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":"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":"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":"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}