Clinical Toxicology最新文献

{"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":"https://doi.org/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":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-02-20","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":"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":"https://doi.org/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 (72%) 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":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","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":"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":"https://doi.org/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":"1-4"},"PeriodicalIF":3.0,"publicationDate":"2025-02-06","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}

{"title":"A pregnant woman with diquat poisoning leading to miscarriage and pontine haematoma.","authors":"Rui-Kai Shang, Qiao-Xin Tian, Xiang-Dong Jian, Hong-Yu Liu, Yu-Ru Liu, Qi-Lu Li","doi":"10.1080/15563650.2025.2454972","DOIUrl":"https://doi.org/10.1080/15563650.2025.2454972","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078697","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":"Does the time between doses in an unintentional double dose bupropion exposure affect the incidence of adverse effects? A retrospective cohort study.","authors":"Michael Keenan, Precious Alabi, Ahmed Alsakha, Jeanna Marraffa, Susan Wojcik, Sarah Burke","doi":"10.1080/15563650.2024.2439019","DOIUrl":"10.1080/15563650.2024.2439019","url":null,"abstract":"<p><strong>Introduction: </strong>Unintentional therapeutic errors with bupropion are common. The impact of the timing of the second dose in a double dose exposure on adverse effects is not well studied. This study aims to compare adverse effects between double doses separated by <720 min and ≥720 min.</p><p><strong>Methods: </strong>This was a retrospective cohort study of unintentional double dose bupropion ingestions in patients reported to a regional poison center between January 2018 and December 2022. Patients were included if the double dose was their own medication, unintentional, and a single substance exposure. Data collected included age, gender, bupropion formulation, prescribed home dose, dosing error details, time between doses, caller site, referral to the emergency department, patient observation at healthcare facilities, clinical effects, and outcome.</p><p><strong>Results: </strong>Among 663 cases screened, 294 met inclusion criteria. The majority involved extended-release preparations (69.0%). Seventy-four were observed in a healthcare facility and monitored for 24 h from initial dose. The incidence of seizures was 5.3%, including one case not observed for a full 24 h. There was no significant difference in the incidence of seizures (2.7% versus 7.7%), tachycardia (27.0% versus 30.8%), hypertension (18.9% versus 38.5%) other signs/symptoms (27.0% versus 23.1%), or any signs/symptoms (48.6% versus 61.5%) between double doses of extended release bupropion separated by <720 min and those separated by ≥720 min, respectively.</p><p><strong>Discussion: </strong>In patients with double dose exposures to extended-release bupropion, it does not appear that the timing of the second dose can be used to risk-stratify patients. Our data are limited by sample size.</p><p><strong>Conclusion: </strong>In this study, the time between double doses of bupropion did not affect the incidence of seizure, tachycardia, hypertension, other signs/symptoms, or any signs/symptoms. Larger, prospective studies investigating this difference would strengthen our understanding and management of these patients.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"127-132"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834342","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":"Extrapyramidal effects in a young child with acute organophosphorus insecticide poisoning.","authors":"Sharon Guy, Kate Webb, Gill Riordan, Cindy Stephen","doi":"10.1080/15563650.2025.2453057","DOIUrl":"10.1080/15563650.2025.2453057","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"151-152"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001238","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":"Abnormalities in brain magnetic resonance imaging associated with vigabatrin therapy in an infant with infantile epileptic spasms syndrome.","authors":"Maria Inês de Sá, Filipa Proença","doi":"10.1080/15563650.2024.2418979","DOIUrl":"10.1080/15563650.2024.2418979","url":null,"abstract":"<p><strong>Introduction: </strong>Vigabatrin, an anticonvulsant drug used for refractory epilepsy and as first-line treatment for infantile epileptic spasms syndrome, can rarely cause brain abnormalities detectable on magnetic resonance imaging. These complications, potentially related to dose, young age, and concomitant high doses of adrenocorticotropic hormone and/or prednisolone, can lead to neurological symptoms. Upon withdrawal or dose reduction, symptoms and imaging changes tend to resolve.</p><p><strong>Case summary: </strong>A 7-month-old infant diagnosed with infantile epileptic spasms syndrome started treatment with vigabatrin and prednisolone. However, spasms recurred, prompting an increase in the dose of vigabatrin and the addition of adrenocorticotropic hormone, which reduced the frequency of spasms. The patient later developed encephalopathy and upper limb tremors.</p><p><strong>Images: </strong>Magnetic resonance imaging revealed symmetrical hyperintense lesions with concomitant restricted diffusion localized in the thalami, basal ganglia, brainstem, and cerebellar dentate nuclei.</p><p><strong>Conclusion: </strong>We report an infant with infantile epileptic spasms syndrome treated with vigabatrin who developed abnormalities on magnetic resonance imaging. There is currently no treatment other than drug withdrawal or reduction.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"137-138"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845929","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":"Human exposures due to animals and exotic pets reported to the poison information centre Erfurt from 2013 to 2022.","authors":"Jennifer Wessling, Dagmar Prasa, Michael Deters","doi":"10.1080/15563650.2024.2445231","DOIUrl":"https://doi.org/10.1080/15563650.2024.2445231","url":null,"abstract":"<p><strong>Introduction: </strong>In Germany, human exposures to animals are rare in comparison to those caused by drugs, chemicals, and plants. We aimed to characterize human exposures to animals and exotic pets, including the age group and sex of the involved person, symptom severity, management, the identity of the individual calling the Poisons Information Centre Erfurt, and the place of exposure.</p><p><strong>Methods: </strong>All human exposures involving animals and exotic pets referred to the Poisons Information Centre Erfurt from 2013 to 2022 were retrospectively analysed.</p><p><strong>Results: </strong>There were 1,799 human exposures to animals between 2013 and 2022, of which 62.8% were symptomatic. Children (<i>n</i> = 655) were involved in 36.4% of cases. The proportion of males (<i>n</i> = 892, 49.6%) exposed to animals was higher than that of females. Exposures to animals increased from 132 in 2013 to 221 in 2022. Between 2013 and 2022, there were 158 exposures to exotic pets, mainly aquatic species (<i>n</i> = 89), of which 63.9% were symptomatic. There were between seven to 22 human exposures to exotic pets per year (mean 15.8 per year). Severe symptoms occurred after exposures to <i>Vipera berus</i> (<i>n</i> = 4) and <i>Crotalus</i> spp. (<i>n</i> = 2). Severe anaphylaxis was observed after stings of <i>Vespa crabro</i> (<i>n</i> = 2), <i>Vespula/Dolichovespula</i> (<i>n</i> = 1), and <i>Insecta</i> spp. unknown (<i>n</i> = 1). A bite of <i>Cheiracanthium</i> spp. (<i>n</i> = 1) resulted in secondary infection. No fatality occurred.</p><p><strong>Discussion: </strong>The low proportion (0.7%) of human exposures to animals (<i>n</i> = 1,799) compared to all human exposures in our study (<i>n</i> = 259,679) can be explained by the lack of highly venomous animals in Germany.</p><p><strong>Conclusions: </strong>Exposures to animals reported to the Poisons Information Centre Erfurt slightly increased from 2013 to 2022, while exposures to exotic pets (mostly aquatic species) stayed at a low level.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 2","pages":"118-126"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440091","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":"Correction.","authors":"","doi":"10.1080/15563650.2024.2430917","DOIUrl":"10.1080/15563650.2024.2430917","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"153"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686263","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":"Forensic pre-hospital deaths related to pentobarbital in the Paris area.","authors":"Léo Dubois, Marc Liautard, Lauriane Charuel, Marjorie Chèze, Bertrand Ludes, Isabelle Fortel, Caroline Rambaud, Charlotte Mayer, Jean-Claude Alvarez, Jérôme Langrand, Dominique Vodovar, Laurène Dufayet","doi":"10.1080/15563650.2024.2435395","DOIUrl":"10.1080/15563650.2024.2435395","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"148-149"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799637","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}