Clinical Toxicology最新文献

{"title":"Response to West et al. \"Identifying and quantifying exposures involving counterfeit opioid analgesic products\".","authors":"Yun-Ling Liu, Lien-Chung Wei","doi":"10.1080/15563650.2024.2421862","DOIUrl":"10.1080/15563650.2024.2421862","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582359","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":"Augmenting the sensitivity for hepatotoxicity prediction in acute paracetamol overdose: combining psi (ψ) parameter and paracetamol concentration aminotransferase activity multiplication product.","authors":"Summon Chomchai, Pattaraporn Mekavuthikul, Jariya Phuditshinnapatra, Chulathida Chomchai","doi":"10.1080/15563650.2024.2412208","DOIUrl":"https://doi.org/10.1080/15563650.2024.2412208","url":null,"abstract":"<p><strong>Introduction: </strong>While factors like high serum paracetamol (acetaminophen) concentration and delayed acetylcysteine treatment increase hepatotoxicity risk, existing predictive tools, such as the paracetamol concentration aminotransferase activity multiplication product and the psi (ψ) parameter, lack definitive accuracy. This study evaluated the paracetamol psi parameter multiplication product addition against the psi parameter and the paracetamol concentration aminotransferase activity multiplication product for predicting hepatotoxicity following an acute paracetamol overdose.</p><p><strong>Methods: </strong>A retrospective analysis of patients with acute paracetamol overdose from January 2007 to December 2016 was conducted. The paracetamol psi parameter multiplication product addition, calculated by summing the psi parameter (mmol/L × h) and the paracetamol concentration aminotransferase activity multiplication product (g U/L²), was used. Hepatotoxicity was defined as aspartate or alanine aminotransferase activities ≥1,000 U/L. Diagnostic accuracy was assessed through sensitivity, specificity, the area under the receiver operating characteristic curve, and their corresponding 95% CI, with the optimal cutoff determined using the maximum Youden index method.</p><p><strong>Results: </strong>The study comprised 421 patients, mostly female (82.9%) with a median age of 23 years. Hepatotoxicity occurred in 13.5% (57 patients). The paracetamol psi parameter multiplication product addition showed an area under the receiver operating characteristic curve of 0.989 (95% CI: 0.974-0.997), with an optimal cutoff at 9.723, providing 96.5% sensitivity and 97.3% specificity. The paracetamol psi parameter multiplication product addition demonstrated superior performance in area under the receiver operating characteristic curve compared to the individual assessments of the psi parameter (0.916; 95% CI: 0.885-0.941) and the paracetamol concentration aminotransferase activity multiplication product (0.901; 95% CI: 0.868-0.928).</p><p><strong>Discussion: </strong>The paracetamol psi parameter multiplication product addition appears to be a more effective diagnostic tool than the psi parameter or the paracetamol concentration aminotransferase activity multiplication product alone.</p><p><strong>Conclusion: </strong>Incorporating the paracetamol psi parameter multiplication product addition into clinical protocols could improve paracetamol overdose management by enabling precise identification of individuals at heightened risk for hepatotoxicity, thereby facilitating the customization of treatment approaches.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567275","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":"Severe food-induced methaemoglobinaemia.","authors":"Alix-Marie Pouget, Fanny Pélissier, Philippe Fournier, Nicolas Delcourt","doi":"10.1080/15563650.2024.2418982","DOIUrl":"https://doi.org/10.1080/15563650.2024.2418982","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557317","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":"Reported recreational drug and new psychoactive substance use versus laboratory detection of substances by high-resolution mass spectrometry in patients presenting to an emergency department in London with acute drug toxicity.","authors":"Caitlin E Wolfe, Ashley Rowe, Simon Hudson, John Rh Archer, Paul I Dargan, David M Wood","doi":"10.1080/15563650.2024.2402070","DOIUrl":"https://doi.org/10.1080/15563650.2024.2402070","url":null,"abstract":"<p><strong>Introduction: </strong>Clinicians managing patients with acute recreational drug or new psychoactive substance toxicity typically depend on self-reported drug(s) used. This study compares patient self-report (and/or from other sources) to the substance(s) that were subsequently identified in serum.</p><p><strong>Methods: </strong>A prospective sample of 1,000 adults presenting to a tertiary care, urban emergency department in London, United Kingdom, with acute recreational drug/new psychoactive substance toxicity was collected from 1 February 2019 to 2 February 2020. A total of 939 appropriate samples underwent qualitative analysis by high-resolution mass spectrometry with comparison to a database of drugs/metabolites. Data on the stated drug(s) used were extracted from the routine medical chart/records; results were batched by drug class, when appropriate, and analysis was performed using R software.</p><p><strong>Results: </strong>Seven hundred and ninety-nine (85.1%) patients were male with a median (IQR) age of 34 years (27 to 42 years). Six hundred and thirty-five (67.6%) patients reported using two or more drugs. The median (IQR) positive predictive value of a self-report substance having been taken was 0.68 (IQR: 0.44-0.86); conversely, the median negative predictive value of a substance having not been taken was 0.90 (IQR: 0.53-0.95). There was variability in the accuracy of reporting. For example, self-reported opioid use had a 90.5% likelihood that opioids were detected on analysis, whereas hallucinogens were only detected in 18.8% of samples when use was reported. Individuals were also mostly accurate in not underreporting substances. For example, those not explicitly reporting gamma-hydroxybutyrate use were 97.5% truly negative.</p><p><strong>Discussion: </strong>Overall, most users were relatively accurate in their self-report of what class of drugs they had used, although there was variability in this accuracy. However, other drugs were present even when not reported, for example, opioids with disproportionate detection of prescription and over-the-counter (non-prescription) opioids that were unreported.</p><p><strong>Conclusions: </strong>Self-report (and/or collateral reports) had overall relatively high concordance with the likelihood that a substance was, or was not, recently used. Therefore, clinicians can make initial treatment decisions based on the self-reported drug(s) used in most cases.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557316","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":"Carbon monoxide poisoning is associated with an increased risk of epilepsy and status epilepticus: a nationwide population-based cohort study conducted in the Republic of Korea between 2002-2021.","authors":"Heewon Hwang, Solam Lee, Kyung Min Kim, Yong Sung Cha","doi":"10.1080/15563650.2024.2418138","DOIUrl":"https://doi.org/10.1080/15563650.2024.2418138","url":null,"abstract":"<p><strong>Introduction: </strong>Carbon monoxide poisoning may result in various neurological injuries, including acute symptomatic seizures. We aimed to investigate the long-term risk of epilepsy and status epilepticus in patients with previous carbon monoxide poisoning.</p><p><strong>Methods: </strong>The study population was derived from the National Health Insurance Service database of the Republic of Korea between 1 January 2002 and 31 December 2021. We included adults with at least one documented visit to medical facilities because of carbon monoxide poisoning (International Classification of Diseases, Tenth Revision, code T58). Patients were matched, on the same index date, with controls, without a T58 code, for age, sex, insurance type, income level, and residence location in a 1:1 ratio. Follow-up continued until death, migration, or the end of the observation period (31 December 2021). The primary outcome was the incidence of epilepsy (codes G40 or R56) and status epilepticus (code G41).</p><p><strong>Results: </strong>This study included 53,380 patients with carbon monoxide poisoning and 53,380 controls, with 44.2% women and a mean age of 45.7 years. The mean (±SD) follow-up period was 5.7 ± 4.3 years in the carbon monoxide poisoned group and 6.4 ± 4.4 years in controls. The overall risk of epilepsy (adjusted hazard ratio 2.60; 95% CI: 2.43-2.78; <i>P</i> < 0.001) and status epilepticus (adjusted hazard ratio 4.10; 95% CI: 2.84-5.92; <i>P</i> < 0.001) was significantly increased in the carbon monoxide poisoned group compared to controls. The risk of epilepsy and status epilepticus was increased in patients with previous carbon monoxide poisoning, regardless of sex, age or a history of stroke, neurodegenerative diseases, or central nervous system tumour or infection. However, in the subgroup analysis according to age, the highest risk of epilepsy and status epilepticus was observed in patients less than 40 years of age.</p><p><strong>Discussion: </strong>In this population-based cohort study, previous carbon monoxide poisoning was associated with an increased risk of epilepsy and status epilepticus. The risk was more noticeable in patients aged less than 40 years. Further studies are needed to confirm such an association in other populations.</p><p><strong>Conclusions: </strong>Previous carbon monoxide poisoning was associated with an increased risk of epilepsy and status epilepticus, particularly in the younger population. The long-term management of survivors of carbon monoxide poisoning should include monitoring for epilepsy and status epilepticus.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521207","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":"Clinical manifestations of alpine pit viper (<i>Trimeresurus gracilis</i>) bites.","authors":"Min-Hui Chen, Hsiao-Feng Hu, Szu-Hsien Wu, Yen-Wen Chen, Yen-Chia Chen","doi":"10.1080/15563650.2024.2419564","DOIUrl":"https://doi.org/10.1080/15563650.2024.2419564","url":null,"abstract":"<p><strong>Introduction: </strong>The alpine pit viper, <i>Trimeresurus gracilis</i>, is an endemic species in Taiwan. The incidence of human envenoming is rare.</p><p><strong>Case summaries: </strong>We present three events in two patients bitten by <i>Trimeresurus gracilis</i>. In the first patient, envenoming inflicted pain, local bleeding, hemorrhagic bulla, and progressive swelling, leading to necrosis of the bite wound. In the second patient, the two snakebites caused pain and progressive swelling. There were no systemic effects such as organ damage or neurological deficits observed. A paraspecific antivenom against <i>Trimeresurus stejnegeri</i> and <i>Protobothrops mucrosquamatus</i> was used to treat both patients, with a favorable outcome in each.</p><p><strong>Discussion: </strong>Combined with the clinical manifestations of two previously reported cases of <i>Trimeresurus gracilis</i> envenoming, the known effects of <i>Trimeresurus gracilis</i> venom in humans include local toxicities, severe soft-tissue damage, compartment syndrome, and coagulopathy without spontaneous systemic bleeding. The paraspecific antivenom, which has demonstrable cross-neutralization effects in animal studies, appeared to be effective against the local toxicities as the patients showed prompt cessation of the progression of their swelling.</p><p><strong>Conclusions: </strong>The knowledge of clinical manifestations and management approaches to <i>Trimeresurus gracilis</i> envenoming is helpful for patient care. The use of the paraspecific antivenom should be considered in managing such envenoming.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496354","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":"The impact of updated national guidelines for managing unintentional paediatric liquid paracetamol exposures: a retrospective poisons centre study.","authors":"Sook Har Ong, Amy B Thomson, Nicole E Wright, Una Nic Ionmhain, Darren M Roberts","doi":"10.1080/15563650.2024.2412203","DOIUrl":"https://doi.org/10.1080/15563650.2024.2412203","url":null,"abstract":"<p><strong>Introduction: </strong>In 2015, Australia and New Zealand treatment guidelines recommended a 2 h paracetamol serum concentration for risk assessment of unintentional paracetamol liquid exposures. We assess our experience with this approach.</p><p><strong>Methods: </strong>Retrospective case review of children <6 years-old with liquid paracetamol overdoses referred to a regional poisons information centre January 2017 to August 2022. We extracted data on the exposure and management from the poisons information centre and hospital medical records. We identified additional cases with two paracetamol concentrations obtained from September 2022 to June 2024.</p><p><strong>Results: </strong>Of 437 paediatric poisonings, 271 were eligible for inclusion. The median age was 24 months, the median time to presentation was 120 min, and paracetamol was the sole ingestant in 92% of cases. Blood testing was recommended in 131 patients (48.3%), occurring at 2 h post-ingestion in 62 patients (47.3%). Testing at a later time was mostly due to delayed presentation, including to hospitals unable to measure paracetamol concentrations. Eighteen patients (16.7%) had repeat blood testing, and five additional cases were identified in the subsequent period. Overall, the concentration decreased in 19 patients (83%), but in three patients it increased, from 73 mg/L to 81 mg/L (0.49-0.54 mmol/L), from 154 mg/L to 179 mg/L (1.03-1.19 mmol/L), and from 56 mg/L to 115 mg/L (0.37-0.77 mmol/L. Symptomatic patients were more likely to receive a second blood test or acetylcysteine while awaiting investigations. Of 19 patients administered acetylcysteine, it was discontinued in five due to low paracetamol serum concentrations. All patients recovered.</p><p><strong>Discussion: </strong>Guidelines were followed in >90% of patients and this testing regimen shortened length of stay. Based on these data, Australian treatment guidelines now recommend repeat testing for 2 h paracetamol serum concentrations >100 mg/L (0.67 mmol/L).</p><p><strong>Conclusion: </strong>A paracetamol serum concentration between 2 h and 4 h post-ingestion in children <6 years-old with unintentional poisonings of paracetamol liquid can facilitate medical discharge.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496355","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":"The trajectory of serum salicylate concentrations after ingestion of medicinal oil containing methyl salicylate.","authors":"Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Anthony T Y Chow, Esther W Y Chan, Timothy Hudson Rainer","doi":"10.1080/15563650.2024.2409826","DOIUrl":"https://doi.org/10.1080/15563650.2024.2409826","url":null,"abstract":"<p><strong>Introduction: </strong>The toxicokinetics of methyl salicylate after unintentional or intentional ingestion of medicinal oil containing methyl salicylate has not been well studied. We aimed to characterize the trajectory of serum salicylate concentrations and to evaluate factors associated with the peak serum salicylate concentration and the time from ingestion to peak concentration.</p><p><strong>Methods: </strong>This was a retrospective cohort study of consecutive patients reported to the Hong Kong Poison Control Centre for laboratory-confirmed methyl salicylate poisoning by all local public emergency departments between 1 July 2008 and 30 June 2023. We analyzed cases with at least three serum salicylate concentrations. Multivariable generalized linear regression was used to identify factors significantly associated with the peak serum concentration and the time from ingestion to peak concentration.</p><p><strong>Results: </strong>We included 41 patients (median age 81.0 years; 32 women and nine men). The median time from ingestion to the first peak serum salicylate concentration was 5.6 h (IQR: 3.2-10.8 h). Multiple regression showed that gastric aspiration (adjusted regression coefficient [β] - 2.50; 95% CI: -3.93 to -1.08; <i>P</i> = 0.001) and single-dose activated charcoal (adjusted β - 1.22; 95% CI: -2.02 to -0.42; <i>P</i> = 0.003) were significantly associated with a lower peak concentration, after adjusting for patient age, sex, exposure due to intentional self-harm, reported ingested dose, time from ingestion to emergency department presentation, vomiting, concurrent use of aspirin (acetylsalicylic acid) and other medications that affect gastric emptying or gastric acid secretion, blood pH, serum albumin concentration, and creatinine clearance.</p><p><strong>Discussion: </strong>The serum salicylate concentration did not peak as quickly as generally believed, highlighting the importance of continued monitoring. Gastric aspiration and single-dose activated charcoal may help reduce gastrointestinal absorption, but their impact on clinical outcomes remains unclear.</p><p><strong>Conclusions: </strong>Given the median time of 5.6 h (IQR: 3.2-10.8 h) from ingestion to the peak salicylate concentration, gastric aspiration and single-dose activated charcoal can be considered in patients up to a few hours after medicinal oil ingestion when the airway is protected.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459655","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":"Corrections.","authors":"","doi":"10.1080/15563650.2024.2415238","DOIUrl":"https://doi.org/10.1080/15563650.2024.2415238","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459652","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":"Identifying and quantifying exposures involving counterfeit opioid analgesic products.","authors":"Nancy A West, Gabrielle E Bau, Heather Olsen, Hannah L Burkett, Geoffrey Severtson, Brooke Kritikos, Amanda Rogers, Richard C Dart, Joshua C Black","doi":"10.1080/15563650.2024.2408360","DOIUrl":"https://doi.org/10.1080/15563650.2024.2408360","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing presence of counterfeit opioid drugs in the United States can contaminate data collection systems and confound estimates derived from surveillance of the opioid epidemic. Data sources and analyses that can quantify the contribution of counterfeit opioid products are needed to provide accurate and timely data to inform public health responses. We describe a novel approach to identify and quantify intentional abuse and misuse exposures involving suspected counterfeit opioid products in United States poison center data.</p><p><strong>Methods: </strong>An ecological study was performed using data, including narrative case notes, reported to participating United States Poison Centers of the Researched Abuse, Diversion and Addiction Related Surveillance System between 2009-Quarter 1 and 2021-Quarter 4. A machine learning natural language processing approach was used to develop a predictive model.</p><p><strong>Results: </strong>Sensitivity for detecting suspected non-counterfeit-involved exposures by the predictive model was 92%, specificity was 73%, and the area under the receiver operating characteristic curve was 92%. Overall, only 2.1% of intentional abuse and misuse exposure calls were predicted to be suspected counterfeit-involved during 2009-2021; however, we observed an exponential increase in suspected counterfeit exposures over this time period. There was a 7-fold increase in the estimated number of suspected counterfeit exposures from 2009 to 2021, and 23.7% of all opioid analgesic intentional abuse and misuse exposures were suspected counterfeit-involved in 2021.</p><p><strong>Discussion: </strong>We demonstrate the feasibility and reliability of using machine learning natural language processing to identify exposures involving suspected counterfeit opioid products in United States poison center data. Results suggest that suspected counterfeits have had a meaningful influence on rates of intentional abuse exposures to opioid analgesics in more recent years.</p><p><strong>Conclusions: </strong>The increasing presence of counterfeit opioid drugs can contaminate data collection systems and compromise the reliability of the data.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459653","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}