Journal of Medical Toxicology最新文献

Diazoxide-Associated Hyperglycemia: A Critical Case Precipitating Hyperosmolar Hyperglycemic State in a Child.

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-12-18 DOI: 10.1007/s13181-024-01052-7

Jennifer A Lawson, Brian Schultz

{"title":"Diazoxide-Associated Hyperglycemia: A Critical Case Precipitating Hyperosmolar Hyperglycemic State in a Child.","authors":"Jennifer A Lawson, Brian Schultz","doi":"10.1007/s13181-024-01052-7","DOIUrl":"https://doi.org/10.1007/s13181-024-01052-7","url":null,"abstract":"Introduction: Diazoxide is the first-line treatment for children with hyperinsulinemic hypoglycemia (HI). In these cases, diazoxide raises blood glucose levels by suppressing insulin release, preventing hypoglycemia, and potentially devastating end-organ sequelae. Hyperosmolar hyperglycemic state (HHS) is an exceedingly rare side effect of diazoxide. This complication has been described in neonates and in adults, but few children.Case report: An 8-year-old female with genetic duplication of glucokinase, and consequent hyperinsulinemia, presented to the emergency department with evidence of hypovolemic shock secondary to severe dehydration with signs of encephalopathy. Point-of-care glucose was > 600 mg/dL. Additional labs were consistent with HHS complicated by acute kidney injury, sodium 106 mEq/L, potassium 2.5 mEq/L, chloride < 60 mEq/L, carbon dioxide 20 mEq/L, glucose 2105 mg/dL, BUN 107 mg/dL, and creatinine 3.99 mg/dL. The patient received aggressive fluid resuscitation and vasopressor support, and was admitted to the pediatric intensive care unit. A diazoxide level was obtained during admission revealing serum concentration previously shown to be associated with hyperglycemia.Discussion: We posit the patient was predisposed to hyperglycemia based on elevated diazoxide serum concentration. We hypothesize severe dehydration led to renal impairment, which decreased diazoxide clearance, causing worsening hyperglycemia and ultimately, HHS. The differential diagnosis also included diabetic ketoacidosis, surreptitious administration of diazoxide, spontaneous resolution of genetic condition, and malabsorption or excretory crisis but none of these adequately explained the patient's presentation. Regardless, this case highlights the potentially lethal complication of HHS as a side effect of diazoxide therapy.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854481","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}

引用次数: 0

Will Artificial Intelligence Replace the Medical Toxicologist: Pediatric Referral Thresholds Generated by GPT-4. 人工智能是否会取代医学毒理学家？GPT-4生成的儿科转诊阈值。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-12-16 DOI: 10.1007/s13181-024-01050-9

Kai Ay Smollin, Craig G Smollin

引用次数: 0

ACMT Position Statement: Mifepristone and Misoprostol Are Not "Controlled Dangerous Substances". ACMT 立场声明：米非司酮和米索前列醇不是 "受管制的危险物质"。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-12-12 DOI: 10.1007/s13181-024-01046-5

Maryann Mazer-Amirshahi, Peggy Ye, Diane P Calello, Andrew I Stolbach

引用次数: 0

Comparison of Laboratory Confirmed Drugs in Acute Recreational Drug Toxicity Presentations to an Urban Hospital in London, UK, 2016/17 versus 2019/20.

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-12-11 DOI: 10.1007/s13181-024-01051-8

Caitlin E Wolfe, Lachlan J Sund, John Rh Archer, Ashley Rowe, Simon Hudson, David M Wood, Paul I Dargan

{"title":"Comparison of Laboratory Confirmed Drugs in Acute Recreational Drug Toxicity Presentations to an Urban Hospital in London, UK, 2016/17 versus 2019/20.","authors":"Caitlin E Wolfe, Lachlan J Sund, John Rh Archer, Ashley Rowe, Simon Hudson, David M Wood, Paul I Dargan","doi":"10.1007/s13181-024-01051-8","DOIUrl":"https://doi.org/10.1007/s13181-024-01051-8","url":null,"abstract":"Introduction: Novel Psychoactive Substance (NPS) use is increasingly prevalent and is often associated with severe acute recreational drug toxicity (ARDT). 258 UK deaths were attributed to NPS use in 2021. Confirmatory testing which identifies NPS is limited by expense and timeliness. We aimed to identify NPS and other recreational drugs in a sample of 1000 ARDT presentations to a central London hospital in 2019/20 and to compare these drugs to those identified from a previous cohort in 2016/2017.Methods: We prospectively enrolled 1000 serum samples from ARDT presentations to St Thomas' Hospital between February 2019 and February 2020. Serum samples were deidentified and underwent qualitative analysis via mass spectrometry. Results were returned at the conclusion of testing and statistical analysis performed using 'R' (R Foundation for Statistical Computing).Results: Twenty-eight unique NPS were detected in 2019/20, compared to 31 in 2016/17. Eight new NPS were detected in 2019/20: four benzodiazepines, two synthetic cannabinoid receptor agonists, one cathinone and one ketamine-analogue. No NPS opioids were detected in either cohort. Cannabis (16%,11% p = 0.02), ketamine (12%,7% p < 0.01) and opioids (57%,24% p < 0.01) were detected significantly more frequently in 2019/20 than in 2016/17, while alcohol (22%,49% p < 0.01), cathinones (1%,15% p < 0.01), GHB (14%,20% p < 0.01) and MDMA (9%,18% p < 0.01) were detected less frequently.Conclusions: Studies that utilise confirmatory testing to detect NPS in presentations of ARDT provide important information for public health interventions. More NPS benzodiazepines and fewer NPS cathinones were detected in 2019/20, following temporal trends of forensic detection throughout Europe and reinforcing the importance of identifying emerging drugs.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813349","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}

引用次数: 0

Misclassification of Pediatric Fentanyl Exposures: An Analysis of Coding Errors.

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-12-11 DOI: 10.1007/s13181-024-01043-8

Courtney Temple, Robert G Hendrickson

引用次数: 0

Correction: Commentary on the Donovan Memorial Lecture: Addiction and Recovery as a Continuum.

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-12-05 DOI: 10.1007/s13181-024-01049-2

Leslie R Dye

引用次数: 0

Biostatistics and Epidemiology for the Toxicologist: Information Bias-Differential and Non-Differential Misclassification (Part I).

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-11-29 DOI: 10.1007/s13181-024-01044-7

Elise Perlman, Sanjay Mohan, Mark K Su

引用次数: 0

Articles You Might Have Missed.

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-11-29 DOI: 10.1007/s13181-024-01045-6

Darien Stratton, Simon Ostrowski, Zach Silberman, Quincy Taylor

引用次数: 0

Emergency Department Patients Presenting after Oral versus Inhaled Cannabinoid use: A Retrospective Analysis.

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-11-29 DOI: 10.1007/s13181-024-01048-3

Tony Zitek, Christopher Raciti, Alvin Nguyen, Valentina Roa, Edward Lopez, Gregory Oliva, David A Farcy

{"title":"Emergency Department Patients Presenting after Oral versus Inhaled Cannabinoid use: A Retrospective Analysis.","authors":"Tony Zitek, Christopher Raciti, Alvin Nguyen, Valentina Roa, Edward Lopez, Gregory Oliva, David A Farcy","doi":"10.1007/s13181-024-01048-3","DOIUrl":"https://doi.org/10.1007/s13181-024-01048-3","url":null,"abstract":"Introduction: Cannabinoid-related emergency department (ED) visits are increasing, yet little has been published about how the route of cannabinoid use (inhaled versus oral) affects ED presentations. We sought to compare ED visits from inhaled versus oral cannabinoid use.Methods: We performed a retrospective cohort study using ED patients with a cannabinoid related diagnosis from January 1, 2020 and May 31, 2023 from a single hospital system in Florida. We performed manual chart review to categorize visits into \"unlikely\", \"possibly\", or \"highly likely\" to be due to acute cannabinoid use. For our primary analysis, we used the \"highly likely\" group to compare the presentations and outcomes of patients who had used oral cannabinoids versus inhaled. Our primary outcome was hospital admission.Results: We deemed 303 patient visits \"highly likely\" to be from acute cannabinoids: 59 (19.5%) inhaled and 244 (80.5%) oral. Zero patients in the inhaled group were admitted compared to 15 (6.2%) in the oral group, a difference of 6.2% (95% CI 3.1-9.2%), p = 0.05. Additionally, 65 (26.7%) of the oral group reported using cannabinoids unintentionally including 8 housekeepers who ate food products left by hotel guests. Comparatively, 4 (6.8%) of the inhaled group unintentionally used cannabinoids (difference 19.9% [95% CI 11.4-28.3]).Conclusions: Most patients who presented to the ED for the effects of acute cannabinoids had used them orally. Compared to patients who had inhaled cannabinoids, those who used them orally required more ED diagnostic resources and were more likely to be admitted to the hospital for additional evaluation or treatment. From a public health perspective, increased regulation of edible cannabinoid products may be needed.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750844","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}

引用次数: 0

Commentary on the Donovan Memorial Lecture: Addiction and Recovery as a Continuum. 多诺万评论：成瘾与康复是一个连续的过程。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-11-19 DOI: 10.1007/s13181-024-01042-9

Leslie R Dye

引用次数: 0