Clinical Toxicology最新文献

{"title":"The relationships of plasma profenofos and ethanol concentrations to clinical outcome in acute profenofos self-poisoning.","authors":"Jeevan Dhanarisi, Michael Eddleston, Klintean Wunnapuk, Indika Gawarammana, Fahim Mohamed","doi":"10.1080/15563650.2024.2437119","DOIUrl":"https://doi.org/10.1080/15563650.2024.2437119","url":null,"abstract":"<p><strong>Introduction: </strong>Many patients acutely self-poisoned with organophosphorus insecticides have co-ingested ethanol. Currently, profenofos 50% emulsifiable concentrate (EC50) is commonly ingested for self-harm in Sri Lanka. Clinical experience suggests that ethanol co-ingestion makes management more difficult. Therefore, we aimed to determine the relationships between plasma ethanol concentration, plasma profenofos concentration and its toxicokinetics, and clinical outcome in acute profenofos self-poisoning.</p><p><strong>Methods: </strong>Demographic and clinical data, including a history of ethanol ingestion and blood samples, were prospectively collected from all cases of acute poisoning with profenofos EC50 presenting to Teaching Hospital Peradeniya, Sri Lanka, over four years. Plasma samples were analyzed by gas chromatography-mass spectrometry to quantify the ethanol (<i>n</i> = 99) and profenofos (<i>n</i> = 30 [15 with ethanol, 15 without ethanol]) concentrations. The PKSolver program was used to calculate the toxicokinetic parameters.</p><p><strong>Results: </strong>Of 99 patients (male 78/99) with acute profenofos self-poisoning, 50 reported a history of ethanol co-ingestion. Plasma from 44 of 99 profenofos-poisoned patients had detectable ethanol concentrations. No statistical difference was observed between the mortality in the ethanol group and the no ethanol group (5/44 [11.4%] versus 3/55 [5.5%]; <i>P</i> = 0.461). Similarly, the median half-lives of plasma profenofos absorption in the ethanol and no ethanol groups (0.1 h and 0.1 h, respectively; time 0-24 h) were not statistically different (<i>P</i> = 0.6594). However, the median half-life of plasma profenofos elimination was significantly longer in the ethanol group than the no ethanol group (23.1 h and 9.9 h, respectively; time 0-24 h; <i>P</i> = 0.0002). According to the regression analysis, the half-life of plasma profenofos elimination was longer by 29.4 h in the ethanol group (<i>P</i> = 0.013).</p><p><strong>Discussion: </strong>No significant differences in outcomes, including death and endotracheal intubation rates, were found between those who did and did not co-ingest ethanol. No differences were found in toxicokinetic variables between the ethanol and no ethanol groups, but the ethanol group had a longer elimination half-life.</p><p><strong>Conclusion: </strong>The co-ingestion of ethanol leads to a slowing of the elimination kinetics of profenofos. However, the study did not reveal a significant impact of ethanol co-ingestion on clinical outcomes.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977664","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":"Characterization of glucagon-like peptide-1 (GLP-1) agonist exposures reported to a single United States poison center.","authors":"Karen Muschler, Rachael Muschalek, Christopher Hoyte","doi":"10.1080/15563650.2024.2444642","DOIUrl":"https://doi.org/10.1080/15563650.2024.2444642","url":null,"abstract":"<p><strong>Introduction: </strong>Glucagon-like peptide-1 agonists have gained attention in recent years due to their efficacy in managing type II diabetes mellitus and their emerging role in weight management. The purpose of this study was to characterize glucagon-like peptide-1 agonist exposures reported to a single United States regional poison center over nine years, including causes of exposure, associated clinical effects, and potential areas for improving patient education and safety.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed all poison center calls involving glucagon-like peptide-1 agonists submitted to a single United States regional poison center from 14 January 2014 to 1 May 2023. Data were abstracted from the electronic medical record of the poison center, including demographics, call volume, drug involved, type of exposure, frequency of hypoglycemia, and other side effects.</p><p><strong>Results: </strong>Two hundred and thirty-seven cases involving glucagon-like peptide-1 agonists were reported to the poison center. The annual number of cases increased sharply over this period. Most patients (<i>n</i> = 166, 70.0%) were females. Most calls (<i>n</i> = 164, 69.2%) were due to unintentional therapeutic errors. Semaglutide was the most frequently involved medication (<i>n</i> = 72, 36.0%). Hypoglycemia was identified in eight patients (3.4%). The lowest mean (±SD) blood glucose concentration in these hypoglycemic patients was 49.6 ± 23.7 mg/dL (2.76 ± 1.3 mmol/L).</p><p><strong>Discussion: </strong>Unintentional therapeutic errors were involved in 164 (69.2%) cases. Despite the generally mild clinical effects observed in this study, the occurrence of hypoglycemia in a subset of patients, often requiring hospitalization, is of concern. With reports of the acquisition of these medications through online platforms and poorly regulated compounding sources, this trend may pose public health risks.</p><p><strong>Conclusions: </strong>This study demonstrates the increasing incidence of glucagon-like peptide-1 agonist exposures reported to a United States regional poison center, predominantly due to unintentional overdoses, which highlights the need for ongoing patient education.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969900","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":"Regional readiness for sodium nitrite-induced methemoglobinemia: availability of methemoglobin testing and methylthioninium chloride (methylene blue) stocking in the Upper Midwestern United States.","authors":"Travis D Olives, Jack B Goldstein, Morgan L Forgette, Paul Young, Jon B Cole","doi":"10.1080/15563650.2024.2436059","DOIUrl":"https://doi.org/10.1080/15563650.2024.2436059","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium nitrite is a potent oxidizer, which may precipitate rapidly lethal methemoglobinemia. Prompt diagnosis and treatment may salvage otherwise fatal cases. It is unclear if emergency departments are prepared for increasing cases. We describe the availability and geographic distribution of real-time methemoglobin testing and methylthioninium chloride (methylene blue) availability in three contiguous United States.</p><p><strong>Methods: </strong>This is a cross-sectional survey of hospitals served by a regional poison center in the Upper Midwestern United States. Hospitals were identified by cross-referencing poison center, health department, and state trauma databases. We queried methemoglobin testing capabilities of each site as well as immediate methylthioninium chloride availability. Resulting data are described with descriptive statistics, and predictors of testing and treatment availability are evaluated in multivariable logistic regression.</p><p><strong>Results: </strong>We identified 320 hospitals with emergency care, analyzing 228 (71.3%) after exclusions. Real-time methemoglobin testing was available at 56 sites (30.6% of 183 respondents). Of hospitals describing methylthioninium chloride availability, 59.4% (130/219) reported having it on-site. A significant difference in real-time methemoglobin testing existed across largest and smallest population strata in adjusted analysis (OR: 64.6: 95% CI: 4.1-1,037). Similarly disparate availability of methylthioninium chloride was observed. Spatial distribution of methemoglobin testing and methylthioninium chloride availability demonstrated notable urban-rural disparities.</p><p><strong>Discussion: </strong>These data demonstrate a wide disparity in the availability of real-time methemoglobin testing and methylthioninium chloride availability, suggesting that the region is ill-prepared to care for severe methemoglobinemia. Our analysis points to a disconnect between our current poison center recommendations and the capacities of our consulting institutions.</p><p><strong>Conclusions: </strong>We demonstrate urban-rural disparities in diagnostic and therapeutic capacity for the management of acute methemoglobinemia in this region, as well as significant geographic variations in methylthioninium chloride stocking and poisoning preparedness. Poison centers must therefore maintain an awareness of antidote availability for this emerging toxicological emergency.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-10"},"PeriodicalIF":3.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945812","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":"Ethyl chloride poisoning from inhalational misuse: clinical features and outcomes.","authors":"You-Jiang Tan, Shimona Q X Khoo, Youhong Tan","doi":"10.1080/15563650.2024.2424460","DOIUrl":"10.1080/15563650.2024.2424460","url":null,"abstract":"<p><strong>Introduction: </strong>Ethyl chloride misuse remains a prevailing concern due to its accessibility, but detailed descriptions of the features of toxicity are limited to sporadic reports, resulting in knowledge gaps in their clinical features and diagnosis.</p><p><strong>Objective: </strong>To describe the clinical features, treatment, and outcomes of patients reported in the literature who developed toxicity from inhalational use of ethyl chloride.</p><p><strong>Methods: </strong>We reviewed relevant literature over the past 50 years and analyzed the characteristics and outcomes of patients with toxicity from the inhalational use of ethyl chloride.</p><p><strong>Results: </strong>A total of 21 studies from 1979 to 2024 were identified, making available 22 patients for analysis. Their median age was 40 years (range 16-62 years), and there were more than four times as many males as females. Ethyl chloride-containing cleaning solvents (8/22, 36%) were most commonly used. Regular inhalation of ethyl chloride was documented in approximately two-thirds of the patients (14/22, 66%), with a median duration of five months of misuse (range 2-360 months). A large proportion of patients (15/22, 68%) inhaled ethyl chloride again within a week from the onset of toxicity. Although features of cerebellar dysfunction were very common at presentation (13/16, 81%), abnormalities on neuroimaging studies were rare. Death occurred in more than a quarter of cases (6/22, 27%), with patients either already deceased or dying shortly after. Half (3/6) of these deaths were directly attributable to the development of lethal cardiac dysrhythmias. Conversely, most survivors either improved or fully recovered within a few days to weeks (14/16, 88%), independent of their presenting symptoms, clinical signs, and the treatments they received.</p><p><strong>Discussion: </strong>Ethyl chloride users are likely young or middle-aged males, and clinical features of toxicity can range from transient neurological symptoms to cardiac dysrhythmias and death. The prominence of neurotoxicity may be attributed to the lipophilic nature of ethyl chloride and its tendency to accumulate in neural tissue, while cardiac dysrhythmias have been attributed to cardiac sensitization to catecholamines through ethyl chloride-induced inhibition of potassium, calcium, and sodium channels.</p><p><strong>Conclusions: </strong>Toxicity from the inhalational misuse of ethyl chloride should be considered in young or middle-aged males presenting with acute cerebellar dysfunction. We recommend that suspected cases undergo telemetric monitoring for 24 h, especially when tachycardia and/or palpitations are present, as deaths from lethal cardiac dysrhythmias are not uncommon.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"50-56"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726596","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":"A recent increasing occurrence of etomidate and propoxate/isopropoxate misuse.","authors":"Yee-Ting Cheung, Chun-Wing Yeung, Kelvin Yat-Chung Yu, Choi-Yee Lau, Hok-Fung Tong, Yeow-Kuan Chong","doi":"10.1080/15563650.2024.2423834","DOIUrl":"10.1080/15563650.2024.2423834","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"65-67"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726592","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":"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":" ","pages":"60-62"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","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":"Ethanol for the management of alcohol withdrawal syndrome: a systematic review.","authors":"Darren Quelch, Nyle Davies, Claire McFauld, Arlene Copland, Carol Appleyard, Gareth Roderique-Davies, Sally Bradberry, Bev John","doi":"10.1080/15563650.2024.2422964","DOIUrl":"10.1080/15563650.2024.2422964","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol withdrawal is typically managed using benzodiazepines. However, modulation of both γ-aminobutyric acid-A and N-methyl-d-aspartate-receptors through ethanol provision may provide an alternative management strategy. This systematic review critically analyses the evidence surrounding the use of oral or intravenous ethanol for the management of alcohol withdrawal syndrome.</p><p><strong>Methods: </strong>Systematic searches of ProQuest - American Psychological Association, PsycInfo, MEDLINE and PubMed Central, Web of Science and Embase were performed (Prospero registration number: CRD42023425224). Search criteria were: Population = Patients receiving pharmacological interventions to treat or prevent alcohol withdrawal in a healthcare setting. Intervention = intravenous or enteral ethanol. Comparator = standard care, benzodiazepines, carbamazepine, adjunct medications including sedatives, or no comparator. Outcomes = complication rates, symptom scores, length of stay in healthcare settings. Exclusions were: preclinical studies, participants less than 18 years old, non-peer reviewed literature, poor study design or poor data quality. Study quality was assessed using an adapted National Institute for Health and Care Research quality tool. A narrative data synthesis approach was adopted.</p><p><strong>Results: </strong>Eight thousand two hundred and four studies were retrieved. Ten were included in the final analysis. Overall study quality was poor. Seven studies reported treatment outcomes that were comparable to a control arm or in which ethanol conferred no detrimental effect. Three studies reported positive outcomes, and one study reported worse outcomes following ethanol administration.</p><p><strong>Discussion: </strong>The review identified heterogeneity in study design and limited reporting surrounding patient demographics, patient alcohol use history and the practicalities of ethanol administration. As such, implementation of ethanol prescribing for the management of alcohol withdrawal is currently limited due to the quality and translatability of existing data surrounding its use.</p><p><strong>Conclusions: </strong>Further studies are required with more transparent and complete outcome reporting and practical implementation recommendations in order to facilitate the translation of ethanol prescribing for the management of alcohol withdrawal syndrome.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"37-49"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667460","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 Toxicology Expert Reviewers 2024.","authors":"","doi":"10.1080/15563650.2025.2450934","DOIUrl":"https://doi.org/10.1080/15563650.2025.2450934","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 1","pages":"72-74"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982616","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":"Pediatric opioid use-associated neurotoxicity with cerebellar edema (POUNCE) syndrome.","authors":"Jason Dietz, Samantha S Klein, Rana Biary, Stephen Blumberg, Suzanne Roberts, Asher Bercow, Bernard Goldwasser, Robert S Hoffman","doi":"10.1080/15563650.2024.2435396","DOIUrl":"10.1080/15563650.2024.2435396","url":null,"abstract":"<p><strong>Introduction: </strong>Unfortunately, children are not spared from the devastating effects of the ongoing opioid epidemic. In rare cases, young children exposed to opioids present with unique neuroimaging findings affecting the white matter, reminiscent of what was once seen with diacetylmorphine (heroin)-associated leukoencephalopathy. This constellation of findings is termed the pediatric opioid use-associated neurotoxicity with cerebellar edema (POUNCE) syndrome.</p><p><strong>Case summary: </strong>A 31-month-old child was found floppy and unresponsive. Upon hospital arrival, there was right gaze deviation, shaking of the arms and legs, miosis, and bradypnea. Response to naloxone was incomplete, and methadone was confirmed in the child's urine.</p><p><strong>Images: </strong>Magnetic resonance imaging of the brain performed 24 h after admission showed abnormal T2/FLAIR hyperintensity with associated restricted diffusion symmetrically involving the cerebellar hemispheres.</p><p><strong>Conclusion: </strong>The imaging findings, although far from pathognomonic, should be recognizable by radiologists and toxicologists when considering possible opioid exposure in a young child.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"57-59"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799639","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":"From coma to recovery: removal of amanitin by percutaneous transhepatic bile drainage in severe <i>Amanita subjunquillea</i> mushroom poisoning.","authors":"Xiuying Ma, Jiawei Geng, Junfeng Wang, Liping Huang, Jinbo Luo, Chibin Li, Ling Zhu","doi":"10.1080/15563650.2024.2430312","DOIUrl":"10.1080/15563650.2024.2430312","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"63-64"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766921","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}