Clinical Toxicology最新文献

{"title":"The relationships of plasma profenofos and ethanol concentrations to clinical outcome in acute profenofos self-poisoning.","authors":"Jeevan Dhanarisi, Michael Eddleston, Klintean Wunnapuk, Indika Gawarammana, Fahim Mohamed","doi":"10.1080/15563650.2024.2437119","DOIUrl":"10.1080/15563650.2024.2437119","url":null,"abstract":"<p><strong>Introduction: </strong>Many patients acutely self-poisoned with organophosphorus insecticides have co-ingested ethanol. Currently, profenofos 50% emulsifiable concentrate (EC50) is commonly ingested for self-harm in Sri Lanka. Clinical experience suggests that ethanol co-ingestion makes management more difficult. Therefore, we aimed to determine the relationships between plasma ethanol concentration, plasma profenofos concentration and its toxicokinetics, and clinical outcome in acute profenofos self-poisoning.</p><p><strong>Methods: </strong>Demographic and clinical data, including a history of ethanol ingestion and blood samples, were prospectively collected from all cases of acute poisoning with profenofos EC50 presenting to Teaching Hospital Peradeniya, Sri Lanka, over four years. Plasma samples were analyzed by gas chromatography-mass spectrometry to quantify the ethanol (<i>n</i> = 99) and profenofos (<i>n</i> = 30 [15 with ethanol, 15 without ethanol]) concentrations. The PKSolver program was used to calculate the toxicokinetic parameters.</p><p><strong>Results: </strong>Of 99 patients (male 78/99) with acute profenofos self-poisoning, 50 reported a history of ethanol co-ingestion. Plasma from 44 of 99 profenofos-poisoned patients had detectable ethanol concentrations. No statistical difference was observed between the mortality in the ethanol group and the no ethanol group (5/44 [11.4%] versus 3/55 [5.5%]; <i>P</i> = 0.461). Similarly, the median half-lives of plasma profenofos absorption in the ethanol and no ethanol groups (0.1 h and 0.1 h, respectively; time 0-24 h) were not statistically different (<i>P</i> = 0.6594). However, the median half-life of plasma profenofos elimination was significantly longer in the ethanol group than the no ethanol group (23.1 h and 9.9 h, respectively; time 0-24 h; <i>P</i> = 0.0002). According to the regression analysis, the half-life of plasma profenofos elimination was longer by 29.4 h in the ethanol group (<i>P</i> = 0.013).</p><p><strong>Discussion: </strong>No significant differences in outcomes, including death and endotracheal intubation rates, were found between those who did and did not co-ingest ethanol. No differences were found in toxicokinetic variables between the ethanol and no ethanol groups, but the ethanol group had a longer elimination half-life.</p><p><strong>Conclusion: </strong>The co-ingestion of ethanol leads to a slowing of the elimination kinetics of profenofos. However, the study did not reveal a significant impact of ethanol co-ingestion on clinical outcomes.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"83-91"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977664","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":"Ethyl chloride poisoning from inhalational misuse: clinical features and outcomes.","authors":"You-Jiang Tan, Shimona Q X Khoo, Youhong Tan","doi":"10.1080/15563650.2024.2424460","DOIUrl":"10.1080/15563650.2024.2424460","url":null,"abstract":"<p><strong>Introduction: </strong>Ethyl chloride misuse remains a prevailing concern due to its accessibility, but detailed descriptions of the features of toxicity are limited to sporadic reports, resulting in knowledge gaps in their clinical features and diagnosis.</p><p><strong>Objective: </strong>To describe the clinical features, treatment, and outcomes of patients reported in the literature who developed toxicity from inhalational use of ethyl chloride.</p><p><strong>Methods: </strong>We reviewed relevant literature over the past 50 years and analyzed the characteristics and outcomes of patients with toxicity from the inhalational use of ethyl chloride.</p><p><strong>Results: </strong>A total of 21 studies from 1979 to 2024 were identified, making available 22 patients for analysis. Their median age was 40 years (range 16-62 years), and there were more than four times as many males as females. Ethyl chloride-containing cleaning solvents (8/22, 36%) were most commonly used. Regular inhalation of ethyl chloride was documented in approximately two-thirds of the patients (14/22, 66%), with a median duration of five months of misuse (range 2-360 months). A large proportion of patients (15/22, 68%) inhaled ethyl chloride again within a week from the onset of toxicity. Although features of cerebellar dysfunction were very common at presentation (13/16, 81%), abnormalities on neuroimaging studies were rare. Death occurred in more than a quarter of cases (6/22, 27%), with patients either already deceased or dying shortly after. Half (3/6) of these deaths were directly attributable to the development of lethal cardiac dysrhythmias. Conversely, most survivors either improved or fully recovered within a few days to weeks (14/16, 88%), independent of their presenting symptoms, clinical signs, and the treatments they received.</p><p><strong>Discussion: </strong>Ethyl chloride users are likely young or middle-aged males, and clinical features of toxicity can range from transient neurological symptoms to cardiac dysrhythmias and death. The prominence of neurotoxicity may be attributed to the lipophilic nature of ethyl chloride and its tendency to accumulate in neural tissue, while cardiac dysrhythmias have been attributed to cardiac sensitization to catecholamines through ethyl chloride-induced inhibition of potassium, calcium, and sodium channels.</p><p><strong>Conclusions: </strong>Toxicity from the inhalational misuse of ethyl chloride should be considered in young or middle-aged males presenting with acute cerebellar dysfunction. We recommend that suspected cases undergo telemetric monitoring for 24 h, especially when tachycardia and/or palpitations are present, as deaths from lethal cardiac dysrhythmias are not uncommon.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"50-56"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726596","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 recent increasing occurrence of etomidate and propoxate/isopropoxate misuse.","authors":"Yee-Ting Cheung, Chun-Wing Yeung, Kelvin Yat-Chung Yu, Choi-Yee Lau, Hok-Fung Tong, Yeow-Kuan Chong","doi":"10.1080/15563650.2024.2423834","DOIUrl":"10.1080/15563650.2024.2423834","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"65-67"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726592","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":"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":"60-62"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","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":"Ethanol for the management of alcohol withdrawal syndrome: a systematic review.","authors":"Darren Quelch, Nyle Davies, Claire McFauld, Arlene Copland, Carol Appleyard, Gareth Roderique-Davies, Sally Bradberry, Bev John","doi":"10.1080/15563650.2024.2422964","DOIUrl":"10.1080/15563650.2024.2422964","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol withdrawal is typically managed using benzodiazepines. However, modulation of both γ-aminobutyric acid-A and N-methyl-d-aspartate-receptors through ethanol provision may provide an alternative management strategy. This systematic review critically analyses the evidence surrounding the use of oral or intravenous ethanol for the management of alcohol withdrawal syndrome.</p><p><strong>Methods: </strong>Systematic searches of ProQuest - American Psychological Association, PsycInfo, MEDLINE and PubMed Central, Web of Science and Embase were performed (Prospero registration number: CRD42023425224). Search criteria were: Population = Patients receiving pharmacological interventions to treat or prevent alcohol withdrawal in a healthcare setting. Intervention = intravenous or enteral ethanol. Comparator = standard care, benzodiazepines, carbamazepine, adjunct medications including sedatives, or no comparator. Outcomes = complication rates, symptom scores, length of stay in healthcare settings. Exclusions were: preclinical studies, participants less than 18 years old, non-peer reviewed literature, poor study design or poor data quality. Study quality was assessed using an adapted National Institute for Health and Care Research quality tool. A narrative data synthesis approach was adopted.</p><p><strong>Results: </strong>Eight thousand two hundred and four studies were retrieved. Ten were included in the final analysis. Overall study quality was poor. Seven studies reported treatment outcomes that were comparable to a control arm or in which ethanol conferred no detrimental effect. Three studies reported positive outcomes, and one study reported worse outcomes following ethanol administration.</p><p><strong>Discussion: </strong>The review identified heterogeneity in study design and limited reporting surrounding patient demographics, patient alcohol use history and the practicalities of ethanol administration. As such, implementation of ethanol prescribing for the management of alcohol withdrawal is currently limited due to the quality and translatability of existing data surrounding its use.</p><p><strong>Conclusions: </strong>Further studies are required with more transparent and complete outcome reporting and practical implementation recommendations in order to facilitate the translation of ethanol prescribing for the management of alcohol withdrawal syndrome.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"37-49"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667460","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 Toxicology Expert Reviewers 2024.","authors":"","doi":"10.1080/15563650.2025.2450934","DOIUrl":"https://doi.org/10.1080/15563650.2025.2450934","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 1","pages":"72-74"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982616","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 opioid use-associated neurotoxicity with cerebellar edema (POUNCE) syndrome.","authors":"Jason Dietz, Samantha S Klein, Rana Biary, Stephen Blumberg, Suzanne Roberts, Asher Bercow, Bernard Goldwasser, Robert S Hoffman","doi":"10.1080/15563650.2024.2435396","DOIUrl":"10.1080/15563650.2024.2435396","url":null,"abstract":"<p><strong>Introduction: </strong>Unfortunately, children are not spared from the devastating effects of the ongoing opioid epidemic. In rare cases, young children exposed to opioids present with unique neuroimaging findings affecting the white matter, reminiscent of what was once seen with diacetylmorphine (heroin)-associated leukoencephalopathy. This constellation of findings is termed the pediatric opioid use-associated neurotoxicity with cerebellar edema (POUNCE) syndrome.</p><p><strong>Case summary: </strong>A 31-month-old child was found floppy and unresponsive. Upon hospital arrival, there was right gaze deviation, shaking of the arms and legs, miosis, and bradypnea. Response to naloxone was incomplete, and methadone was confirmed in the child's urine.</p><p><strong>Images: </strong>Magnetic resonance imaging of the brain performed 24 h after admission showed abnormal T2/FLAIR hyperintensity with associated restricted diffusion symmetrically involving the cerebellar hemispheres.</p><p><strong>Conclusion: </strong>The imaging findings, although far from pathognomonic, should be recognizable by radiologists and toxicologists when considering possible opioid exposure in a young child.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"57-59"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799639","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":"From coma to recovery: removal of amanitin by percutaneous transhepatic bile drainage in severe <i>Amanita subjunquillea</i> mushroom poisoning.","authors":"Xiuying Ma, Jiawei Geng, Junfeng Wang, Liping Huang, Jinbo Luo, Chibin Li, Ling Zhu","doi":"10.1080/15563650.2024.2430312","DOIUrl":"10.1080/15563650.2024.2430312","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"63-64"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766921","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 10-year retrospective review of exposures to volatile nitrites reported to the Victorian Poisons Information Centre.","authors":"James White, Rohan A Elliott","doi":"10.1080/15563650.2024.2423832","DOIUrl":"10.1080/15563650.2024.2423832","url":null,"abstract":"<p><strong>Introduction: </strong>Volatile nitrites, such as amyl nitrite, are used recreationally to enhance sexual experience and provide a feeling of euphoria. They are associated with severe adverse reactions including methaemoglobinaemia and maculopathy. The aim of this study was to explore the epidemiology and clinical effects of volatile nitrite exposures reported to the Victorian Poisons Information Centre in Australia over a 10-year period.</p><p><strong>Methods: </strong>This was a retrospective, observational study of poison centre call records. Data were extracted for all exposures to volatile nitrites reported from 2013 to 2022.</p><p><strong>Results: </strong>There were 132 calls about volatile nitrites, representing 122 exposures, with a more than five-fold increase in the annual number of exposures (from five in 2013 to 26 in 2022). Ingestion (49.2%) and inhalation (27.9%) were the most common routes of exposure. Seventy-six (62.3%) patients reported one or more symptoms related to volatile nitrite exposure. The most common symptoms were light-headedness/dizziness (20.5%), oro-mucosal irritation (15.6%), ocular irritation (14.8%), nasal irritation (12.3%), and nausea/vomiting (9.8%). Less common, but potentially serious, adverse effects included methaemoglobinaemia (4.1%), hypoxia (1.6%) and hypotension (0.8%). Symptom severity was usually classified as minor (70/76, 92.1%) at the time of the poisons centre call. Fifty-four (44.3%) patients were either in the hospital when the poisons centre was contacted or were referred to the hospital by the poisons centre.</p><p><strong>Discussion: </strong>The increase in reported volatile nitrite exposures observed in this study aligns with epidemiological data showing an increase in volatile nitrite usage in Australia. The findings about the nature of exposures and symptoms experienced can be used to inform harm reduction and education efforts for community members and health professionals.</p><p><strong>Conclusions: </strong>Exposures to volatile nitrites reported to an Australian poisons centre increased between 2013 and 2022. More than 40% of exposures resulted in a hospital presentation. Methaemoglobinaemia was reported in 4.1% of cases.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"32-36"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615697","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":"After the bite: evaluating a specialized clinic for follow-up care for snake envenomation.","authors":"William Rushton, Erin Ryan, Jessica Rivera, Matthew Kelly, Sukhshant Atti, Stacy Marshall, Dag Shapshak","doi":"10.1080/15563650.2024.2425068","DOIUrl":"10.1080/15563650.2024.2425068","url":null,"abstract":"<p><strong>Introduction: </strong>Pit viper envenomation causes tissue damage that can persist for weeks to months despite antivenom. Many patients do not receive post-discharge care beyond testing for late coagulopathy and primary care follow-up. The aim of this report is to describe a snake envenomation patient cohort, complications, and management strategies after three years of operation of a specialized outpatient clinic offering post-discharge evaluation and wound care therapy.</p><p><strong>Methods: </strong>This was an observational study of patients treated in a newly established snakebite follow-up clinic from June 1, 2021 to November 30, 2023. Patient demographics, snake species, and hospital course were abstracted from poison center records. Persistent symptoms upon clinic evaluation were recorded as well as the therapies prescribed by the clinic wound care physicians.</p><p><strong>Results: </strong>Of the 465 snake envenomations reported to the state poison center, 52 patients presented to the clinic. The median patient age was 29 years (range 5-88 years), and the majority (65.4%) were male. Antivenom was given during hospitalization in 92.3% of cases. <i>Agkistrodon</i> spp. envenomations (including <i>Agkistrodon contortrix</i> and <i>Agkistrodon piscivorus)</i> were most common (<i>n</i> = 33) with a smaller number of <i>Crotalus horridus</i> (<i>n</i> = 7) and 12 unidentified pit viper envenomations. Persistent edema (61.5%) and bullae (38.5%) were common at follow-up. Interventions provided included compression (38.5%), physical therapy referral (32.7%), tissue debridement (9.6%), and antibiotics (5.8%). Rates of edema and bullae were numerically higher in patients envenomated by <i>Agkistrodon</i> spp. compared to those envenomated by <i>Crotalus horridus.</i></p><p><strong>Discussion: </strong>In this primarily <i>Agkistrodon</i> spp.-envenomated cohort, persistent edema, wounds, and functional limitations were common in the post-discharge period. Our outpatient snake envenomation clinic leveraged the expertise of wound care physicians and the public health reach of the state poison center to address the significant morbidity seen on follow-up and provide interventions to facilitate recovery.</p><p><strong>Conclusion: </strong>This snake envenomation wound care clinic addressed a neglected aspect of pit viper envenomation by providing post-discharge management of enduring tissue damage and other complications.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"16-22"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726594","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}