Clinical Toxicology最新文献

{"title":"Why so blue? A novel presentation of methaemoglobinaemia secondary to an inhaled occupational nitric acid exposure.","authors":"James M Colalillo, Kirsty Skinner","doi":"10.1080/15563650.2024.2440547","DOIUrl":"https://doi.org/10.1080/15563650.2024.2440547","url":null,"abstract":"<p><strong>Introduction: </strong>Nitric and hydrofluoric acids are commonly used in the commercial cleaning industry. We are unaware of reports of nitric acid inhalation forming methaemoglobin. Additionally, methaemoglobinaemia and treatment with methylthioninium chloride (methylene blue) may precipitate clinical uncertainty due to similar wavelengths of absorbance in pulse oximetry.</p><p><strong>Cases: </strong>We report two patients with respiratory distress from symptomatic methaemoglobinaemia following a prolonged, inhaled occupational exposure to nitric acid in the context of industrial cleaning. Their methaemoglobinaemia was successfully treated with methylthioninium chloride, per remote toxicology advice. However transient oxygen desaturation as reported by pulse oximetry resulted in concern from the treating team.</p><p><strong>Discussion: </strong>The liberation of oxides of nitrogen from nitric acid bypasses the upper airway without irritation and dissolves in the mucoid lower respiratory tract, oxidising haemoglobin to methaemoglobin. Prolonged undetected exposure with filter saturation, and impaired ventilation is the proposed cause of methaemoglobinaemia in the cases presented. Additionally, methylthioninium chloride absorbs light at the 660 nm wavelength interfering with pulse oximeter interpretation, precipitating the appearance of rapid, severe oxygen desaturation.</p><p><strong>Conclusion: </strong>Lack of upper airway irritation can lead to unrecognised prolonged nitric acid fume exposure causing methaemoglobinaemia. Remote toxicology advice should include pulse oximeter interference expectations in the presence of methaemoglobinaemia and when administering methylthioninium chloride.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846049","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":"https://doi.org/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":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","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":"Refractory methemoglobinemia after ingestion of <i>N,N</i>-dimethyl-<i>p</i>-toluidine.","authors":"Chih-Yang Mao, Yen-Syuan Liao, Te-I Weng, Hsien-Yi Chen","doi":"10.1080/15563650.2024.2439566","DOIUrl":"https://doi.org/10.1080/15563650.2024.2439566","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834344","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":"Pediatric exposure to illicit fentanyl is associated with drug availability in the community.","authors":"Robert G Hendrickson, Amber L Lin, Courtney Temple","doi":"10.1080/15563650.2024.2438271","DOIUrl":"https://doi.org/10.1080/15563650.2024.2438271","url":null,"abstract":"<p><strong>Introduction: </strong>Fentanyl has replaced diacetylmorphine (heroin) as the primary illicit opioid in the United States. Over the last several years, exposures to illicit fentanyl in small children have increased nationally. We hypothesized that the increase in illicit fentanyl in the community, as measured by regional drug seizures, would be associated with the number of pediatric exposures to illicit fentanyl.</p><p><strong>Methods: </strong>To assess the number of pediatric illicit fentanyl exposures, we searched the regional poison center database for human exposures in children under 6 years old from January 1, 2019-December 31, 2023. We searched for all cases with fentanyl in the substance field and excluded cases that identified prescription fentanyl in the substance code, product code, or had an exposure reason not consistent with illicit fentanyl. We quantified illicit fentanyl drug seizures in our state by using the Drug Enforcement Administration data. We used Poisson regression to assess the association between drug availability in the community (drug seizures) and pediatric fentanyl exposures.</p><p><strong>Results: </strong>Between 2019 and 2023, there was an increase in both illicit fentanyl drug seizures (from 11.7 kg/year to 177 kg/year) and pediatric fentanyl exposures (from zero to 16), and there was a significant association (incident rate ratio 1.90; 95% CI: 1.50-2.53; <i>P</i> <0.001) between these rates.</p><p><strong>Discussion: </strong>We report a strong association between drug availability in the community and pediatric exposures, suggesting that drug seizure data may be a valuable tool for poison centers, medical toxicologists, and public health officials.</p><p><strong>Conclusions: </strong>Our data suggest that monitoring regional drug seizure data may be a tool to determine new trends in pediatric exposure, guide research in the area, and target outreach and education.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806331","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":"https://doi.org/10.1080/15563650.2024.2435395","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-12-09","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}

{"title":"Electrocardiographic changes in severe quetiapine poisoning.","authors":"Fumiya Inoue, Yuji Okazaki, Toshihisa Ichiba, Takuyo Chiba, Akira Namera","doi":"10.1080/15563650.2024.2436618","DOIUrl":"https://doi.org/10.1080/15563650.2024.2436618","url":null,"abstract":"<p><strong>Introduction: </strong>Quetiapine shares sodium channel-blocking properties with tricyclic antidepressants. We present the electrographic findings in two patients with severe quetiapine poisoning.</p><p><strong>Case summaries: </strong>Two patients poisoned with quetiapine presented with impaired consciousness, requiring mechanical ventilation and vasopressor support, with one also experiencing status epilepticus. Their peak serum quetiapine concentrations were 4.52 mg/L and 25.6 mg/L.</p><p><strong>Images: </strong>On admission, electrocardiograms for both patients revealed a tall R wave in lead aVR, deep S wave in lead I, and QRS complex duration of 120 ms. These findings gradually resolved in parallel with the improvement in their symptoms.</p><p><strong>Conclusion: </strong>Severe quetiapine poisoning may cause electrographic changes. Further studies are needed to determine the utility of these electrocardiogram findings for predicting the severity of quetiapine poisoning.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799555","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":"Development of squamous cell carcinoma at the bite sites several years following suspected cobra (<i>Naja naja</i>) envenomings.","authors":"Subramanian Senthilkumaran, José R Almeida, Jarred Williams, Harry F Williams, Ponniah Thirumalaikolundusubramanian, Sakthivel Vaiyapuri","doi":"10.1080/15563650.2024.2432407","DOIUrl":"https://doi.org/10.1080/15563650.2024.2432407","url":null,"abstract":"<p><strong>Introduction: </strong>Snakebite envenoming is a multidimensional issue that causes severe functional and life-challenging consequences among rural communities in tropical countries. Current research and treatments are largely focused on the acute effects of envenomation and short-term health outcomes. The knowledge of snakebite-induced long-term consequences is highly limited.</p><p><strong>Case series: </strong>We report the development of squamous cell carcinoma at the bite site several years later in four patients who are suspected to have been bitten by cobras (<i>Naja naja</i>). Following bites, the victims presented typical symptoms of cobra envenomings including ptosis, altered sensorium, and breathing difficulties. However, difficult-to-heal wounds were a chronic health sequelae with frequent desquamation cycles which led to squamous cell carcinoma. Surgery as the primary therapeutic approach was used for all patients to address this issue.</p><p><strong>Discussion: </strong>These patients highlight the importance of squamous cell carcinoma in previously damaged tissue from snakebites as a possible long-term consequence. This emphasises the need for surveillance systems focused on a broad range of snakebite-induced consequences including long-term pathological, psychological, and socioeconomic conditions.</p><p><strong>Conclusion: </strong>This case series describes pathological complications following cobra bites that require further research to determine mechanistic and epidemiological insights in the most affected regions by snakebites, specifically in India.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766920","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":"2023 Annual Report of the National Poison Data System® (NPDS) from America's Poison Centers®: 41st Annual Report.","authors":"David D Gummin, James B Mowry, Michael C Beuhler, Daniel A Spyker, Laura J Rivers, Ryan Feldman, Kaitlyn Brown, Nathaniel P T Pham, Alvin C Bronstein, Carol DesLauriers","doi":"10.1080/15563650.2024.2412423","DOIUrl":"10.1080/15563650.2024.2412423","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This is the 41&lt;sup&gt;st&lt;/sup&gt; Annual Report of America's Poison Centers® National Poison Data System®. As of 1 January, 2023, all 55 of the nation's poison centers uploaded case data automatically to NPDS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed the case data, tabulating specific indices from the NPDS®. The methodology was as in previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologists using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality of the exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 2023, 2,421,251 closed encounters were logged by the National Poison Data System®: 2,080,659 human exposures, 41,857 animal exposures, 293,663 information requests, 5,046 human confirmed nonexposures, and 26 animal confirmed nonexposures. The upload interval was 4.88 [4.43, 9.33] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system. Total encounters showed a 2.49% decrease from 2022 while human exposure cases increased by 0.764% and health care facility human exposure cases increased by 2.38%. All information requests decreased by 19.1%, medication identification (Drug ID) requests decreased by 14.0%, and medical information requests showed a 61.3% decrease, returning to pre-COVID-19 pandemic numbers. Drug Information requests showed a 17.6% decrease, due to continued declining COVID-19 vaccine calls to poison centers, but these still comprised 21.7% of all information contacts. Human exposures with less serious outcomes have decreased by 1.58% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased by 4.25% per year since 2000.Consistent with the previous year, the top 4 substance classes most frequently involved in all human exposures were analgesics (11.00%), household cleaning substances (7.12%), antidepressants (5.58%), and cosmetics/personal care products (5.01%). Cardiovascular drugs (4.97%) replaced antihistamines as the 5&lt;sup&gt;th&lt;/sup&gt; most common substance class. As a class, analgesic exposures increased most rapidly, by 1,260 cases/year (2.72%/year) over the past 10 years for cases with more serious outcomes.The top 5 most common exposures in children aged 5 years or less were household cleaning substances (10.1%), analgesics (9.13%), cosmetics/personal care products (9.10%), foreign bodies/toys/miscellaneous (8.03%), and dietary supplements/herbals/homeopathic (6.88%). The National Poison Data System® documented 3,272 human exposures resulting in death; 2,700 (82.5%) of these were judged as related (Relative Contribution to Fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;These data support the continued value of poison center expertise and the need for specialized medical toxicology informa","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"793-1027"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834340","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":"National Poison Data System^® Annual Report: under the hood.","authors":"James B Mowry","doi":"10.1080/15563650.2024.2429442","DOIUrl":"https://doi.org/10.1080/15563650.2024.2429442","url":null,"abstract":"<p><strong>Introduction: </strong>The 41st National Poison Data System^® Annual Report from America's Poison Centers^® is published in this issue of <i>Clinical Toxicology.</i> This Commentary focuses on comparing the different poisoning-related surveillance systems in the United States while highlighting some of the strengths and weaknesses of the National Poison Data System^®. It also reviews the process underlying the fatality review section of the Annual Report.</p><p><strong>Comparison of poisoning surveillance systems: </strong>In order to place the data reported by the National Poison Data System^® in context, the National Poison Data System^® was compared to other available poisoning surveillance systems in the United States: the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, the Centers for Disease Control and Prevention Injury Prevention and Control Web-based Injury Statistics Query and Reporting System (WISQARS^™) which partners with the Consumer Products Safety Commission's National Electronic Injury Surveillance System - All Injury Program (NEISS-AIP), and the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database. Differences exist in the scope and focus of these databases, including the underlying population base and sources of reporting, use of statistical sampling, type of medical outcomes reported, type and number of products/substances reportable, granularity of product/substances reported, case volumes, timeliness of reporting and surveillance activities.</p><p><strong>National poison data system fatality review process: </strong>The National Poison Data System^® mortality data may vary from data collected by other sources but has some characteristics that render it unique, including the publication of narratives of selected fatalities. Each direct death undergoes a rigorous review by medical and clinical toxicologists at the regional poison center and by America's Poison Centers^® Fatality Review Committee. This review process is outlined in detail and compared to other poisoning mortality reporting systems.</p><p><strong>Conclusion: </strong>National Poison Data System^® data from poison centers in the United States provide a unique perspective of the epidemiology of poisoning that is distinct but complementary to other poisoning surveillance systems in the United States. The National Poison Data System^® conducts a rigorous fatality review process that incorporates a variety of inputs that provide additional verification of the poisoning fatalities reported to it. The availability of and routine publication of fatality narratives is a unique feature of the National Poison Data System^®.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"62 12","pages":"787-792"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881406","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":"https://doi.org/10.1080/15563650.2024.2430917","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1"},"PeriodicalIF":3.0,"publicationDate":"2024-11-22","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}