Clinical Toxicology最新文献

{"title":"A survey study of urban retailers selling alkyl nitrites (\"poppers\") in the New York City area which led to public health interventions.","authors":"Abigail Olinde, Chelsea Hayman, Ivan Ivanov, Lauren Schwartz, Joshua Bloom, Mark K Su, Rana Biary","doi":"10.1080/15563650.2025.2455531","DOIUrl":"https://doi.org/10.1080/15563650.2025.2455531","url":null,"abstract":"<p><strong>Introduction: </strong>Alkyl nitrites (\"poppers\") are used recreationally for sexual enhancement, muscle relaxation, and euphoria. However, they can be toxic and cause adverse reactions such as methemoglobinemia. While inhalation is the typical route of usage, the New York City Poison Center has noted an increase in calls related to ingestion. Given the uncertainty of usage instructions at the point of sale, our study aimed to assess instructions provided to consumers about alkyl nitrite use and to evaluate the proximity and co-sale of alkyl nitrites with similarly appearing energy drink shots.</p><p><strong>Methods: </strong>We conducted a cross-sectional convenience sample survey of smoke shops, cannabis dispensaries, and exotic shops within the catchment area of an urban poison center. Plain clothes \"investigators\" (i.e., the researchers) visited these retailers and followed a predetermined protocol and script to request information regarding the availability and usage of alkyl nitrites. Additionally, the researchers attempted to visually assess the proximity of alkyl nitrites to similarly appearing energy drink shots during their visit.</p><p><strong>Results: </strong>Ninety-eight stores were visited in the New York City area, and eighty-six met the inclusion criteria of selling alkyl nitrites. After being questioned, forty-one (48%) retailers advised inhalation. Thirty-eight (44%) vendors were unsure how to use alkyl nitrites or refused to answer. Seven (8%) stores recommended ingestion. Furthermore, fifty-one (59%) vendors also sold 5-Hour Energy^® drinks and alkyl nitrites were located near these energy drink shots in twenty (39%) of these fifty-one stores.</p><p><strong>Discussion: </strong>Many commercial alkyl nitrite retailers in our survey area lack knowledge or provide potentially inaccurate information regarding the use of alkyl nitrites. Additionally, alkyl nitrites are often sold alongside commercial energy drinks, potentially increasing the risk of incidental ingestion.</p><p><strong>Conclusions: </strong>Further research is necessary to determine the impact of these patterns of sale and potential misinformation. Discussing preliminary results of our survey with the New York City Department of Health led to the rapid creation of an informational poster and local outreach. Clinicians should report cases of alkyl nitrite use to their regional poison center to allow for more targeted and timely public health intervention.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613574","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":"https://doi.org/10.1080/15563650.2025.2477197","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","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":"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":"https://doi.org/10.1080/15563650.2025.2477195","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","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}

{"title":"One poison center's experience with \"snake\" firework ingestions.","authors":"Matthew S Correia, Adrienne Hughes, Robert G Hendrickson","doi":"10.1080/15563650.2025.2474563","DOIUrl":"https://doi.org/10.1080/15563650.2025.2474563","url":null,"abstract":"<p><strong>Introduction: </strong>\"Snake\" fireworks are a type of pyrotechnic device that, when ignited, burn and transform into a friable, snake-like structure. The inclusion of barium salts produces a green flame. Ingestion of these fireworks poses a risk of barium toxicity, which may result in hypokalemia, weakness, dysrhythmias, and respiratory distress.</p><p><strong>Methods: </strong>We evaluated firework-related cases at a single poison center between 2009 and 2023 and extracted those pertaining to snake fireworks. Cases were eligible for analysis if oral exposure was suspected or confirmed. Cases were excluded if there was no oral exposure, the missing firework was located after the initial call, or there was no longitudinal follow up after a suspected or witnessed exposure (that is, premature case closure). Pertinent details related to the exposure or those associated with barium toxicity were extracted and evaluated in a descriptive fashion.</p><p><strong>Results: </strong>Sixty-four cases met inclusion criteria. No deaths, dysrhythmias, weakness, or respiratory compromise were reported. All six children (9.3%) who were symptomatic had gastrointestinal complaints at initial contact with our poison center. Only two symptomatic patients had hypokalemia with the minimum serum potassium concentrations falling to 3.4 mmol/L and 2.1 mmol/L. Four additional patients developed mild hypokalemia (lowest 3.0 mmol/L) but no symptoms. The maximal latency after exposure until nadir potassium concentration was 8 h.</p><p><strong>Discussion: </strong>Oral exposures to snake fireworks occasionally resulted in mild symptomatic toxicity. The presence of symptoms did not appear to predict whether hypokalemia would develop. In the instances in which hypokalemia was present, or there was a notable downtrend in the serum potassium concentration, the repletion of potassium usually did not correlate with the extent of rebound.</p><p><strong>Conclusion: </strong>In our case series, most children who had oral exposure to snake fireworks in an exploratory setting did not develop symptoms. Although severe toxicity reassuringly did not occur in our review, evaluation and monitoring are nevertheless prudent for symptomatic children.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604222","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":"Effectiveness and tolerability of methylthioninium chloride (methylene blue) for the treatment of methemoglobinemia: twenty-four years of experience at a single poison center.","authors":"Roger Rothenberg, Rana Biary, Robert S Hoffman","doi":"10.1080/15563650.2025.2470428","DOIUrl":"https://doi.org/10.1080/15563650.2025.2470428","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the widely accepted use of methylthioninium chloride (methylene blue) to treat methemoglobinemia, data regarding clinical outcomes are sparse. We sought to better elucidate the efficacy and tolerability of methylthioninium chloride.</p><p><strong>Methods: </strong>We identified all cases reported to the New York City Poison Center from 2000 to 2024 in which methylthioninium chloride was administered for methemoglobinemia. We extracted clinical data from these cases, which we assessed using primarily descriptive statistics.</p><p><strong>Results: </strong>A total of 185 cases were included. The median methemoglobin level was 29% (IQR: 19-42%). Implicated xenobiotics were most frequently volatile nitrites (41%), local anesthetics (15%), and dapsone (11%). The median methylthioninium chloride dose was 1 mg/kg (IQR: 1-2 mg/kg; range: 0.5-4 mg/kg). Multiple doses of methylthioninium chloride were administered in 11% of cases, with a median total dose of 2 mg/kg (IQR: 2-3 mg/kg), the majority of which were associated with volatile nitrites (<i>n</i> = 7) or dapsone (<i>n</i> = 6). Improvement after administration of methylthioninium chloride was reported in 98% of cases (95% CI: 96-100%). Adverse effects attributable to methylthioninium chloride were reported in nine cases (4.9%; 95% CI: 4.6-5.1%), including one instance of hemolysis. Glucose-6-phosphate dehydrogenase activity was found to be deficient in two of seven patients tested, only one of whom did not improve after methylthioninium chloride. Two deaths occurred in this series, both associated with sodium nitrite exposure.</p><p><strong>Discussion: </strong>Most patients with methemoglobinemia improved after 1-2 mg/kg of methylthioninium chloride, supporting current treatment recommendations. Despite few instances of glucose-6-phosphate dehydrogenase activity testing, major adverse effects attributable to methylthioninium chloride were extremely rare. A relatively large proportion of cases receiving multiple doses were associated with dapsone exposure.</p><p><strong>Conclusions: </strong>In this series, methylthioninium chloride was both efficacious and well tolerated in patients with methemoglobinemia, with a single dose of 1-2 mg/kg being sufficient to treat most patients.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584970","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":"https://doi.org/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":"1-5"},"PeriodicalIF":3.0,"publicationDate":"2025-03-06","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 hypoglycemia and hypothermia in massive metformin overdose.","authors":"Keahi M Horowitz, Alyrene Dorey, B Zane Horowitz","doi":"10.1080/15563650.2025.2472948","DOIUrl":"https://doi.org/10.1080/15563650.2025.2472948","url":null,"abstract":"<p><strong>Introduction: </strong>Metformin is a biguanide medication thought to contribute to increased insulin sensitivity. It does not induce insulin release or act via insulin receptors, so it is not considered a common cause of hypoglycemia, even in overdose. However, massive metformin overdoses may be associated with severe hypoglycemia as well as hypothermia.</p><p><strong>Methods: </strong>Four patients who had hypoglycemia after metformin overdoses are presented. None had access to other diabetic medications or a known diagnosis of diabetes mellitus.</p><p><strong>Results: </strong>Severe hypoglycemia (blood glucose concentration <2.2 mmol/L [<39.6 mg/dL]) in all patients was diagnosed on presentation or within 9 h of initial presentation. Peak serum lactate concentrations were observed after hypoglycemia in each patient. Three patients developed hypothermia. Three patients received extracorporeal therapy; hemodialysis (one), continuous kidney replacement therapy (one), both modalities (one). One patient died. The remainder were discharged home within 2-6 days of presentation.</p><p><strong>Discussion: </strong>The complex mechanisms of metformin may explain the observed progression of manifestations following large metformin overdoses.</p><p><strong>Conclusion: </strong>Large metformin ingestions exceeding 60 g can be associated with critically low serum glucose concentrations concurrently with or preceding increases in serum lactate concentrations. Hypothermia may also occur. Further study is needed to determine the exact mechanisms and true incidence of this manifestation, which may be underrecognized.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566018","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":"https://doi.org/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":"1-10"},"PeriodicalIF":3.0,"publicationDate":"2025-03-04","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":"Presence of sibutramine and sildenafil in weight loss dietary supplements: a case series with analytical and clinical investigation.","authors":"Marie Carles, Tessa Pietri, Joelle Micallef, Clara Corteggiani-Giraud, Magali Richez, Caroline Solas-Chesneau, Bruno Lacarelle, Nicolas Fabresse","doi":"10.1080/15563650.2025.2452297","DOIUrl":"10.1080/15563650.2025.2452297","url":null,"abstract":"<p><strong>Introduction: </strong>The use of weight loss supplements is increasing, often driven by online marketing. However, many of these supplements are adulterated with undeclared pharmaceutical substances, potentially posing significant health risks. We investigated the presence of sibutramine and sildenafil in weight loss supplements and assessed the associated clinical outcomes.</p><p><strong>Materials and methods: </strong>A total of 12 weight loss supplement samples (capsules, tea, and coffee bags) were analyzed using liquid chromatography-high resolution mass spectrometry. Demographic and clinical data were collected by the Marseille Regional Pharmacovigilance Centre from 29 patients who reported using these products.</p><p><strong>Results: </strong>All samples were found to contain sibutramine, with concentrations ranging from 7.5 mg to 15.4 mg per unit. Sildenafil was detected in all samples, with concentrations ranging from 1.7 mg to 4.8 mg per unit. Clinical data from 29 users showed significant weight loss, with an average of 7.5 kg after 37 days of use. Adverse effects included anorexia (<i>n</i> = 15), tachycardia (<i>n</i> = 13), insomnia (<i>n</i> = 2) and chest pain (<i>n</i> = 4). In some cases, more serious effects such as seizures and dependence were observed.</p><p><strong>Discussion: </strong>Both sibutramine and sildenafil were withdrawn from the market due to cardiovascular risks. As such, the unregulated use of these products pose a serious risk to public health, particularly in individuals with underlying cardiovascular disease.</p><p><strong>Conclusion: </strong>We detected sibutramine and sildenafil in all 12 weight loss supplements tested, which highlights the need for stricter regulation and monitoring.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"193-195"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045709","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":"Veno-venous extracorporeal membrane oxygenation (VV-ECMO) for acute poisonings in United States: a retrospective analysis of the Extracorporeal Life Support Organization Registry.","authors":"Hong K Kim, Andrew O Piner, Lauren N Day, Kevin M Jones, Danilo Alunnifegatelli, Matteo Di Nardo","doi":"10.1080/15563650.2024.2447496","DOIUrl":"10.1080/15563650.2024.2447496","url":null,"abstract":"<p><strong>Introduction: </strong>Veno-arterial extracorporeal membrane oxygenation is frequently considered and implemented to help manage patients with cardiogenic shock from acute poisoning. However, utilization of veno-venous extracorporeal membrane oxygenation in acutely poisoned patients is largely unknown.</p><p><strong>Method: </strong>We conducted a retrospective study analyzing the epidemiologic, clinical characteristics and survival of acutely poisoned patients placed on veno-venous extracorporeal membrane oxygenation using the Extracorporeal Life Support Organization registry. Adult cases in the United States were included after a systematic search of the registry between January 1, 2003, and November 30, 2019. Study outcomes included survival to discharge, time to cannulation, and changes in metabolic, hemodynamic, and ventilatory parameters stratified by survival.</p><p><strong>Results: </strong>One hundred and seventeen cases were included in the analysis after excluding 216 non-poisoning-related cases. Their median age was 34 years and 69.2% were male. Opioids (45.3%) were most commonly implicated, followed by neurologic drugs (e.g., antidepressants, antiepileptics) (14.5%) and smoke inhalation (13.7%); 23 patients (19.7%) had a pre-extracorporeal membrane oxygenation cardiac arrest. The median time from admission to extracorporeal membrane oxygenation was 47 h with a median duration of extracorporeal membrane oxygenation support of 146.5 h. Survivors were cannulated significantly earlier than non-survivors (25 h versus 123 h; <i>P</i> = 0.02). Eighty-four patients (71.2%) survived to hospital discharge. Clinical parameters (hemodynamic, metabolic, and ventilatory) improved with veno-venous extracorporeal membrane oxygenation support, but no statistically significant difference was noted between survivors and non-survivors.</p><p><strong>Discussion: </strong>Our study showed that veno-venous extracorporeal membrane oxygenation was infrequently utilized for poisoning-associated acute respiratory distress syndrome. Opioids were the most frequently reported exposure among the cases in which indirect lung injury may have occurred from aspiration. Although no specific clinical parameters were associated with survival, early initiation of extracorporeal membrane oxygenation may improve clinical outcomes.</p><p><strong>Conclusions: </strong>The use of veno-venous extracorporeal membrane oxygenation for refractory respiratory failure due to poisoning was associated with a clinically significant survival benefit compared to other respiratory diagnoses requiring veno-venous extracorporeal membrane oxygenation.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"204-211"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045711","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}