Clinical Toxicology最新文献

{"title":"Report of zinc phosphide being sold to residents of New York City.","authors":"Victoria Pereira, Adam Blumenberg","doi":"10.1080/15563650.2025.2491660","DOIUrl":"10.1080/15563650.2025.2491660","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"521-522"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977509","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":"Acute parenteral poisoning from calcium copper edetate.","authors":"Wai Yan Rachel Yuen, Adam C Pomerleau, Janet Liang","doi":"10.1080/15563650.2025.2501776","DOIUrl":"10.1080/15563650.2025.2501776","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"445-446"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","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":"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":"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":"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":"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}

{"title":"Out-of-hospital assessment and triage of paracetamol (acetaminophen) exposure in the United States and Canada: a consensus guideline.","authors":"Evelyn J Fox, Alicia M Dalton, Michael E Mullins, Theresa Matoushek, Anne-Michelle Ruha, Michele M Burns, Karen Simone, Michael C Beuhler, Kennon J Heard, Maryann Mazer-Amirshahi, Christine M Stork, Shawn M Varney, Alexandra R Funk, F Lee Cantrell, Jon B Cole, William Banner, Andrew I Stolbach, Robert G Hendrickson, Scott N Lucyk, Marco L A Sivilotti, Mark K Su, Lewis S Nelson, Barry H Rumack, Richard C Dart","doi":"10.1080/15563650.2025.2471915","DOIUrl":"10.1080/15563650.2025.2471915","url":null,"abstract":"<p><strong>Introduction: </strong>Consensus guidelines for out-of-hospital assessment and triage of paracetamol (acetaminophen) exposure were published in 2006. Changes in the healthcare system, paracetamol ingestion trends, and availability of paracetamol-containing products necessitate an update to these guidelines. Updated guidelines were created for out-of-hospital management of paracetamol exposure in the United States and Canada.</p><p><strong>Methods: </strong>A modified Delphi consensus methodology was used to create a decision framework to evaluate clinical aspects of care related to paracetamol overdose in the out-of-hospital setting. Twenty-one panelists were selected by four clinical toxicology societies (America's Poison Centers®, American Academy of Clinical Toxicology, American College of Medical Toxicology, and Canadian Association for Poison Centres and Clinical Toxicology) to participate as panelists. Guidelines were collected from most poison centers in the United States and Canada, and systematic collection and review of medical literature was conducted.</p><p><strong>Results: </strong>The panel developed a guideline for out-of-hospital management of paracetamol exposure that encompasses acute and repeated supratherapeutic ingestion patterns. Acute ingestion is defined as any ingestion presenting within 24 h of initial ingestion, regardless of ingestion pattern. Repeated supratherapeutic ingestion is defined as an exposure that occurs over a period of 24 h or more. This guideline emphasizes the importance of obtaining accurate history. When ingestion history is determined as accurate, dosage and ingestion pattern are used to decide treatment referral. It is recommended that patients be referred to the emergency department if their ingestion amount is: (1) ≥200 mg/kg or 10 g (whichever is less) within 24 h; (2) ≥150 mg/kg/24 h or 6 g/day (whichever is less) within 48 h; (3) ≥100 mg/kg/24 h or 4 g/day (whichever is less) for more than 48 h.</p><p><strong>Discussion: </strong>The need for standardizing the out-of-hospital assessment and triage of paracetamol exposure is pressing. Despite the availability of acetylcysteine, some patients develop fatal liver failure due to missed diagnoses and delays in treatment. Failure to recognize cases requiring acetylcysteine is associated with significant morbidity and mortality.</p><p><strong>Conclusion: </strong>This consensus statement provides evidence-based guidance for out-of-hospital management of paracetamol ingestion to standardize healthcare facility referral criteria for paracetamol exposed patients.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"348-352"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566092","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 metabolic derangements in an adolescent with cannabinoid hyperemesis syndrome.","authors":"John Tumberger, Tony Rianprakaisang, Amr Nabaah, Travis Langner, Francesca Pérez Marquès, Shawn Sood","doi":"10.1080/15563650.2025.2477195","DOIUrl":"10.1080/15563650.2025.2477195","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"363-364"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604224","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}