Journal of Medical Toxicology最新文献

{"title":"Articles You Might Have Missed.","authors":"Abigail Olinde","doi":"10.1007/s13181-026-01162-4","DOIUrl":"https://doi.org/10.1007/s13181-026-01162-4","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metal Chelation Following Inappropriate Testing: Approach to Non-Medically Indicated Therapy Requests : Ethics in Practice.","authors":"Neeraj Chhabra, Sean McCann","doi":"10.1007/s13181-026-01149-1","DOIUrl":"10.1007/s13181-026-01149-1","url":null,"abstract":"<p><p>Requests for chelation therapy following inappropriate or scientifically unsound testing in medical toxicology practice raise important ethical tensions between patient autonomy, professional integrity, and the therapeutic relationship. The central tension is how medical toxicologists should respond when patients strongly request non-medically indicated therapies that lack evidence of benefit and carry potential risk. We argue that while respect for patient autonomy requires earnest engagement with patient concerns, it does not obligate physicians to provide therapies they believe are scientifically unsupported or potentially harmful. Ethical care in these situations requires balancing patient autonomy with nonmaleficence and responsibilities to preserve professional integrity and public trust. Patients pursuing alternative therapies are sometimes motivated by prior experiences of dismissal, unresolved symptoms, and distrust of conventional medicine. Reflexive refusal or adversarial communication may further erode trust and increase the likelihood of patients pursuing unsafe therapies elsewhere. We propose that medical toxicologists should approach these encounters with transparent communication, acknowledgment of medical uncertainty and patient suffering, and continued therapeutic engagement even when declining requested treatment. Maintaining a therapeutic alliance while avoiding non-indicated interventions is challenging in practice but promotes long-term patient health and preserves trust, both between physician and patient and between the public and profession of medical toxicology.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"498-500"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review and Meta-Analysis of Lipid Emulsion for Non-Local Anesthetic Poisoning.","authors":"Zhengxin Tang, Megan Zhao, Alexandra Barabanova, Quincy McCrary, Michael R Fettiplace","doi":"10.1007/s13181-026-01151-7","DOIUrl":"10.1007/s13181-026-01151-7","url":null,"abstract":"<p><strong>Introduction: </strong>Practitioners routinely use intravenous lipid emulsion for local anesthetic systemic toxicity, but its role in non-local anesthetic poisonings remains unclear. We conducted a systematic review and meta-analysis comparing lipid emulsion with standard care for non-local anesthetic toxicities.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Scopus and Web of Science from January 1st 2010 until March 16th 2026 for human randomized controlled trials evaluating lipid emulsion for non-local anesthetic poisoning. Volunteer studies and pediatric-only studies were excluded. The primary outcome was intensive care unit admission (with intubation as a surrogate for unit-level needs). Secondary outcomes included mortality, seizures, and hospital length of admission. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random-effect meta-analysis was conducted. Heterogeneity was analyzed using Cochran's Q and I².</p><p><strong>Results: </strong>Twelve studies with 816 patients were included, predominantly using 20% SMOFlipid® 280 - 500 mL. Lipid emulsion reduced intensive care unit admission compared to standard care (RR=0.70; 95% CI: [0.53, 0.93], 8 studies, n=369) with moderate heterogeneity (Q=9.43, p=0.02; I²=32.12%). Lipid emulsion also reduced mortality (RR=0.65; 95% CI: [0.53, 0.80]) and length of admission (Mean diff. =-34.16; 95% CI: [-42.29,-26.02]). Seizure incidence was lowered but not significantly (RR=0.27; 95% CI [0.06, 1.26]).</p><p><strong>Discussion: </strong>Intravenous lipid emulsion is associated with reduced intensive care unit admission and mortality for aluminum phosphide and organophosphate poisonings and a reduced length of admission for aluminum phosphide, organophosphate, and antipsychotic poisonings. The evidence is limited by study heterogeneity and study quality. Larger, high-quality trials are needed to confirm benefit.</p><p><strong>Registration number: </strong>CRD42025645519.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"461-471"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Medication Errors in the Non-Healthcare Facility Setting Associated with Hospital Admission, 2000-2024.","authors":"Srija Nuguri, Sandhya Kistamgari, Hannah L Hays, Natalie I Rine, Nichole L Michaels, Motao Zhu, Gary A Smith","doi":"10.1007/s13181-026-01158-0","DOIUrl":"10.1007/s13181-026-01158-0","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated the characteristics and trends of therapeutic medication errors reported to United States (US) poison centers that occurred in a non-healthcare facility setting and were associated with hospital admission.</p><p><strong>Methods: </strong>Using a retrospective cohort design, National Poison Data System data from 2000 to 2024 were analyzed. US Census Bureau data were used to calculate population-based rates.</p><p><strong>Results: </strong>There were 115,071 therapeutic medication errors that occurred in a non-healthcare facility setting and were associated with hospital admission reported to US poison centers from 2000 to 2024. Most involved females (55.5%), individuals > 49 years old (56.9%), a single substance (71.5%), or occurred in a residence (96.0%). In addition, 39.0% were admitted to a critical care unit and 53.3% were associated with a serious medical outcome, including moderate effects (45.4%), major effects (7.2%), or death (0.7%, n = 745). Cardiovascular drugs (24.7%), analgesics (18.2%), and antidepressants (11.3%) were most commonly involved. The overall hospitalized therapeutic medication error rate per one million US population increased by 196.9% from 7.06 in 2000 to 20.97 in 2024; the rate was highest among adults > 69 years old, females, and errors involving cardiovascular drugs. Of the 115,009 exposures in which at least one therapeutic medication error scenario was reported, the most common scenarios were \"other incorrect dose\" (23.6%), \"wrong medication taken/given\" (16.7%), and \"inadvertently took/given medication twice\" (13.9%).</p><p><strong>Conclusions: </strong>These study findings highlight opportunities to strengthen prevention efforts targeting therapeutic medication errors, particularly among older adults and individuals using cardiovascular medications, which could meaningfully decrease associated morbidity, mortality, and healthcare costs.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"430-440"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Trends in Early Childhood Lead Exposure Using the National Poison Data System: 2007-2024.","authors":"Joseph Meyer Ebersole, Thao-Phuong Christy Hallett, Stephanie Kieszak, Amy Helene Schnall, Michael Yeh","doi":"10.1007/s13181-026-01152-6","DOIUrl":"10.1007/s13181-026-01152-6","url":null,"abstract":"<p><strong>Introduction: </strong>Lead is an important public health problem in the U.S., as blood lead concentrations have been linked to decreases in IQ in otherwise asymptomatic children. The role of poison centers (PCs) in childhood lead exposures has yet to be described. We sought to characterize lead exposures reported to U.S. poison centers for infants, toddlers, and preschool-age children (≤ 5 years) from 2007 to 2024.</p><p><strong>Methods: </strong>Retrospective data collection and descriptive analyses were performed for childhood lead exposures occurring in the United States reported to the National Poison Data System (NPDS) between 2007 and 2024 among children aged 0-5 years. Descriptive analyses were performed to examine demographic characteristics, exposure characteristics, treatments, and medical outcomes associated with lead exposures.</p><p><strong>Results: </strong>There were a total of 20,009 lead exposure cases reported in NPDS between 2007 and 2024. Lead exposures decreased from 1,798 cases reported in 2007 to 914 in 2020. Since 2020, lead exposures increased to 1,390 cases reported in 2024. Specific substances or sources of lead were not identified or described in most cases (17,846, 89.2%). In cases where specific sources of concern were identified (2,163, 10.8%), common sources reported include fishing sinkers (577, 26.7%), lead pellets (547, 25.3%), magazine print (533, 24.6%), and aquarium thermometers (324, 15.0%). Among patients followed to a known medical outcome, few experienced moderate (516, 2.6%), or major (57, 0.3%) effects, and there were no recorded deaths.</p><p><strong>Conclusions: </strong>Lead exposure cases reported to NPDS in early childhood declined overall from 2007 to 2020 but have been increasing since 2020. In most cases, no specific substance of concern was identified. Additionally, few cases reported to poison centers experienced severe outcomes. Children aged 1-2 years accounted for the majority of cases in the National Poison Data System. Reasons may include increased mobility and exploration, hand-to-mouth behaviors, and efficient lead absorption in this age range. Other factors such as mandated lead testing at ages 12 and 24 months for children enrolled in Medicaid might also contribute to the observed age distribution.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"441-447"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting Mitochondrial Dysfunction in Acute Organophosphate Toxicity: A Preliminary Evaluation of Cyclosporine A.","authors":"David H Jang, Jarelis Cabrera, Jonathan Starr, Abigail Insana, Angela N Viaene, John C Greenwood, Frances S Shofer, Johannes K Ehinger, Shih-Han Kao, Todd J Kilbaugh","doi":"10.1007/s13181-026-01144-6","DOIUrl":"10.1007/s13181-026-01144-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Organophosphate (OP) compounds are widely used agricultural chemicals that pose significant public health and chemical threat concerns due to their neurotoxic effects. Although OP toxicity has classically been attributed to acetylcholinesterase inhibition and cholinergic crisis, emerging evidence suggests mitochondrial dysfunction may represent an additional and clinically relevant mechanism of injury. Experimental OP exposure has been associated with impaired electron transport chain activity, reduced ATP production, increased oxidative stress, and disruption of mitochondrial membrane integrity. However, there are currently no established mitochondrial-targeted therapies for OP poisoning. Diisopropyl fluorophosphate (DFP), a well-established OP surrogate, reproduces several neurologic and mitochondrial features of nerve agent exposure. Cyclosporine A (CsA), an inhibitor of the mitochondrial permeability transition pore (mPTP), may represent a potential mitochondrial-targeted intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This preliminary translational study employed both in vitro and in vivo models to evaluate mitochondrial respiratory dysfunction following acute DFP exposure and to explore the feasibility of mitochondrial-targeted treatment paradigms using CsA. Human donor-derived peripheral blood mononuclear cells (PBMCs) were used for DFP and CsA dose-finding and mitochondrial respiratory characterization using high-resolution respirometry (Oroboros O2k) with standardized substrate-uncoupler-inhibitor titration (SUIT) protocols. In parallel, a non-survivor Sprague-Dawley rat model of acute DFP exposure was developed incorporating invasive hemodynamic monitoring, controlled ventilation, venous blood gas analysis, and CsA treatment paradigms administered either following DFP exposure or as pretreatment prior to exposure. Brain cortical homogenates were prepared for ex vivo respiratory assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Preliminary findings demonstrated that DFP exposure was descriptively associated with impaired mitochondrial respiration across multiple oxidative phosphorylation (OXPHOS)- and electron transport system (ETS)-linked respiratory states in both PBMC and rodent models. DFP exposure was additionally associated with physiologic and metabolic derangements, including acidosis and elevated lactate concentrations. Post-DFP CsA administration was associated with partial preservation of mitochondrial respiration across several respiratory states, while the Pre-DFP CsA group demonstrated respiratory profiles more closely approximating control values in select OXPHOS- and ETS-linked states, accompanied by relatively preserved physiologic and metabolic parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;These preliminary findings support the feasibility of integrating mitochondrial respiratory phenotyping into translational models of acute OP toxicity and further support investigation of mitochondrial-target","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"472-479"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACMT Position Statement: Public Health Risks of 7-Hydroxymitragynine and Other Kratom-Associated Compounds.","authors":"Michael J Moss, Jacob Altholz, Kavita Babu, Jeanmarie Perrone, Andrew Stolbach","doi":"10.1007/s13181-026-01154-4","DOIUrl":"10.1007/s13181-026-01154-4","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"513-516"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Emerging Synthetic Opioid in the Drug Supply: A Case of Opioid Overdose with Biological Confirmation of Cychlorphine.","authors":"Rebecca Kusko, David Liss, Stacey L House, Serena B House, Alex Krotulski, Kim Aldy","doi":"10.1007/s13181-026-01146-4","DOIUrl":"10.1007/s13181-026-01146-4","url":null,"abstract":"<p><strong>Introduction: </strong>Cychlorphine (also referred to as N-propionitrile chlorphine) is a non-fentanyl synthetic opioid that has been linked to the illicit drug supply and fatal overdoses in the United States since 2024.</p><p><strong>Case report: </strong>A female in her 20s presented to the emergency department (ED) following ingestion of what the patient reported was alprazolam. Unresponsiveness and respiratory depression prompted 6 mg of intranasal naloxone administration by emergency medical services prior to arrival to the ED. Comprehensive toxicological testing of serum revealed the presence of cychlorphine. Additional substances found were bromazolam, carboxy-THC, acetaminophen, caffeine, citalopram, cotinine, naloxone, naproxen, nicotine, and trazodone and its metabolite.</p><p><strong>Discussion: </strong>This rare case of clinical signs of opioid overdose with cychlorphine detected is the first to provide direct evidence linking a non-fatal overdose to cychlorphine exposure. A naloxone responsive opioid toxidrome is described with an opiate and fentanyl negative initial urine drug screen. Advanced analytical techniques were required to identify the presence of cychlorphine.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"490-492"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACMT Position Statement: Preventing Cannabis Exposures in Children (2026).","authors":"Robert G Hendrickson, Maryann Mazer-Amirshahi, Caitlin Bonney, Michele Burns, Diane P Calello, Suzanne Doyon, Jeremy Hardin, Hannah Hays, Diane E Hindman, Erica Liebelt, Michael J Moss, Lewis Nelson, Simon Ostrowski, Lesley Pepin, Brian Schultz, Silas W Smith, Mark K Su, Marit S Tweet, George Sam Wang, Andrew Stolbach","doi":"10.1007/s13181-026-01155-3","DOIUrl":"10.1007/s13181-026-01155-3","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"509-512"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACMT Position Statement: Current Evidence Does Not Support Routine Use of Leucovorin for Autism Spectrum Disorder.","authors":"Maryann Mazer-Amirshahi, Jason R Siebert, Diane P Calello, Erin R Fox, Shan Yin, Andrew Stolbach","doi":"10.1007/s13181-026-01147-3","DOIUrl":"10.1007/s13181-026-01147-3","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"517-519"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}