Clinical Toxicology最新文献

{"title":"Acute parenteral poisoning from calcium copper edetate.","authors":"Wai Yan Rachel Yuen, Adam C Pomerleau, Janet Liang","doi":"10.1080/15563650.2025.2501776","DOIUrl":"https://doi.org/10.1080/15563650.2025.2501776","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paracetamol (acetaminophen) poisoning; consensus definitions of poisoning types and outcomes to be used in the clinical toxicology recommendations collaborative systematic review.","authors":"Angela L Chiew, David M Wood, Dazhe Cao, Adam Overberg, Katrin Faber, Anselm Wong, Ruben Thanacoody, Adam C Pomerleau, Sophie Gosselin, Ashish Bhalla, Davide Lonati, D Nicholas Bateman","doi":"10.1080/15563650.2025.2479721","DOIUrl":"10.1080/15563650.2025.2479721","url":null,"abstract":"<p><strong>Introduction: </strong>Paracetamol (acetaminophen) poisoning is common, and many publications describe various outcomes and treatments. As internationally agreed definitions are non-existent to describe patterns of paracetamol overdose (acute, repeated supratherapeutic, chronic, or staggered), it is difficult to analyze outcomes between studies. The Clinical Toxicology Recommendations Collaborative was tasked to provide guidance on the management of paracetamol poisoning and formed the Paracetamol Workgroup. The Workgroup concluded that an agreed set of terms was needed to perform the systematic review and categorize the evidence.</p><p><strong>Methods: </strong>A modified Delphi process was employed to establish uniform definitions to categorize various patterns of paracetamol overdose.</p><p><strong>Results: </strong>Group consensus was reached for each one of the following standard definitions for each pattern of poisoning: acute, staggered, repeated supratherapeutic ingestions, and chronic for use in their upcoming systematic review. \"Acute\" ingestion represents an excessive amount of paracetamol ingested over a total time (from first paracetamol dose ingested to last paracetamol dose ingested) of less than 8 h. \"Staggered\" ingestion involves an excessive amount of paracetamol ingested over a total time period of between 8 h and 24 h. \"Repeated supratherapeutic ingestion\" describes ingestions exceeding the recommended daily dose for more than 24 h, and \"chronic\" ingestion includes both staggered or repeated supratherapeutic ingestions. \"High-risk overdoses\" are defined by either an ingested dose, that is greater than 500 mg/kg or 30 g (whichever is less), or an initial serum or plasma paracetamol concentration of greater than 300 mg/L (1,985 µmol/L) at 4 h on the Rumack-Matthew nomogram line.</p><p><strong>Discussion: </strong>The definitions established by the Paracetamol Workgroup will structure the upcoming systematic review, ensuring consistent categorization of studies within each ingestion pattern to enable clearer comparisons of treatments and outcomes.</p><p><strong>Conclusion: </strong>We encourage researchers to define overdose patterns and patients at increased risk of hepatotoxicity consistently and to include these definitions in publications to improve research reliability and comparability.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"343-347"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"out-of-hospital assessment and triage of paracetamol (acetaminophen) exposure in the United States and Canada\".","authors":"James B Leonard, Curtis J Elko, Marlo Murray, Scott D Phillips","doi":"10.1080/15563650.2025.2493732","DOIUrl":"10.1080/15563650.2025.2493732","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"372"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling tenfold administration errors of oral risperidone solution in children.","authors":"Dania Takagi, Nir Friedman, Daniel Kurnik, Yael Lurie","doi":"10.1080/15563650.2025.2471916","DOIUrl":"10.1080/15563650.2025.2471916","url":null,"abstract":"<p><strong>Introduction: </strong>In early 2023, the Israeli National Poison Information Center received reports of children exposed to tenfold dosing errors of oral risperidone solution. To assess the scope of this issue, we systematically searched for all similar cases reported to the Israeli National Poison Information Center. Our aims were to describe the occurrence and causes of such errors and explore potential preventive measures.</p><p><strong>Methods: </strong>Using the Israeli National Poison Information Center database, we retrospectively identified and reviewed cases of unintentional tenfold oral risperidone solution overdoses in children under 13 years of age between 1 January 2020, and 31 December 2023. We collected information about demographics, the circumstances of the administration error, and patient disposition and outcomes.</p><p><strong>Results: </strong>We identified 60 children (median age 7 years; IQR: 5.5-9 years; 73% boys) who were exposed to a tenfold error in the administration of oral risperidone solution. In 48% of cases, the error occurred upon the first administration. The main contributing factor to this dosing error appeared to be the discrepancy between the small dosing volume of the doses prescribed (approximately 0.25 mL) and the comparatively large syringe size provided by the manufacturer in the package (3 mL). We reported this issue to the Israeli Ministry of Health, which published a safety alert warning health care professional about such administration errors.</p><p><strong>Discussion: </strong>Oral medication solutions need to be measured individually and are therefore associated with a higher likelihood of dosing errors compared to tablets.</p><p><strong>Conclusion: </strong>Health care workers and caregivers need to be aware of the risk of dosing errors when administrating oral risperidone solution to children. Supplying appropriate dosing syringes with the medication bottle may mitigate the risks of such administration errors.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"325-329"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excitatory neurological effects associated with <i>Amanita pseudopantherina</i> intoxication.","authors":"Xiaoli Bi, Jipin Li, Yongyun Kuang, Chonggui Chen, Yinglian Fang, Qunmei Yao, Chengmin Yu, Jiaju Zhong","doi":"10.1080/15563650.2025.2490221","DOIUrl":"10.1080/15563650.2025.2490221","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"370-371"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local envenoming following a bite by <i>Montivipera xanthina</i>.","authors":"Mark Pucci, Ryan Lee, Nathaniel Keymer, David Lalloo","doi":"10.1080/15563650.2025.2488306","DOIUrl":"10.1080/15563650.2025.2488306","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"366-367"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and clinical management of etomidate-like substance withdrawal.","authors":"Yi-Chun Ho, Ting-Chun Kuo, Hu-Ming Chang","doi":"10.1080/15563650.2025.2477197","DOIUrl":"10.1080/15563650.2025.2477197","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"368-369"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven patients with analytically confirmed MDMB-4en-PINACA toxicity associated with the use of electronic vaping devices.","authors":"Mark Pucci, Emma Moyns, Peter Welby-Everard, Lauren Starbrook","doi":"10.1080/15563650.2025.2489079","DOIUrl":"10.1080/15563650.2025.2489079","url":null,"abstract":"<p><strong>Introduction: </strong>There have been increasing reports of electronic vaping devices (e-cigarettes) being contaminated with synthetic cannabinoid receptor agonists.</p><p><strong>Methods: </strong>This is an observational case series of patients admitted to two acute hospitals in the United Kingdom between February 2022 and February 2025 who declared use of vaping products and were found on routine toxicological screening of urine to have been exposed to MDMB-4en-PINACA.</p><p><strong>Results: </strong>Seven patients were exposed to MDMB-4en-PINACA via a vaping device. Six patients (85.7%) were male. The median age was 17 years (range 14-37 years). Five patients (71.4%) presented with unusual changes in behaviour; six patients (85.7%) were agitated on admission; four patients (57.1%) displayed psychotic features, including hallucinations and delusions. In three cases, MDMB-4en-PINACA was the only substance detected.</p><p><strong>Discussion: </strong>In young patients presenting to hospital with psychiatric symptoms, it is important to ask about the use of vaping products and consider testing for synthetic cannabinoids.</p><p><strong>Conclusion: </strong>We describe seven patients with analytically confirmed MDMB-4en-PINACA toxicity associated with the use of electronic vaping devices who presented over three years. Most patients were adolescents and presented with a change in behaviour associated with agitation, with or without psychotic features.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"360-362"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal fluid lactate gap in ethylene glycol poisoning.","authors":"Fumiya Inoue, Yuji Okazaki, Toshihisa Ichiba, Takuyo Chiba, Akira Namera","doi":"10.1080/15563650.2025.2482886","DOIUrl":"10.1080/15563650.2025.2482886","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"367-368"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of clinical challenges and prognostic risk factors for 195 cases of iatrogenic botulism in China.","authors":"Yaqing An, Baopu Lv, Tuokang Zheng, Yu Gong, Jianhang Hou, Heyule Tian, Fangyu Chen, Bokai Wei, Jiajia Lu, Yiming Yun, Penglong Yang, Muchao Zhang, Zeqing Hu, Yang Wu, Hengbo Gao, Yingping Tian, Dongqi Yao","doi":"10.1080/15563650.2025.2491662","DOIUrl":"10.1080/15563650.2025.2491662","url":null,"abstract":"<p><strong>Introduction: </strong>Improper use of botulinum neurotoxin may result in poisoning. This study aimed to investigate the causes, characteristics, and risk factors of iatrogenic botulism incidents in China.</p><p><strong>Methods: </strong>Patients diagnosed with iatrogenic botulism who presented to the emergency department of the Second Hospital of Hebei Medical University between June and July 2024 were included. We assessed baseline demographics, clinical symptoms, disease grade, and botulinum toxin type A-related variables. Multivariate regression analysis was used to identify independent risk factors influencing the 30-day prognosis.</p><p><strong>Results: </strong>A total of 195 patients were included in the study, with a median age of 38 years (IQR: 33-47 years) and a male-to-female ratio of 1:38. Blurred vision was the most common early feature (82.1%), followed by dizziness and ptosis (75.9%), fatigue (65.1%), and dysarthria (63.1%). The most frequently observed complications were acute gastroenteritis (9.7%), followed by aspiration pneumonia (7.2%). Fifty-one patients experienced severe poisoning with early ocular, facial, limb muscle, and respiratory muscle involvement. Thirty-two patients (16.4%) required mechanical ventilation. The median latent period was 3 days (IQR: 2-4 days), with a median interval of 7 h (IQR: 4-10 h) observed between symptom onset and antitoxin administration. The median duration of hospitalization was 6 days (IQR: 4-8 days). Adverse reactions to the antitoxin included serum sickness in 11 patients and allergic reactions in 20 patients. Based on the presence or absence of clinical signs 30 days post-discharge, we categorized the cohort into good and poor prognostic groups; 87 patients (44.6%) had a poor prognosis. Independent risk factors for a poor prognosis included a latent period ≤3 days, increased time from onset of features to antitoxin treatment, longer hospital duration, disease severity, and need for mechanical ventilation.</p><p><strong>Discussion: </strong>Iatrogenic botulism frequently leads to severe outcomes due to delayed diagnosis and intervention. We identified a disease severity grading system alongside additional risk factors to predict patient prognosis.</p><p><strong>Conclusion: </strong>Our study underscores the critical importance of early recognition and timely treatment of iatrogenic botulism. Clinicians should implement prompt treatment to mitigate disease progression.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"337-342"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}