Clinical Toxicology最新文献

{"title":"Comparative evaluation of the ability to detect major cardiac events with the modified cocaine history, electrocardiogram, age, risk factors and troponin (HEART) score, HEART pathway and original HEART score in patients with cocaine-associated chest pain presenting at the emergency department.","authors":"Femke Gresnigt, Jelle van Essen, Claudine Hunault, Eric Franssen, Dylan de Lange, Robert Riezebos","doi":"10.1080/15563650.2025.2472955","DOIUrl":"10.1080/15563650.2025.2472955","url":null,"abstract":"<p><strong>Introduction: </strong>This study primarily aimed to assess the ability to detect major cardiac events using the history, electrocardiogram, age, risk factors and troponin <b>(</b>HEART) pathway, modified cocaine HEART score, and HEART score among patients with cocaine-associated chest pain.</p><p><strong>Methods: </strong>This single-centre retrospective study included consecutive patients with cocaine-associated chest pain admitted between January 2016 and December 2022 who were age and sex-matched in a 1:2 ratio to patients with chest pain not associated with cocaine use. The primary outcome was the percentage of major adverse cardiovascular events within 30 days.</p><p><strong>Results: </strong>In total, 1,412 patients were included, with 1,653 presentations, of whom 551 presented with cocaine-associated chest pain and were ≥18 years old. Most presentations involved male patients (84%). Major adverse cardiovascular events occurred in 139 presentations: 50 (9.1%) among patients with cocaine-associated chest pain and 89 (8.1%) among patients with non-cocaine-associated chest pain. The number of low-risk presentations of cocaine-associated chest pain patients was 409 (74.2%), 345 (62.6%) and 394 (71.5%) according to the HEART score, modified cocaine HEART score and HEART pathway, respectively. The HEART pathway had the lowest percentage of observed major adverse cardiac events in low-risk patients (0%; 95% CI: 0-0.9%), followed by the modified cocaine HEART score (0.3%; 95% CI: 0.007-1.6%) and the HEART score (0.7%; 95% CI: 0.2-2.1%). Sensitivity, negative predictive value, and area under the curves were very similar between the three scores.</p><p><strong>Discussion: </strong>The occurrence of missed major adverse cardiovascular events in low-risk patients was below 0.7% (95% CI: 0.2%-2.1%) in all three risk stratification scores. The HEART pathway was the safest risk stratification tool with a sensitivity and negative predictive value of 100%. Nevertheless the differences with the other risk stratification scores were non-significant.</p><p><strong>Conclusions: </strong>All three risk stratification scores performed well in a low-risk population with cocaine-associated chest pain, with a percentage of 0.7% of patients with a missed major adverse cardiovascular event.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"317-324"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991677","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":"Subclinical adrenal suppression and urine immunoassay detection of etomidate in an electronic cigarette user.","authors":"Stephanie Tak Hei Liang, Rex Pui Kin Lam, Ngo Tin James Chan, Martin Mou Know Leung, Sik Hon Tsui, Timothy Hudson Rainer","doi":"10.1080/15563650.2025.2476016","DOIUrl":"10.1080/15563650.2025.2476016","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"364-366"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647575","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 effects of acute lamotrigine overdose (ATOM-10).","authors":"Angela L Chiew, Geoffrey K Isbister, Kiet Nguyen, Kristy McCulloch, Úna Nic Ionmhain, Katherine Z Isoardi","doi":"10.1080/15563650.2025.2471906","DOIUrl":"10.1080/15563650.2025.2471906","url":null,"abstract":"<p><strong>Introduction: </strong>Lamotrigine overdose is not typically associated with severe toxicity. However, both severe toxicity and serotonin toxicity is occasionally reported following large ingestions. We aimed to investigate the clinical effects of lamotrigine overdose.</p><p><strong>Methods: </strong>This was a prospective observational study from July 2020-March 2024. Patients >14 years-old with acute lamotrigine overdose (≥2 g ingestion) were recruited from the Australian Toxicology Monitoring study or identified from three toxicology units. Data extracted included clinical features, lamotrigine concentrations, management, and outcomes.</p><p><strong>Results: </strong>Fifty-four patients were included, median age 29 years (IQR: 21-42 years), 37 (69%) were female. The median ingested dose was 4.8 g (IQR: 3.2-6.3 g) and 41 patients (76%) co-ingested other substances. The median maximum lamotrigine concentration was 18.5 mg/L (IQR: 12.4-25.0 mg/L) at a median time of 4.3 h (IQR: 3.2-10.8 h) post-ingestion. Clinical effects and their management included sedation in 44 (81%) with 29 patients (54%) endotracheally intubated, tachycardia in 39 (72%), hypotension in 21 (39%) with 15 (28%) receiving inotropes, and seizures in 11 (20%). Serotonin toxicity occurred in 23 (43%) patients with four having severe toxicity characterised by temperature >38.5 °C and/or rigidity treated with muscle paralysis. Higher peak lamotrigine concentrations were correlated with severe outcomes such as endotracheal intubation for coma (<i>P</i> <0.0001), patients with hypotension receiving inotropes (<i>P</i> = 0.0269) and patients developing seizures (<i>P</i> = 0.0002). Patients who co-ingested another serotonin agent (some in therapeutic doses) had a higher incidence of developing serotonin toxicity (22/33 [67%]) versus those who had not (1/21 [5%]); <i>P</i> <0.0001).</p><p><strong>Discussion: </strong>Severe toxicity was associated with higher peak lamotrigine concentrations. Serotonin toxicity was common in those who were exposed to another serotonergic agent.</p><p><strong>Conclusion: </strong>Coma, seizures and hypotension following lamotrigine overdose appeared to be concentration dependent. Serotonin toxicity occurred in those who co-ingested another serotonergic agent and was unrelated to lamotrigine concentration.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"310-316"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691215","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":"Barriers to the performance of timely hemodialysis when recommended by one United States poison center: a retrospective review.","authors":"Marlis Gnirke, Emily Davies, Robert S Hoffman, Mark K Su","doi":"10.1080/15563650.2025.2454292","DOIUrl":"10.1080/15563650.2025.2454292","url":null,"abstract":"<p><strong>Introduction: </strong>Hemodialysis has an essential role in the treatment of certain poisoned patients, both by enhancing the elimination of select poisons and correcting underlying fluid, electrolyte, and acid-base disturbances. We sought to identify barriers to the performance of hemodialysis when it was recommended by our poison center.</p><p><strong>Methods: </strong>Data from a single United States poison center were retrospectively queried for adult patients for whom the poison center recommended intermittent hemodialysis for poison removal. The primary outcome was the performance of intermittent hemodialysis within 12 h of the poison center recommendation, which we defined as timely hemodialysis. Univariable and multivariable logistic regressions were performed to assess the effect of the following variables on this outcome: age group, patient sex, time of day of the recommendation, day of week of the recommendation, year of the recommendation, hospital location, and poison category.</p><p><strong>Results: </strong>A total of 535 patient encounters were analyzed. The majority (73.5%) of patients had intermittent hemodialysis performed within 12 h of when it was recommended. The multivariable analyses showed that the odds of receiving recommended intermittent hemodialysis within 12 h were significantly lower when the recommendation was made during the nighttime (OR: 0.660; 95% CI: 0.442-0.987) compared to daytime and during the weekend (OR: 0.605; 95% CI: 0.398-0.918) compared to weekdays.</p><p><strong>Discussion: </strong>Intermittent hemodialysis is resource-intensive and requires specialized equipment and personnel, which is likely less available outside of regular business hours. This study is limited by its retrospective nature and may not be generalizable to other poison centers.</p><p><strong>Conclusion: </strong>Patients for whom our poison center recommended intermittent hemodialysis during non-weekday times had lower odds of receiving timely hemodialysis. Hospital administrators and healthcare providers should be aware of this potential treatment obstacle for poisoned patients and identify the specific barriers involved in order to facilitate timely hemodialysis.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"267-272"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381777","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":"Gamma-hydroxybutyrate poisoning: clinical diagnosis versus laboratory findings.","authors":"Didrik Skjelland, Benedicte M Jørgenrud, Karsten Gundersen, Mari Asphjell Bjørnaas, Mette Brekke, Vivian M Dalaker, Håvard Furuhaugen, Odd Martin Vallersnes","doi":"10.1080/15563650.2025.2463700","DOIUrl":"10.1080/15563650.2025.2463700","url":null,"abstract":"<p><strong>Introduction: </strong>Patients poisoned with gamma-hydroxybutyrate may need urgent medical treatment. The clinical manifestations are heterogeneous, and the level of consciousness is often unstable, with fluctuations between agitation and coma. We aimed to investigate the accuracy of the clinical diagnosis of gamma-hydroxybutyrate poisoning compared to laboratory findings in blood samples.</p><p><strong>Methods: </strong>We did a prospective observational study, including patients ≥16 years of age admitted to hospital with a clinical diagnosis of gamma-hydroxybutyrate poisoning. The diagnosis was established by the doctor treating the patient based on the clinical information and/or information from the patient and/or the patient's companions. Blood samples were taken at admission and analyzed using ultra high-performance liquid chromatography-tandem mass spectrometry.</p><p><strong>Results: </strong>There were 87 patients with a median age of 35 years (IQR: 30-42 years), and 58.6% (51/87) were male. Gamma-hydroxybutyrate was found in blood samples taken from 60 (69.0%) patients. The median Glasgow Coma Scale of all patients on arrival at hospital was 6 (IQR: 3-10), and 53.3% of the patients who tested positive for gamma-hydroxybutyrate presented with a Glasgow Coma Scale of 3. The Glasgow Coma Scale was significantly lower (<i>P</i> <0.001) among patients who tested positive for gamma-hydroxybutyrate, and was inversely correlated with gamma-hydroxybutyrate concentrations. Among the 60 patients testing positive for gamma-hydroxybutyrate, 28 (46.7%) needed treatment in an intensive care unit, and three (5.0%) required endotracheal intubation. In 58 (96.7%) of the 60 patients who tested positive for gamma-hydroxybutyrate, other drugs were also found, most frequently amfetamines, cocaine, and benzodiazepines.</p><p><strong>Discussion: </strong>The frequent co-consumption of other psychoactive drugs makes the clinical diagnosis of gamma-hydroxybutyrate challenging, and poisoning with other central nervous system depressants was frequently observed among those patients testing negative for the gamma-hydroxybutyrate.</p><p><strong>Conclusions: </strong>In only two out of three patients with clinically suspected gamma-hydroxybutyrate poisoning was gamma-hydroxybutyrate found in a blood sample, indicating that clinicians might overdiagnose gamma-hydroxybutyrate poisoning.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 4","pages":"253-260"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984341","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":"Nephrotoxicity biomarkers following propanil (3,4-dichloropropionanilide) self-poisoning.","authors":"Fathima Shihana, Thilini Madushanka Wijerathna, Indika Bandara Gawarammana, Seyed Shahmy, Umesh Chathuranga, Chathura Palangasinghe, Ahmed Mostafa, Lorraine Mackenzie, Michael S Roberts, Nicholas A Buckley, Fahim Mohamed","doi":"10.1080/15563650.2025.2457515","DOIUrl":"10.1080/15563650.2025.2457515","url":null,"abstract":"<p><strong>Background: </strong>Propanil toxicity is characterised by severe prolonged methaemoglobinaemia, cyanosis, acidosis, and progressive end-organ dysfunction. <i>In vitro</i> studies report propanil-induced kidney toxicity, which has not been studied clinically. This study determined the incidence of acute kidney injury and of methaemoglobinaemia after propanil self-poisoning and reported the diagnostic performance of novel and traditional biomarkers of acute kidney injury.</p><p><strong>Methods: </strong>Sixty-seven previously healthy patients were recruited following acute propanil self-poisoning, between October 2010 and October 2014. Concentrations of serum biomarkers and urine biomarkers normalised for urine creatinine excretion were measured. Plasma and urine concentrations of propanil, its main metabolite 3,4-dichloroaniline, the antidote methylthioninium chloride (methylene blue), and methaemoglobin levels were measured.</p><p><strong>Results: </strong>Kidney biomarkers were measured in 52 of the 67 patients, with 40% developing acute kidney injury (stage 1 [32%] and stage 2 [8%]). Blood methaemoglobin levels were recorded in 23 patients. Normalised urine biomarker concentrations of kidney injury molecule-1, trefoil factor 3, neutrophil gelatinase-associated lipocalin and beta₂ microglobulin increased in patients who developed acute kidney injury, but only trefoil factor 3 and cystatin C showed a significantly predicted acute kidney injury at 16-24 h and 8-16 h post-ingestion, respectively. In contrast, serum creatinine concentrations had a very good diagnostic performance throughout the 24 h post-ingestion period, with area under the receiver operating characteristic curve values of 0.79-0.96. Blood methaemoglobin levels were higher in patients with acute kidney injury and correlated with plasma propanil and 3,4-dichloroaniline concentrations. Concentrations of serum creatinine, urine beta₂ microglobulin, and trefoil factor 3 significantly correlated with plasma and urine concentrations of propanil, 3,4-dichloroaniline, and methylthioninium chloride.</p><p><strong>Discussion: </strong>Severe methaemoglobinaemia can impair oxygen delivery and may cause acute ischaemic kidney injury. The poor diagnostic performance of novel biomarkers may be attributed to non-renal factors influencing creatinine concentration or an unusual site or mechanism of nephrotoxicity after propanil poisoning.</p><p><strong>Conclusions: </strong>Patients with propanil self-poisoning exhibited reversible kidney injury diagnosable using serum creatinine concentrations within 4 h. Although other biomarkers were increased, they were not effective for early diagnosis.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"236-245"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540454","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":"Ivabradine exposures reported to United States poison centers 2015-2023.","authors":"Laura Szczesniak, Stephen Thornton, Ryan Feldman, Justin Corcoran","doi":"10.1080/15563650.2025.2460660","DOIUrl":"10.1080/15563650.2025.2460660","url":null,"abstract":"<p><strong>Introduction: </strong>Ivabradine was approved for use in the United States in 2015 for the management of heart failure. It acts through inhibition of sodium channels found in cardiac myocytes (the \"funny\" pacemaker current, I_f), which reduces heart rate without significantly affecting inotropy.</p><p><strong>Methods: </strong>We queried the National Poison Data System^® for reported ivabradine exposures from April 15, 2015-December 31, 2023. Age was stratified into child (0-5 years), adolescent (6-17 years), adult (18-64 years) and geriatric (65+ years). Other descriptive statistics gathered included patient sex, management site, and medical outcome as coded by America's Poison Centers^®.</p><p><strong>Results: </strong>There were 240 ivabradine exposures, with 55.0% managed on-site and not transferred to a healthcare facility. The most common reported symptom was bradycardia, reported in 36 patients (15.1%). There were 139 cases that were followed to a known outcome. Within this cohort, 60%, 14%, and 27% of patients suffered no effect, minor effect, or moderate effect, respectively. Exposures in children comprised 18.8% of cases; none required intervention. Intentional self-harm exposures comprised 17.1% of all cases and were more likely to have worse outcomes. Five adult patients received intensive therapy (endotracheal intubation, vasopressors, cardiac pacing, hemodialysis). There were no reported deaths from ivabradine exposure.</p><p><strong>Discussion: </strong>This study has limitations. First, our data source was limited by being retrospective and incomplete; we could only study the information that was reported to poison centers, and exposures were not confirmed by laboratory testing. It is possible that cases without further follow-up had other treatments and clinical effects not reported here. Finally, reports to poison centers likely underestimate the true number of ivabradine exposures.</p><p><strong>Conclusion: </strong>Adults with unintentional, asymptomatic exposures to ivabradine may be candidates for home monitoring. In ivabradine exposures refractory to medical management, clinicians should consider cardiac pacing or other supportive measures as a temporizing measure.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"278-283"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482369","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":"Quantitative analysis of recreational psychoactive mushroom gummies in Portland, Oregon.","authors":"Matthew S Correia, Mikayla J Gonzaga, Courtney Temple, Roy R Gerona","doi":"10.1080/15563650.2025.2450240","DOIUrl":"10.1080/15563650.2025.2450240","url":null,"abstract":"<p><strong>Introduction: </strong>In November 2020, Oregon passed Measures 109 and 110 altering the legal landscape for psychoactive substances by regulating psilocybin use and decriminalizing possession of Schedule I substances. This coincided with the growth of the commercial nootropic (cognitive enhancers) mushroom industry, including products such as mushroom gummies marketed for \"legal highs.\" Despite these product claims, concerns have been raised about their safety profile. Our study aimed to assess the accuracy of labeling of these products and quantify their psychoactive contents.</p><p><strong>Methods: </strong>Eight gummy products were procured from seven different smoke and vape shops in Portland, Oregon. Gummy samples were homogenized and analyzed using liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Products were screened for psychoactive compounds, including psilocybin, psilocin, and their analogues, as well as for purported <i>Amanita muscaria</i> derivatives. Quantitative analysis of identified compounds was performed using isotope dilution.</p><p><strong>Results: </strong>Neither ibotenic acid nor muscimol, the active components of <i>Amanita muscaria</i>, were detected in the two products claiming to contain <i>Amanita muscaria</i> extracts. However, these products contained psilocin and tryptamine derivatives. One product labeled as psilocybin-free tested positive for psilocybin. Another sample claiming to be nootropic contained undisclosed Δ9-tetrahydrocannabinol. Overall, seven of the eight products contained psilocin, and six contained 4-acetoxy-N,N,dimethyltryptamine. Other detected compounds included various tryptamine congeners and kavalactones.</p><p><strong>Discussion: </strong>Labeling was inaccurate and inconsistent in many of the products examined. Users are likely to experience psychoactive symptoms considering the concentrations of xenobiotics determined. Serotonergic effects are expected from products containing tryptamine derivatives, including those inaccurately labeled as containing <i>Amanita muscaria</i> extracts.</p><p><strong>Conclusions: </strong>The labeling of psychoactive mushroom gummies we tested was overall inaccurate. Products suggesting <i>Amanita muscaria</i> content instead contained serotonergic tryptamines, including some which falsely claimed to be free of psilocybin.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"261-266"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467271","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":"Authors' reply to comment on Cole et al. \"Comparison of children receiving extracorporeal treatments for poisoning at United States centers with and without a pediatric nephrologist\".","authors":"Jon B Cole, Anne M Kouri, Joshua D King, Travis D Olives, Nathaniel L Scott, Carrie L Oakland","doi":"10.1080/15563650.2025.2483385","DOIUrl":"10.1080/15563650.2025.2483385","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"300-301"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751307","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":"Comparison of children receiving extracorporeal treatments for poisoning at United States centers with and without a pediatric nephrologist.","authors":"Jon B Cole, Anne M Kouri, Joshua D King, Travis D Olives, Nathaniel L Scott, Carrie L Oakland","doi":"10.1080/15563650.2025.2456109","DOIUrl":"10.1080/15563650.2025.2456109","url":null,"abstract":"<p><strong>Background: </strong>Pediatric nephrologists are rare in the United States; many children with poisoning needing extracorporeal treatments may not have timely access to care. This study compared outcomes in children receiving extracorporeal treatments for poisoning at centers with and without a pediatric nephrologist.</p><p><strong>Methods: </strong>This was a retrospective cohort study of all patients aged ≤17 years reported to an American poison center covering three upper midwestern states during 2000-2024.</p><p><strong>Results: </strong>We identified 72 patients: 54 received extracorporeal treatments at a hospital with pediatric nephrologists, and 18 patients aged 14-17 years (minimum weight, 35 kg) received extracorporeal treatments at hospitals staffed solely by adult nephrologists. The most common responsible poisons were toxic alcohols (10/18, 55%) and salicylates (4/18, 22%). Children receiving extracorporeal treatments from adult nephrologists more commonly (<i>P</i> <0.001) received intermittent hemodialysis (18/18, 100%) compared to pediatric nephrologists (31/54, 57%). Conversely, children treated by pediatric nephrologists more commonly (<i>P</i> <0.05) received continuous kidney replacement therapy (28/54, 52%) compared to adult nephrologists (0/18). We found no difference (<i>P</i> = 0.1) in mortality between the children treated by pediatric nephrologists (9/54, 17%) compared to those treated by adult nephrologists (0/18).</p><p><strong>Discussion: </strong>Teenage children commonly received hemodialysis from adult nephrologists for poisoning and had similar outcomes to those treated by pediatric nephrologists.</p><p><strong>Conclusions: </strong>These data suggest adult nephrologists can successfully perform extracorporeal treatments for poisoning in teenage children.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"292-295"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255010","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}