi sheiks organophosphate poisoning tocp tox tunes toxicological history Source Type: news
Case report: seizures after exposure to 25B-NBOMe (N-Bomb)
Blue Batman pills (25C-NBOMe)
3 out of 5 stars
Beware of blotting paper hallucinogens: severe toxicity with NBOMes. Isbister GK et al. Med J Aust 2015 Sep 21;203:266-267
Reference
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 the sympathomimetic toxidrome (α effects.) Since these drugs are so potent, they are often sold in the form of impregnated blotter paper and misrepresented as LSD. Street names include N-Bomb, Wizard, Smiles, and Blue Batman.
This brief...
Source: The Poison Review - September 24, 2015 Category: Toxicology Authors: Leon Tags: Medical 25B-NBOMe hallucinogenic stimulant n-bomb Source Type: news
Tox Tunes #101: Alcohol and Jake Blues (Tommy Johnson, 1930)
One of the most interesting, and tragic, episodes of mass poisoning in U.S. history involves “jake paralysis“. The first depiction in the medical literature was in a June 1930 New England Journal of Medicine article, that described an epidemic of motor neuropathy that occurred in the midwestern and southern states. As I explained in the “Toxicology Rounds” column in Emergency Medicine News:
Onset of this condition was usually heralded by lower leg muscular pain and tingling, rapidly followed by weakness that often also involved the upper extremities. Distal deep tendon reflexes were diminished. Sens...
Source: The Poison Review - September 21, 2015 Category: Toxicology Authors: Leon Tags: Medical jake leg jake walk limber leg neurotoxicity opidn organophosphate induced delayed neuropathy Tommy Johnson Source Type: news
Implications of obesity for pharmacology and toxicology
3.5 out of 5 stars
A Review of the Toxicologic Implications of Obesity. Zuckerman M et al. J Med Toxicol 2015 Sep;11(3):342-54
Abstract
The authors of this thought-provoking study propose that obese patients be considered a “special population” — similar to children, the elderly, and pregnant women — for matters of medical toxicology.
Obesity — defined as a body mass index (BMI) > 30 kg/m2 — is associated with a number of pharmacokinetic and pharmacodynamic changes that can impact on toxicology:
increased blood volume and cardiac output
impaired respiratory function
alterations in gastric emptying (...
Source: The Poison Review - September 19, 2015 Category: Toxicology Authors: Leon Tags: Medical medical toxicology obesity pharmacodynamics pharmacokinetics Source Type: news
Colchicine in acute gout: high-dose or low-dose or no-dose?
3.5 out of 5 stars
Does Colchicine Improve Pain in an Acute Gout Flare? Turner J, Cooper D. Ann Emerg Med 2015 sep;66:260-1.
Reference
The 7th edition of Tintinalli’s Emergency Medicine (2011) has this to say about using colchicine to treat gout:
Oral colchicine is typically administered in a dose of 0.6 milligrams/h until intolerable side effects (vomiting or diarrhea) or efficacy ensues.
This “typical” dosing schedule goes back decades, and even when I was a medical student who didn’t know an Ewald tube from an Ewok it never made sense to me. The instructions might as well have been “Take ...
Source: The Poison Review - September 11, 2015 Category: Toxicology Authors: Leon Tags: Medical acute gout adverse events cochrane review colchicine toxicity dosing Source Type: news
Case report: use of ECMO in colchicine poisoning
Colchicum autumnale (Autumn crocus)
3.5 out of 5 stars
Extracorporeal life support in the treatment of colchicine poisoning. Boisramé-Helms J et al. Clin Toxicol 2015;53:827-829.
Abstract
Colchicine toxicity occurs roughly in 3 phases. During the initial 24 hours, severe gastrointestinal symptoms — nausea, vomiting, and diarrhea — can cause hypotension and shock if fluid losses are not adequately replaced. During the second phase, severe toxicity can manifest with pancytopenia, sepsis, rhabdomyolysis, and renal failure. In addition, within days after ingestion, patients can develop cardiogenic shock and sudden cardia...
Source: The Poison Review - September 11, 2015 Category: Toxicology Authors: Leon Tags: Medical autumn crocus colchicine poisoning colchicum autumnale ECLS ECMO extracorporeal life support extracorporeal membrane oxygenation Source Type: news
Case report: veno-venous ECMO as a bridge to lung transplantation in paraquat poisoning
3 out of 5 stars
Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning. Tang X et al. Clin Toxicol 2015 Aug 28 [Epub ahead of print]
Abstract
Conceptually, extracorporeal membrane oxygenation (ECMO) seems a perfect technique for treating some of the sickest toxicology patients, buying time until failing vital functions can recover.
With severe cardiotoxins — for example, calcium channel blockers, beta blockers or bupropion — veno-arterial ECMO can provide complete cardiopulmonary bypass, replacing both cardiac a...
Source: The Poison Review - September 9, 2015 Category: Toxicology Authors: Leon Tags: Medical ECMO extracorporeal membrane oxygenation lung transplantation paraquat poisoning Source Type: news
Is ED use of flumazenil safe?
2 out of 5 stars
Lack of adverse effects from flumazenil administration: an ED observational study. Nguyen TT et al. Am J Emerg Med 2015 Jul 21 [Epub ahead of print]
Abstract
The use of the antidote flumazenil in patients with suspected benzodiazepine poisoning is controversial. The major concern is for inducing seizures in a patient who has a proconvulsant medication on board, is tolerant to benzodiazepines, or has an underlying seizure disorder.
The goal of this single-hospital retrospective observational study was to “assess adverse events and clinical outcomes of flumazenil administration in known and suspected...
Source: The Poison Review - September 4, 2015 Category: Toxicology Authors: Leon Tags: Medical antagonist antidote benzodiazepine overdose flumazenil Source Type: news
Delayed seizure after exposure to a synthetic cannabinoid product
PB-22
3 out of 5 stars
Delayed seizure-like activity following analytically confirmed use of previously unreported synthetic cannabinoid analogues. Schep LJ et al. Hum Exp Toxicol 2015 May;34:557-60.
Abstract
Exposure to s0-called synthetic cannabinoid products, which may consist of any of 100s of specific compounds — of a combination of these chemicals — have been associated with a wide range of signs and symptoms, including anxiety and agitation, drowsiness, vomiting, tachycardia, hallucinations, and seizures. Diagnoses associated with such exposure have included myocardial infarction, ischemia stroke, and acute kid...
Source: The Poison Review - September 1, 2015 Category: Toxicology Authors: Leon Tags: Medical 5F-PB-22 AM-2233 JWH-122 seizure spice synthetic cannabinoid Source Type: news
The first 100 “Tox Tunes”
On January 3, 2010, TPR launched “Tox Tunes,” a series of clips of songs about drug, toxins, and poisons starting with Keith Richards’ version of Reverent Gary Davis’s “Cocaine Blues.” Last week, we featured our one-hundredth tune, Amy Winehouse’s classic — and tragically ironic — song “Rehab.” To celebrate the 100-tunes milestone, we are listing all the selections with links to the original posts. Enjoy!
#1: Cocaine Blues (Keith Richards)
#2: Sister Morphine (Marianne Faithfull)
#3: Reefer Man (Cab Calloway)
#4: Modern Times (Charlie Chaplin)
#5: Who Put the Benz...
Source: The Poison Review - August 31, 2015 Category: Toxicology Authors: Leon Tags: Medical first hundred tox tunes Source Type: news
Management of body packers
This article from Hillingdon Hospital in London — located a mere 4 miles from Heathrow airport — was intended to evaluate the facility’s existing protocol for managing body packers.
Although some details of their protocol are not justified or even well-described, in general they align with the trend towards conservative treatment of asymptomatic patients, with observation bowel cleansing agents — they used Picolax (sodium picosulfate with magnesium citrate) or Klean-Prep (polyethylene glycol.) Surgery was reserved for patients showing signs of toxicity from cocaine or heroin, or gastrointestinal obstruction, bu...
Source: The Poison Review - August 25, 2015 Category: Toxicology Authors: Leon Tags: Medical body packers cocaine Hillingdon Hospital management mules Source Type: news
