Clinical Toxicology最新文献

{"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}

{"title":"The effect of acetylcysteine on the prothrombin time and international normalized ratio: a narrative review.","authors":"Messia Nazar, Jenny E Kootstra-Ros, Paola Mian, Daniel J Touw, Marieke G G Sturkenboom","doi":"10.1080/15563650.2025.2451642","DOIUrl":"10.1080/15563650.2025.2451642","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Patients poisoned with paracetamol are treated with acetylcysteine. In patients without hepatocellular injury, an increased prothrombin time or international normalized ratio has been observed during acetylcysteine administration. The international normalized ratio is preferred as it is a standardized calculation of prothrombin time independent of reagents and machinery. Since the prothrombin time and international normalized ratio are used as markers of liver injury in patients with paracetamol poisoning, it is important to assess the magnitude of the effect of acetylcysteine treatment on the prothrombin time and international normalized ratio. The aim of this narrative review is to describe the effect of acetylcysteine on the prothrombin time and international normalized ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Embase, PubMed and Web of Science were searched to identify the effect of acetylcysteine on coagulation factors II, VII, IX or X, the prothrombin time and the international normalized ratio in &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt; studies in healthy subjects and clinical studies involving both those poisoned with paracetamol and surgical patients. The search terms employed were acetylcysteine combined with prothrombin time, international normalized ratio, coagulation or haemostasis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search identified a total of 2,471 articles, of which 19 studies were included. Six &lt;i&gt;in vitro&lt;/i&gt; and/or &lt;i&gt;in vivo&lt;/i&gt; studies, five clinical studies in paracetamol-poisoned patients and eight clinical studies in surgical patients were included. Acetylcysteine caused a 15-30% increase in prothrombin time and international normalized ratio. This increase was dose-dependent and was caused by a decrease in the activity of coagulation factors II, VII, IX and X. The effect of acetylcysteine on the increased prothrombin time and international normalized ratio was more prominent after the high loading dose but remained present during the lower maintenance dose of acetylcysteine. The effect was observed in both &lt;i&gt;in vitro&lt;/i&gt; and &lt;i&gt;in vivo&lt;/i&gt; studies and confirmed in clinical studies in paracetamol-poisoned patients without hepatic injury. Studies in surgical patients treated with acetylcysteine showed conflicting results. Twelve of the 13 clinical studies suffered from risk of bias, limiting the value of these studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The moderate 15-30% increase in the international normalized ratio induced by acetylcysteine is especially important in hospitals using the international normalized ratio as a marker for hepatotoxicity due to paracetamol poisoning and underlines the need for the international normalized ratio to be assessed at admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Acetylcysteine treatment leads to an estimated 15-30% increase in prothrombin time and international normalized ratio in both experimental studies and paracetamol-poisoned patients. Isolated incr","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"166-175"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058258","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":"Safety profile of antivenom in a cohort of patients envenomed by <i>Deinagkistrodon acutus</i> in Hangzhou, Zhejiang Province, Southeast China.","authors":"Mengyun Tu, Tao Yu, Yuchen Shen, Sipin Hu","doi":"10.1080/15563650.2025.2449938","DOIUrl":"https://doi.org/10.1080/15563650.2025.2449938","url":null,"abstract":"<p><strong>Introduction: </strong>Antivenom treatment is the specific treatment for <i>Deinagkistrodon acutus</i> envenomation. However, safety concerns regarding the use of antivenom in this population have been reported only infrequently in the literature. We aimed to determine the incidence of anaphylactic reactions and serum sickness following antivenom administration in a cohort of patients envenomed by <i>Deinagkistrodon acutus</i>.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of patients admitted to the Hangzhou TCM Hospital between January 2018 and December 2022 with bites from <i>Deinagkistrodon acutus</i>. The information collected included patient demographics, clinical information, laboratory findings, details of antivenom use, use of premedications, and details of anaphylactic reactions and serum sickness.</p><p><strong>Results: </strong>A total of 157 patients with bites from <i>Deinagkistrodon acutus</i> were treated with antivenom (median dose four vials) and were included in the study. All treated patients received premedications (dexamethasone and antihistamines). Adverse reactions were noted in 18 patients (11.5%). Ten of these individuals (6.4%) suffered anaphylactic reactions within the first 24 h following antivenom administration, categorized as mild (<i>n</i> = 5), moderate (<i>n</i> = 4), or severe (<i>n</i> = 1). Symptoms included rash, urticaria, diaphoresis, nausea, dyspnoea, wheezing, anaphylactic shock, loss of consciousness, and angioedema. Serum sickness occurred in eight patients (5.1%), manifesting primarily as urticaria or erythematous rash, fever, myalgia, arthralgia, malaise, and gastrointestinal symptoms.</p><p><strong>Discussion: </strong>This study provided data on adverse reactions associated with antivenom administration in patients admitted with bites from <i>Deinagkistrodon acutus</i> admitted to a regional referral centre specializing in the management of patients with severe or complex health conditions in Zhejiang Province, China. Our results indicate a relatively low incidence of severe adverse reactions. Nevertheless, clinicians must administer appropriate snake antivenom and maintain vigilance during antivenom administration and post-treatment follow-up.</p><p><strong>Conclusions: </strong>Antivenom therapy was efficacious in treating <i>Deinagkistrodon acutus</i> envenomation. Approximately one in every eight patients developed anaphylactic reactions or serum sickness, although anaphylactic shock was uncommon (0.6%).</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 3","pages":"196-203"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662958","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":"Delayed cerebrospinal fluid removal is ineffective in treating intrathecal baclofen overdose.","authors":"Nicolas Mutel, Jérémy Lecot, Fabien Lamoureux, Doria Ikhlef, Chloé Bruneau, Ariella Ganem, Dominique Vodovar, Fabienne Tamion, Marion Giry","doi":"10.1080/15563650.2025.2451641","DOIUrl":"10.1080/15563650.2025.2451641","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"221-222"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001028","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 two-bag and three-bag acetylcysteine regimens in the treatment of paracetamol poisoning: a systematic review and meta-analysis.","authors":"Larissa Nakatsu, Josh R Lopez, Christian Mateo Garcia, Mathew Cherian, Jacob Nash, Davood Tofighi, Steven A Seifert, Susan Smolinske, Brandon J Warrick","doi":"10.1080/15563650.2025.2456116","DOIUrl":"10.1080/15563650.2025.2456116","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Worldwide, paracetamol poisoning is a common cause of acute liver failure and referral to transplant centers. Acetylcysteine has long been the mainstay of treatment, but recent literature suggests that a simplification of the \"three-bag\" method may decrease adverse effects. Our primary hypothesis is that a simplified dosing regimen (two-bag regimen) is non-inferior to the three-bag method in preventing liver injury. Our secondary hypothesis is that a simplified regimen will have lower rates of adverse effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Medline/PubMed, Google, Google Scholar, Cochrane Library, Embase and Toxnet on May 23, 2022. The Medical Subject Headings terms were NAC, acetaminophen toxicity, acetyl-cysteine, N-acetylcysteine, paracetamol, APAP, 2-bag, and 3-bag. The Embase terms were acetylcysteine, NAC, 2-bag, two bag, 3-bag, three bag, simplified dosing, acetaminophen, Tylenol&lt;sup&gt;®&lt;/sup&gt;, paracetamol, APAP, drug overdose, poisoning, and overdose. Studies included both non-United States Food and Drug Administration-approved and United States Food and Drug Administration-approved acetylcysteine regimens. Case reports, review articles, and animal studies were excluded. Two authors independently reviewed each study using Rayyan QCRI to determine if the studies met search criteria while blinded to the selections of each other. The two authors discussed until reaching a consensus. We used a primary outcome of non-inferiority of hepatotoxicity. We used secondary outcomes of non-allergic anaphylactoid reactions and adverse events. We conducted a fixed-effect meta-analysis using R package meta. To visually summarize the meta-analysis results, we also produced forest plots. We used Cochran's Q test and &lt;i&gt;I&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; statistical analysis to assess heterogeneity between the studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our search resulted in 657 total citations, which were reduced to unique citations. Of the 643 studies, 46 met the criteria for full text review, and eight met the study criteria. Of the eight studies investigating a simplified acetylcysteine regimen, four studies utilized some form of a modified two-bag infusion regimen, varying in duration or dosing of infusions, and four studies shared the same \"common\" two-bag treatment, a regimen that delivers acetylcysteine 200 mg/kg over 4 h, followed by 100 mg/kg acetylcysteine over 16 h. The six studies comparing a two-bag dosing regimen to the three-bag technique were utilized for our random effect model meta-analysis. We found no significant heterogeneity amongst the six studies for either hepatotoxicity (&lt;i&gt;Q&lt;/i&gt;(5) = 1.11; &lt;i&gt;P&lt;/i&gt; = 0.95; &lt;i&gt;I&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 0%; 95% CI: 0%-74.6%) or non-allergic anaphylactoid reactions and adverse events (&lt;i&gt;Q&lt;/i&gt;(5) = 10.15; &lt;i&gt;P&lt;/i&gt; = 0.07; &lt;i&gt;I&lt;sup&gt;2&lt;/sup&gt;&lt;/i&gt; = 50.7%; 95% CI: 0%-80.4%). Compared to the traditi","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"155-165"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514860","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":"Sotalol poisoning and its unique treatment considerations compared with traditional therapies for beta-adrenoceptor blocking drug poisoning.","authors":"Jon B Cole, Nathan M Kunzler, Arthur R Jurao, Ryan T Fuchs, Travis D Olives, Jenna L Wilkinson","doi":"10.1080/15563650.2025.2454291","DOIUrl":"10.1080/15563650.2025.2454291","url":null,"abstract":"<p><strong>Introduction: </strong>Sotalol is a beta-adrenoceptor blocking drug with unique physical and pharmacologic properties. Unlike most beta-adrenoceptor blocking drugs, sotalol is amenable to extracorporeal removal and causes QT interval prolongation and ventricular dysrhythmias. These properties have implications for treating sotalol poisoning.</p><p><strong>Patients: </strong><b><i>Patient 1</i></b>: A man in his seventh decade of life overdosed on sotalol 9 g and presented with bradycardia, hypotension, QT interval >600 msec and transient ventricular tachycardia. Dopamine, isoprenaline (isoproterenol), and a transvenous pacemaker were used instead of high-dose insulin due to the risk of iatrogenic hypokalemia. Hemodynamics improved, and the pacemaker was removed six days later. <b><i>Patient 2:</i></b> A woman in her seventh decade of life on sotalol presented with hypotension in the setting of anuric acute kidney failure. Hypotension worsened after administration of additional sotalol. Hemodialysis was performed for refractory hypotension, followed by improvement in hemodynamics and kidney function.</p><p><strong>Discussion: </strong>High-dose insulin, a standard therapy in beta-adrenoceptor blocking drug poisoning, causes hypokalemia, which may exacerbate QT interval prolongation and ventricular dysrhythmias in patients with sotalol poisoning. Sotalol is cleared renally and is amenable to extracorporeal removal; hemodialysis may be a useful therapy in patients with cardiotoxicity and concomitant kidney injury.</p><p><strong>Conclusions: </strong>Chronotropes and overdrive pacing may be preferred therapies for patients with severe sotalol poisoning. If concomitant kidney injury occurs, hemodialysis may be a useful adjunctive therapy.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"217-220"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute complications and treatment in critically ill patients with 3,4-methylenedioxymetamfetamine intoxication: a 10-year retrospective observational study in an intensive care unit in an Amsterdam hospital.","authors":"Mirte J Zuidema, Elles Reimerink, Dena Akhoundzadeh, Bas van den Bogaard, Femke M J Gresnigt","doi":"10.1080/15563650.2025.2453619","DOIUrl":"10.1080/15563650.2025.2453619","url":null,"abstract":"<p><strong>Introduction: </strong>The persistent increase in the use of 3,4-methylenedioxymetamfetamine has led to an increase in emergency department presentations. Our aim was to study the most frequent reasons for admission to the intensive care unit of critically ill patients with 3,4-methylenedioxymetamfetamine intoxication and to describe their complications, management and outcome.</p><p><strong>Methods: </strong>This retrospective cohort study included all patients with confirmed or self-reported 3,4-methylenedioxymetamfetamine intoxication admitted to the intensive care of a tertiary care hospital in Amsterdam between 2010 and 2020.</p><p><strong>Results: </strong>Seventy-four patients (73% male) were included. Three patients (4%) died. The most common reason for intensive care admission was a threatened airway (<i>n</i> = 35, 47%) due to trismus, which led to respiratory acidosis in 25 patients (71%). Two patients developed aspiration pneumonia, and one patient developed a pneumothorax. Seventeen patients (39%) presented with hyponatraemia, of whom 65% were treated with hypertonic saline, leading to a median serum sodium concentration correction of 13 mmol/L (IQR 7-15 mmol/L) after 8 h. Lastly, eight patients (11%) presented with hyperthermia of whom seven patients received cooling therapy. All displayed secondary complications, such as rhabdomyolysis, acute kidney injury, acute liver injury, acute liver failure and disseminated intravascular coagulation. Patients with a temperature <39 °C did not develop complications of hyperthermia.</p><p><strong>Discussion: </strong>Unlike other studies, trismus was the most common reason for intensive care unit admission in our study. Trismus, or its treatment with benzodiazepines, may lead to respiratory acidosis. The median correction of the serum sodium concentration in our population was greater than advised in the European guideline. The occurrence of osmotic demyelination was not reported.</p><p><strong>Conclusion: </strong>The three most common complications of 3,4-methylenedioxymetamfetamine use necessitating intensive care admission were a threatened airway due to trismus, hyponatraemia and hyperthermia. Severe complications can arise, especially in patients presenting with hyperthermia. Although the majority of patients included in this study made a full recovery, 4% died.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"176-182"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467270","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 case series of ibogaine toxicity reported to the United Kingdom National Poisons Information Service (NPIS) over a 10-year period.","authors":"Ella P Edwards, Laurence A Gray, Muhammad E M O Elamin, Aravindan Veiraiah, Ruben H K Thanacoody, James M Coulson","doi":"10.1080/15563650.2024.2447500","DOIUrl":"10.1080/15563650.2024.2447500","url":null,"abstract":"<p><strong>Introduction: </strong>Ibogaine is a psychoactive alkaloid derived from the root bark of the West African shrub <i>Tabernanthe iboga</i>. It is not licensed in the United Kingdom but is used by individuals to alleviate drug or alcohol use.</p><p><strong>Methods: </strong>A retrospective analysis of telephone enquiries involving ibogaine between 1 January 2012 and 31 December 2022 to the United Kingdom National Poisons Information Service was performed.</p><p><strong>Case series: </strong>Eleven enquiries relating to seven patients were made to the United Kingdom National Poisons Information Service in this period. Five of these patients were male (71%) with the majority in the age category 31-40 years (57%). All patients presented symptomatically. The circumstances for all seven cases were recorded as \"recreational abuse.\" The exact indication was not specified in three cases but in two cases it was being used to alleviate diacetylmorphine (heroin) use and in another two cases it was being used for relief from insomnia. Three sources of ibogaine were reported - in one case it was bought online, in one case by a dealer and in two cases it was bought from a shaman. When reported, the dose ingested ranged from 5g to 34g. Two patients took it in tablet form and four patients ingested the root bark. The time since exposure, when reported, ranged from 16 h to 1 month. Seven patients experienced neurological symptoms and six displayed features of cardiotoxicity. The most frequently reported features included cardiac arrest, hypoxia, torsade de pointes, QT interval prolongation, coma, convulsions, stupor, bradycardia, vomiting and anxiety.</p><p><strong>Discussion: </strong>Our cases are consistent with other case reports that demon-strate ibogaine can cause severe cardiotoxicity, including ventricular tachyarrhythmias, prolonged QT interval, and tor-sade de pointes; which can lead to loss of cardiac output and arrest.</p><p><strong>Conclusions: </strong>Individuals using ibogaine in variable doses to self-treat for drug use are at risk of developing severe cardiotoxicity and neurological symptoms. Further studies to quantify dose-response relationship and to further improve knowledge of its pharmacokinetics are required.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"212-216"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064140","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":"Differences in the clinical presentation of acute 3,4-methylenedioxymetamfetamine intoxication by co-intoxication and patient sex to European emergency departments.","authors":"Joep J J Ouwerkerk, David M Wood, Alison M Dines, Christopher Yates, Florian Eyer, Fridtjof Heyerdahl, Isabelle Giraudon, Knut Erik Hovda, Matthias E Liechti, Òscar Miró, Odd Martin Vallersnes, Paul I Dargan, F M J Gresnigt","doi":"10.1080/15563650.2025.2453052","DOIUrl":"https://doi.org/10.1080/15563650.2025.2453052","url":null,"abstract":"<p><strong>Introduction: </strong>This study hypothesized that 3,4-methylenedioxymetamfetamine intoxication presents with distinct clinical features and outcomes when combined with other substances of misuse, compared to mono-3,4-methylenedioxymetamfetamine intoxication. This study investigated the clinical presentation of acute mono-3,4-methylenedioxymetamfetamine intoxication, 3,4-methylenedioxymetamfetamine intoxication with exclusive co-usage of ethanol, and 3,4-methylenedioxymetamfetamine-co-intoxication with co-usage of other substances with or without ethanol, with a focus on patient sex differences.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using the Euro-DEN Plus database (2013-2022), which collects data on emergency department presentations with acute drug intoxication from 28 sentinel centres in 18 European countries. Odds ratios for clinical features were calculated for the three study groups with mono-3,4-methylenedioxymetamfetamine intoxication as the reference group. A sub-analysis explored patient sex differences in clinical features.</p><p><strong>Results: </strong>Among 4,102 presentations, 3,4-methylenedioxymetamfetamine-ethanol intoxication (<i>n</i> = 1,376) was associated with increased odds of agitation (OR: 1.34), drowsiness (OR: 2.30), and vomiting (OR: 1.85) compared to mono-3,4-methylenedioxymetamfetamine intoxication (<i>n</i> = 359). 3,4-Methylenedioxymetamfetamine-co-intoxication (<i>n</i> = 2,367) was associated with higher odds of bradycardia (OR: 3.14), psychosis (OR: 1.91), and coma (OR: 1.72). Mortality rates did not significantly differ across groups. Females reported a lower incidence of chest pain (OR 0.78) while reporting higher rates of vomiting (OR: 1.64), headache (OR: 1.61), and hypotension (OR: 1.89) compared to males.</p><p><strong>Discussion: </strong>The variation in clinical manifestation of acute 3,4-methylenedioxymetamfetamine intoxication is associated with co-intoxication and patient sex. Co-intoxication with ethanol or other substances was associated with an increased incidence of more severe symptoms, such as agitation and psychosis, necessitating tailored management. These variations suggest the need for physicians to consider the type of co-intoxication and patient sex to optimize treatment strategies. Although co-intoxication affected the clinical trajectory, the mortality risk remains low.</p><p><strong>Conclusions: </strong>Ethanol co-intoxication, co-intoxication with other substances of misuse, and patient sex were associated with varying clinical presentations in the emergency department, necessitating tailored treatment approaches.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 3","pages":"183-192"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662956","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":"https://doi.org/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":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","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}