Clinical Toxicology最新文献

{"title":"Increased prevalence of pentylone and dipentylone in combination with other drugs in New South Wales, Australia.","authors":"Darren M Roberts, Thanjira Jiranantakan, Catherine McDonald, Una Cullinan, Jared Brown","doi":"10.1080/15563650.2024.2411323","DOIUrl":"10.1080/15563650.2024.2411323","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"781-782"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459654","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":"Extravasation with methylthioninium chloride.","authors":"Esha Chebolu, Marlis Gnirke, Hannah St Francis, Samara Soghoian, Mark K Su","doi":"10.1080/15563650.2024.2401088","DOIUrl":"10.1080/15563650.2024.2401088","url":null,"abstract":"<p><strong>Introduction: </strong>Methylthioninium chloride is used for multiple treatment purposes and is sometimes administered through peripheral intravenous lines. We highlight the potential adverse effects of methylthioninium chloride extravasation during continuous peripheral intravenous administration.</p><p><strong>Case summary: </strong>A 38-year-old woman presented to the emergency department with multifactorial hypovolemic and septic shock. She was treated with a continuous peripheral infusion of intravenous methylthioninium chloride for shock refractory to multiple vasopressors.</p><p><strong>Images: </strong>One day after administration commenced, the patient developed blue staining of the left upper arm due to extravasation of methylthioninium chloride proximal to the site of infusion. Further images show its later spread.</p><p><strong>Conclusion: </strong>While reported cases of methylthioninium chloride extravasation are rare, it is our preference that methylthioninium chloride should be administered through a central line in cases of continuous infusion due to the risk of potential toxicity from extravasation.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"776-778"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281414","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 patients with a snakebite presenting to healthcare facilities and reported to poison and drug information centers-Arizona, 2017-2021.","authors":"Cedar L Mitchell, Geoffrey Smelski, Kim Schmid, Maureen Roland, Matthew Christenberry, Katherine D Ellingson, Daniel E Brooks, Kenneth Komatsu, Steven Dudley, Farshad Shirazi, Theresa A Cullen","doi":"10.1080/15563650.2024.2402937","DOIUrl":"10.1080/15563650.2024.2402937","url":null,"abstract":"<p><strong>Introduction: </strong>Envenomation after a North American rattlesnake (<i>Crotalus</i> spp. and <i>Sistrusus</i> spp.) bite is associated with substantial morbidity. Arizona reports the highest number of rattlesnake envenomations annually in the United States. We evaluated the performance of poison and drug information centers for snakebite surveillance, compared with the hospital and emergency department discharge database. We used both datasets to improve the characterization of epidemiology, healthcare costs, and clinical effects of snakebite envenomations in Arizona.</p><p><strong>Methods: </strong>We identified patients with a snakebite during 2017-2021 using Arizona hospital and emergency department discharge data and snakebite consults with two regional Arizona poison centers. Patients were matched using name and birthdate. The performance of poison center data for snakebite surveillance was evaluated using the percentage of snakebite patients in hospital and emergency department discharge data that consulted with poison centers. Patient demographics, healthcare characteristics, clinical effects, and context of snakebite events were described using both datasets.</p><p><strong>Results: </strong>In total, 1,288 patients with a snakebite were identified using the Arizona hospital and emergency department discharge data, which resulted in 953 (74%) consultations with poison centers. The median age of patients was 48 years (IQR 28-62 years), and they were predominantly male (66%), White (90%), and non-Hispanic (84%). The median billed charges were US$ 84,880 (IQR US$ 13,286-US$ 168,043); the median duration of a healthcare stay was 34 h (IQR 13-48 h), and 29% of patients were transferred between healthcare facilities. Among 953 consulted poison center calls for a snakebite, a median of 14 vials of antivenom was administered per patient; 375 (60%) bites occurred near the home, and 345 (43%) patients were bitten on a lower extremity. One death was identified.</p><p><strong>Discussion: </strong>Snakebites in Arizona can cause severe morbidity and require extensive healthcare resources for treatment. Poison centers are valuable for monitoring venomous snakebites in Arizona.</p><p><strong>Conclusions: </strong>Using hospital and emergency department discharge data with poison center records can improve public health surveillance data regarding snakebite epidemiology and human-snake interaction information and be used to tailor interventions to increase awareness of snake encounters and prevent snakebites.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"754-761"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342901","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":"VipGrade^® electronic clinical tool: retrospective evaluation on a paediatric cohort of European viper bites.","authors":"Isabelle Claudet, Hugo Germain","doi":"10.1080/15563650.2024.2418388","DOIUrl":"https://doi.org/10.1080/15563650.2024.2418388","url":null,"abstract":"<p><strong>Introduction: </strong>The VipGrade^® is a French electronic clinical tool that was created in 2022 to help frontline clinicians grade envenomations due to European <i>Vipera</i> spp. and decide whether to use specific immunotherapy. The aim of this study was to test VipGrade^® on a paediatric retrospective cohort (2001-2022) of cases of <i>Vipera</i> spp. envenomation and evaluate the concordance with the initial grading assigned by clinicians on admission.</p><p><strong>Methods: </strong>For each child in the cohort (<i>n</i> = 116), VipGrade^® was applied by a single physician unaware of the initial clinical grading. We compared VipGrade^® results with those obtained at the time of admission using the Audebert-Boels classification system.</p><p><strong>Results: </strong>The proportion of discrepancies represented 26% of initial grade I (<i>n</i> = 39) cases, meaning that 10 children were upgraded to grade IIa (<i>n</i> = 9) or IIb (<i>n</i> = 1). The main reason was the VipGrade^® cut-off for oedema size (4 cm) to distinguish grade I from grade II, while oedema evaluation using the Audebert-Boels clinical classification differs in this regard. The global correlation κ score was equal to 0.78; 0.71 with the exception of grades 0 (which is not usually a diagnostic issue); 0.64 considering both results for young children (age <6 years, <i>n</i> = 51) and 0.79 for older ones.</p><p><strong>Discussion: </strong>Upgrading cases inappropriately could have a major impact on treatment and the use of the antivenom. Even if specific immunotherapy with Viperfav^® (MicroPharm Ltd, Newcastle Emlyn, Carmarthenshire, SA38 9BY, United Kingdom) is safe, its use when inappropriate cannot be justified, particularly in times of supply shortage, as we have experienced over the last 10 years.</p><p><strong>Conclusion: </strong>The current version of the VipGrade^® electronic clinical tool produces a different distribution of envenomation grades, notably in grade I by overgrading a substantial number of cases. We suggest creating a paediatric version that incorporates the same oedema evaluation method as the Audebert-Boels clinical classification but also includes a more refined definition of \"local or regional\" oedema.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"62 11","pages":"726-732"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686264","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":"https://doi.org/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":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-10-28","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":"Peri-operative management of alcohol withdrawal with ethanol prescribing: a case study.","authors":"Darren Quelch, Mark Pucci, Tessa Thompson, Arlene Copland, Carol Appleyard, Anand Arora, Gareth Roderique-Davies, Bev John, Sally Bradberry","doi":"10.1080/15563650.2024.2395536","DOIUrl":"10.1080/15563650.2024.2395536","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"673-675"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119149","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":"Detection of ethanol, cannabinoids, benzodiazepines, and opioids in older adults evaluated for serious injuries from falls.","authors":"Kavita M Babu, Yara K Haddad, Shakiera T Causey, Carmen C Vargas-Torres, Patricia Mae Martinez, Elizabeth M Goldberg, Jon D Dorfman, Julia A Bleser, Brittany P Chapman, Jeffrey T Lai, Riyadh Saif, Romanda Elhoussan, Lindsey A Graham, Alex J Krotulski, Sara E Walton, F Dennis Thomas, Barry K Logan, Roland C Merchant","doi":"10.1080/15563650.2024.2400186","DOIUrl":"10.1080/15563650.2024.2400186","url":null,"abstract":"<p><strong>Background: </strong>In 2020, there were 36.7 million reported falls among older adults (65+) in the United States. Ethanol and other sedating substances may increase fall risk among older adults due to their effect on cognitive and physical function. We estimate the prevalence of these substances in blood specimens of older adults presenting with a fall injury at selected trauma centers.</p><p><strong>Methods: </strong>The initial study collected blood specimens from May 2020 through July 2021 from adults undergoing a trauma team evaluation at selected United States Level 1 trauma centers. We limited our study to older adults evaluated after a fall (<i>n</i> = 1,365) and selected a random sample (<i>n</i> = 300) based on age, sex, and trauma-center quotas. Medical health records and blood specimens obtained at trauma center presentation were analyzed. We estimated the prevalence of ethanol, benzodiazepines, cannabinoids, and opioids in the blood specimens. Two-sample tests of binomial proportions and Chi-square two-tailed tests were used to compare prevalence estimates of substances by demographic characteristics.</p><p><strong>Results: </strong>At least one substance was detected among 31.3% of samples analyzed. Prevalences of specific substances detected were 9.3% (95% CI: 6.0-12.6%) for benzodiazepines, 4.3% (95% CI: 2.0-6.7%) for cannabinoids, 8.0% (95% CI: 5.2-11.7%) for ethanol, and 15.0% (95% CI: 10.9-19.1%) for opioids. There were 18 deaths (6%; 95% CI: 3.6-9.3%). One-third of decedents had at least one substance detected in their blood.</p><p><strong>Discussion: </strong>Opioids were the most frequently detected substance, followed by benzodiazepines, ethanol, and cannabinoids. Substance use prevalence was not uniform across demographics, with differences observed by sex and age.</p><p><strong>Conclusions: </strong>This study provides insight into the frequency of the presence of substances that may contribute to fall risk and serious injury among older adults. Screening older adults for substances that impair cognitive and physical function can enhance clinical fall prevention efforts.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"661-668"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342902","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 of intramuscular naloxone 1,600 μg in addition to titrated intravenous naloxone 100 μg for opioid poisoning: a randomised controlled trial.","authors":"Katherine Z Isoardi, Keith Harris, Elizabeth Currey, Nicholas A Buckley, Geoffrey K Isbister","doi":"10.1080/15563650.2024.2396447","DOIUrl":"10.1080/15563650.2024.2396447","url":null,"abstract":"<p><strong>Introduction: </strong>Naloxone is an effective antidote, but its short half-life means repeated doses, and infusions are often required. We investigated the effectiveness of adding intramuscular naloxone to titrated intravenous naloxone in opioid overdose in preventing recurrence of respiratory depression.</p><p><strong>Methods: </strong>This double-blinded randomised placebo-controlled trial was conducted in patients with suspected opioid poisoning and respiratory depression (respiratory rate <10 breaths/min or oxygen saturation <93%). Patients were randomised to receive either intramuscular naloxone 1,600 µg or saline placebo. All patients received titrated intravenous naloxone 100 µg and were managed on an opioid poisoning care pathway. The primary outcome was recurrence of respiratory depression within 4 h. Secondary outcomes were the proportion receiving naloxone infusions, number of naloxone boluses administered, reversal of respiratory depression at 10 min, and precipitation of opioid withdrawal (any symptom).</p><p><strong>Results: </strong>Recurrence of respiratory depression within 4 h was less common in 28/69 (41%) patients receiving intramuscular naloxone versus 48/67 (72%) patients receiving placebo (difference 31%, 95% CI: 13-46%; <i>P</i> < 0.001). Fewer naloxone infusions (5/69; 7% versus 25/67; 37%, difference 30%, 95% CI: 15 to 55%; <i>P</i> < 0.001) and fewer naloxone doses were administered (median 2, IQR: 1 to 5, versus median 5, IQR: 2 to 8; <i>P</i> = 0.001) in the intramuscular group. Reversal of respiratory depression at 10 min was similar between groups (51/69; 74% intramuscular naloxone versus 47/67; 70% placebo; <i>P</i> = 0.703). Opioid withdrawal occurred in 35/69 (51%) given intramuscular naloxone compared to 28/67 (42%) in the placebo group (difference 9%; 95% CI: -8 to 27%; <i>P</i> = 0.308).</p><p><strong>Discussion: </strong>The favourable pharmacokinetics of intramuscular naloxone, particularly its longer duration of activity, likely explains the improved effectiveness with lower recurrence of respiratory depression.</p><p><strong>Conclusion: </strong>The addition of intramuscular naloxone 1,600 µg to titrated intravenous naloxone prolonged effective reversal of respiratory depression, with fewer naloxone doses and infusions given, and no significant difference in patients developing withdrawal.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"643-650"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132048","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":"Towards policy impact - an exploration of <i>Clinical Toxicology</i> research cited in policy documents and patents.","authors":"Lisa Schölin, Michael Eddleston","doi":"10.1080/15563650.2024.2398136","DOIUrl":"10.1080/15563650.2024.2398136","url":null,"abstract":"<p><strong>Introduction: </strong>Individual researcher impact through scientific citations is carefully monitored, with little attention to the impact of individual journals through policy and patent mentions. We aimed to describe policy and patent mentions for articles published in <i>Clinical Toxicology</i>.</p><p><strong>Methods: </strong>Using Altmetric Explorer, we extracted mentions from 1 January 2013 to 31 December 2023, noting the citing source, <i>Clinical Toxicology</i> article title, and author-generated keywords. We used descriptive statistics to analyse the data.</p><p><strong>Results: </strong>We identified 165 individual policy documents (<i>n</i> = 139) and patents (<i>n</i> = 26), citing 146 articles with median of 6.4 years between publication and mention. The highest number of citing documents were by the World Health Organization (<i>n</i> = 45), European Monitoring Centre for Drugs and Drug Addiction (<i>n</i> = 22), and United States Centers for Disease Control and Prevention (<i>n</i> = 16). Most patents were registered in the United States (<i>n</i> = 17) and by the European Patent Office (<i>n</i> = 10), with the main classification of human necessities (<i>n</i> = 23). The commonest subjects of papers cited in policy and patents, from keywords, related to medical conditions and symptoms (26%) and recreational drugs (22%). The most cited article was \"A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment.\"</p><p><strong>Discussion: </strong><i>Clinical Toxicology</i> articles are cited in policy documents and patents, with a comparable number of mentions to the top-ranked journals in the field. This likely contributes to policy impact, but further work is needed to understand how cited articles are used and ripple effects through onwards citations of policy documents.</p><p><strong>Conclusions: </strong><i>Clinical Toxicology</i> is a toxicology journal for which published research gets recognised within influential policy sources. The Journal can play a key role in guiding public health policy through its selection and development of submitted publications.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"636-642"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307259","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":"Elemental impurities (heavy metals) in kratom products: an assessment of published individual product analyses.","authors":"Kimberly Snow Caroti, Alen Joseph, Amy Sapowadia, C Michael White","doi":"10.1080/15563650.2024.2395552","DOIUrl":"10.1080/15563650.2024.2395552","url":null,"abstract":"<p><strong>Introduction: </strong>Kratom is commonly used by consumers, and the elemental impurity exposure that consumers would have at different kratom ingestion doses has been determined.</p><p><strong>Methods: </strong>This assessment used original data from independent third-party laboratory testing of kratom products to identify the percentage of products that exceeded permissible daily exposure limits for lead (5 µg/day), nickel (200 µg/day), arsenic (15 µg/day), and cadmium (5 µg/day), the interim reference level for lead in adults (12.5 µg/day), and the tolerable upper intake level for manganese (11 mg/day) and nickel (1 mg/day). We assessed all products regardless of type and then evaluated non-extract products, extract products, and a soda preparation separately for elemental impurities.</p><p><strong>Results: </strong>Three assessments of elemental impurities in kratom products have been published, totaling 68 products. Assessing all products and assuming a 3 g daily dose of kratom, 7.4% would exceed the permissible daily exposure limits for lead, 0% for nickel, 3.1% for arsenic, and 0% for cadmium. At a kratom dose of 25 g daily, 70.6% would exceed the permissible daily exposure limits for lead, 20.6% for nickel, 9.4% for arsenic, and 0% for cadmium. The interim reference level for lead would be exceeded by 1.5% of products at a kratom daily dose of 3 g and 33.8% of products at 25 g. The tolerable upper intake level for manganese would be exceeded by 12.5% of products at a kratom daily dose of 3 g and 41.7% of products at 25 g. Non-extract products generally contain greater concentrations of elemental impurities than extract products or the soda preparation.</p><p><strong>Discussion: </strong>Apart from their concentrations in a gram of product, assessing the amount of exposure to elemental impurities at different kratom ingestion doses is also important. Elemental impurities exceeding regulatory permissible concentrations for many products, especially with greater daily kratom ingestion doses, may impact human health.</p><p><strong>Conclusions: </strong>Some kratom products contain excessive concentrations of elemental impurities of toxicological concern, such as lead and arsenic. Non-extract products (powders, capsules, tablets) generally contain greater concentrations of elemental impurities than extract products or the soda preparation. Daily use of these products can result in exposures exceeding regulatory thresholds and adverse health effects.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"651-660"},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132049","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}