Clinical Toxicology最新文献

{"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}

{"title":"Characterization of hypofibrinogenemia following rattlesnake envenomation treated with crotalidae immune F(ab')₂ (equine) antivenom.","authors":"Thom S Maciulewicz, David R Axon, Farshad Mazda Shirazi","doi":"10.1080/15563650.2024.2406427","DOIUrl":"10.1080/15563650.2024.2406427","url":null,"abstract":"<p><strong>Introduction: </strong>Hemotoxicity is common following rattlesnake envenomation. Published experiences with equine-derived crotalidae immune F(ab')₂ antivenom have characterized hemotoxicity as delayed, recurrent, or persistent. This study investigated recovery of hypofibrinogenemia following rattlesnake envenomation treated with equine-derived crotalidae immune F(ab')₂ antivenom.</p><p><strong>Methods: </strong>This is a retrospective analysis of human rattlesnake envenomations reported to the Arizona Poison and Drug Information Center over four years. We included rattlesnake-envenomated patients who developed hypofibrinogenemia (<1,500 mg/L) and were treated with equine-derived crotalidae immune F(ab')₂ antivenom. The primary outcomes were recovery period (h) and recovery rate (mg/L/h) of hypofibrinogenemia following equine-derived crotalidae immune F(ab')₂ antivenom administration. Collected data included demographics, laboratory values, and antivenom administered. Statistics used were percentages, medians, and Kruskall-Wallis test.</p><p><strong>Results: </strong>There were 527 rattlesnake envenomations treated with antivenom, of which 80 met the inclusion criteria. Patients receiving treatment with F(ab')₂ antivenom and had a median fibrinogen concentration recovery rate of 62.3 mg/L/h (IQR: 42.0-74.3 mg/L/h) and median recovery period of 19.2 h (IQR: 13.8-26.2 h). There were statistically significant differences between categories for time to antivenom for the median recovery period (<i>P</i> = 0.0154).</p><p><strong>Discussion: </strong>Hypofibrinogenemia is a common laboratory finding following rattlesnake envenomation in Arizona. This study investigated rattlesnake envenomated patients treated with F(ab')₂ antivenom and monitored fibrinogen concentrations as a surrogate marker of venom toxicity. Additionally, time to administration of F(ab')₂ antivenom was a statistical significant marker of the recovery period from hypofibrinogenemia. Limitations of this study included the geographic coverage of the poison center and exclusion of patients with insufficient laboratory monitoring or those who received another antivenom.</p><p><strong>Conclusions: </strong>Following rattlesnake envenomation in Arizona, recovery from hypofibrinogenemia was able characterized in a rate (mg/L/h) and period (h) with the quantity and time to administration of antivenom. More studies are needed to assess this finding with other antivenoms and its clinical significance.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"749-753"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342900","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":"An outbreak of <i>Galerina sulciceps</i>-like (Galerina cf. sulciceps) mushroom poisoning.","authors":"Mengxia Cao, Shan Luo, Ting Kang, Santao Ou","doi":"10.1080/15563650.2024.2402501","DOIUrl":"10.1080/15563650.2024.2402501","url":null,"abstract":"<p><strong>Objective: </strong>Amatoxin-containing mushroom poisoning is a significant threat to public health worldwide. We report a mass poisoning of <i>Galerina sulciceps</i>-like mushrooms (Galerina cf. sulciceps) in Luzhou, Sichuan Province, China, aiming to offer insights for future prevention and treatment strategies.</p><p><strong>Methods: </strong>We performed a retrospective survey of mass mushroom poisoning patients admitted to our hospital. The demographic data, clinical presentations, laboratory findings, therapeutic measures and prognostic information were collected and analyzed. We used the 2020 Chinese consensus on the clinical diagnosis and treatment of amatoxin-containing mushroom poisoning to assess the severity of poisoning. Mushrooms were examined through morphological analysis, molecular biology identification, and toxin detection.</p><p><strong>Results: </strong>Our patient cohort consisted of nine males and six females, with mean (±SD) age of 34.9 ± 13.0 years. Gastrointestinal symptoms were the first to manifest, with mean (±SD) latency period of 13.4 ± 3.9 h. The majority of patients (86.7%) experienced nausea, vomiting, and diarrhea. Liver dysfunction was noted in 66.7% of patients, and thrombocytopenia was present in 26.7% of patients. In terms of the severity of poisoning, there were 10 mild cases and five severe cases. The mushrooms were provisionally labeled as <i>Galerina cf. sulciceps</i>, containing the toxins α-amanitin, β-amanitin, and γ-amanitin. All patients eventually recovered.</p><p><strong>Discussion: </strong>We report what appears to be a new type of mushroom that is morphologically and phylogenetically similar to the known <i>Galerina sulciceps</i>, but further study is required to determine if it represents a distinct species.</p><p><strong>Conclusion: </strong>This poisoning event was caused by unintentional ingestion of <i>Galerina cf. sulciceps</i>, an amatoxin-containing mushroom. Early symptoms are primarily gastrointestinal, with acute liver damage and coagulopathy being the main toxic effects. Thrombocytopenia is also prominent, particularly in severe cases. Accurate assessment and prompt, individualized, and intensive treatment are crucial for managing patients with acute <i>Galerina cf. sulciceps</i> poisoning effectively.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"707-713"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281412","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":"Corrections.","authors":"","doi":"10.1080/15563650.2024.2415238","DOIUrl":"10.1080/15563650.2024.2415238","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"786"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459652","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 trajectory of serum salicylate concentrations after ingestion of medicinal oil containing methyl salicylate.","authors":"Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Anthony T Y Chow, Esther W Y Chan, Timothy Hudson Rainer","doi":"10.1080/15563650.2024.2409826","DOIUrl":"10.1080/15563650.2024.2409826","url":null,"abstract":"<p><strong>Introduction: </strong>The toxicokinetics of methyl salicylate after unintentional or intentional ingestion of medicinal oil containing methyl salicylate has not been well studied. We aimed to characterize the trajectory of serum salicylate concentrations and to evaluate factors associated with the peak serum salicylate concentration and the time from ingestion to peak concentration.</p><p><strong>Methods: </strong>This was a retrospective cohort study of consecutive patients reported to the Hong Kong Poison Control Centre for laboratory-confirmed methyl salicylate poisoning by all local public emergency departments between 1 July 2008 and 30 June 2023. We analyzed cases with at least three serum salicylate concentrations. Multivariable generalized linear regression was used to identify factors significantly associated with the peak serum concentration and the time from ingestion to peak concentration.</p><p><strong>Results: </strong>We included 41 patients (median age 81.0 years; 32 women and nine men). The median time from ingestion to the first peak serum salicylate concentration was 5.6 h (IQR: 3.2-10.8 h). Multiple regression showed that gastric aspiration (adjusted regression coefficient [β] - 2.50; 95% CI: -3.93 to -1.08; <i>P</i> = 0.001) and single-dose activated charcoal (adjusted β - 1.22; 95% CI: -2.02 to -0.42; <i>P</i> = 0.003) were significantly associated with a lower peak concentration, after adjusting for patient age, sex, exposure due to intentional self-harm, reported ingested dose, time from ingestion to emergency department presentation, vomiting, concurrent use of aspirin (acetylsalicylic acid) and other medications that affect gastric emptying or gastric acid secretion, blood pH, serum albumin concentration, and creatinine clearance.</p><p><strong>Discussion: </strong>The serum salicylate concentration did not peak as quickly as generally believed, highlighting the importance of continued monitoring. Gastric aspiration and single-dose activated charcoal may help reduce gastrointestinal absorption, but their impact on clinical outcomes remains unclear.</p><p><strong>Conclusions: </strong>Given the median time of 5.6 h (IQR: 3.2-10.8 h) from ingestion to the peak salicylate concentration, gastric aspiration and single-dose activated charcoal can be considered in patients up to a few hours after medicinal oil ingestion when the airway is protected.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"733-742"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459655","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":"An unexpected place for a fentanyl patch.","authors":"Marianne E C Leenders, Corine C Visser, Dylan W de Lange","doi":"10.1080/15563650.2024.2407056","DOIUrl":"10.1080/15563650.2024.2407056","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"782-783"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342888","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":"10.1080/15563650.2024.2412421","DOIUrl":"10.1080/15563650.2024.2412421","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"785"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388606","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":"Carbon monoxide poisoning is associated with an increased risk of epilepsy and status epilepticus: a nationwide population-based cohort study conducted in the Republic of Korea between 2002-2021.","authors":"Heewon Hwang, Solam Lee, Kyung Min Kim, Yong Sung Cha","doi":"10.1080/15563650.2024.2418138","DOIUrl":"10.1080/15563650.2024.2418138","url":null,"abstract":"<p><strong>Introduction: </strong>Carbon monoxide poisoning may result in various neurological injuries, including acute symptomatic seizures. We aimed to investigate the long-term risk of epilepsy and status epilepticus in patients with previous carbon monoxide poisoning.</p><p><strong>Methods: </strong>The study population was derived from the National Health Insurance Service database of the Republic of Korea between 1 January 2002 and 31 December 2021. We included adults with at least one documented visit to medical facilities because of carbon monoxide poisoning (International Classification of Diseases, Tenth Revision, code T58). Patients were matched, on the same index date, with controls, without a T58 code, for age, sex, insurance type, income level, and residence location in a 1:1 ratio. Follow-up continued until death, migration, or the end of the observation period (31 December 2021). The primary outcome was the incidence of epilepsy (codes G40 or R56) and status epilepticus (code G41).</p><p><strong>Results: </strong>This study included 53,380 patients with carbon monoxide poisoning and 53,380 controls, with 44.2% women and a mean age of 45.7 years. The mean (±SD) follow-up period was 5.7 ± 4.3 years in the carbon monoxide poisoned group and 6.4 ± 4.4 years in controls. The overall risk of epilepsy (adjusted hazard ratio 2.60; 95% CI: 2.43-2.78; <i>P</i> <0.001) and status epilepticus (adjusted hazard ratio 4.10; 95% CI: 2.84-5.92; <i>P</i> <0.001) was significantly increased in the carbon monoxide poisoned group compared to controls. The risk of epilepsy and status epilepticus was increased in patients with previous carbon monoxide poisoning, regardless of sex, age or a history of stroke, neurodegenerative diseases, or central nervous system tumour or infection. However, in the subgroup analysis according to age, the highest risk of epilepsy and status epilepticus was observed in patients less than 40 years of age.</p><p><strong>Discussion: </strong>In this population-based cohort study, previous carbon monoxide poisoning was associated with an increased risk of epilepsy and status epilepticus. The risk was more noticeable in patients aged less than 40 years. Further studies are needed to confirm such an association in other populations.</p><p><strong>Conclusions: </strong>Previous carbon monoxide poisoning was associated with an increased risk of epilepsy and status epilepticus, particularly in the younger population. The long-term management of survivors of carbon monoxide poisoning should include monitoring for epilepsy and status epilepticus.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"686-692"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521207","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":"Identifying and quantifying exposures involving counterfeit opioid analgesic products.","authors":"Nancy A West, Gabrielle E Bau, Heather Olsen, Hannah L Burkett, Geoffrey Severtson, Brooke Kritikos, Amanda Rogers, Richard C Dart, Joshua C Black","doi":"10.1080/15563650.2024.2408360","DOIUrl":"10.1080/15563650.2024.2408360","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing presence of counterfeit opioid drugs in the United States can contaminate data collection systems and confound estimates derived from surveillance of the opioid epidemic. Data sources and analyses that can quantify the contribution of counterfeit opioid products are needed to provide accurate and timely data to inform public health responses. We describe a novel approach to identify and quantify intentional abuse and misuse exposures involving suspected counterfeit opioid products in United States poison center data.</p><p><strong>Methods: </strong>An ecological study was performed using data, including narrative case notes, reported to participating United States Poison Centers of the Researched Abuse, Diversion and Addiction Related Surveillance System between 2009-Quarter 1 and 2021-Quarter 4. A machine learning natural language processing approach was used to develop a predictive model.</p><p><strong>Results: </strong>Sensitivity for detecting suspected non-counterfeit-involved exposures by the predictive model was 92%, specificity was 73%, and the area under the receiver operating characteristic curve was 92%. Overall, only 2.1% of intentional abuse and misuse exposure calls were predicted to be suspected counterfeit-involved during 2009-2021; however, we observed an exponential increase in suspected counterfeit exposures over this time period. There was a 7-fold increase in the estimated number of suspected counterfeit exposures from 2009 to 2021, and 23.7% of all opioid analgesic intentional abuse and misuse exposures were suspected counterfeit-involved in 2021.</p><p><strong>Discussion: </strong>We demonstrate the feasibility and reliability of using machine learning natural language processing to identify exposures involving suspected counterfeit opioid products in United States poison center data. Results suggest that suspected counterfeits have had a meaningful influence on rates of intentional abuse exposures to opioid analgesics in more recent years.</p><p><strong>Conclusions: </strong>The increasing presence of counterfeit opioid drugs can contaminate data collection systems and compromise the reliability of the data.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"743-748"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459653","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}