Journal of Medical Toxicology最新文献

{"title":"Vasopressor Use, Critical Care Management, and Outcomes in Dihydropyridine Calcium Channel Blocker Toxicity.","authors":"Hannah H Spungen, John Michael Sherman, Kaitlin Ryan, Jessica J Krueger, Michael Levine, Meghan B Spyres","doi":"10.1007/s13181-025-01069-6","DOIUrl":"https://doi.org/10.1007/s13181-025-01069-6","url":null,"abstract":"<p><strong>Introduction: </strong>Although dihydropyridine calcium channel blockers (DHP CCBs) are considered to have less direct myocardial toxicity than non-dihydropyridines, DHPs remain a common cause of morbidity and mortality. We sought to examine various indices of critical illness and describe the clinical course of a population of DHP CCB-poisoned patients with special attention to vasopressor dosing and ischemic complications.</p><p><strong>Methods: </strong>This is a retrospective chart review of DHP CCB exposures admitted to a single center. The study site was a single tertiary referral center with an in-house medical toxicology consultation/admitting service. Inclusion criteria included age ≥ 14 years and DHP ingestion noted on departmental patient log. Patients were excluded if DHP exposure was not documented in the medical record. The study period ranged from July 1, 2010 through December 31, 2022. Data on clinical presentation, management, and outcomes were reported.</p><p><strong>Results: </strong>Sixty-eight cases of DHP exposure were analyzed; 87% were intentional ingestions. Amlodipine represented 88% of cases. 85% included cases involved co-ingestions. Vasopressors were administered in 42 cases (62%), with a median of three agents (IQR 1-4). Norepinephrine was most common (N = 41; 98%), followed by epinephrine (N = 23; 55%); median maximal rates were 45.0 (IQR 13.5-70.0) and 25.0 (IQR 12.0-30.0) mcg/min, respectively. 15% (N = 10) received high dose insulin-euglycemic therapy (HIE); all had > 2 vasopressors administered before administration of HIE. Twelve (18%) patients had ischemic complications; five (7%) experienced ischemic complications not evident before vasopressor administration. There were five deaths (7%).</p><p><strong>Conclusions: </strong>Multiple vasopressor use was common in this population of patients with DHP CCB toxicity. Despite the high doses of vasopressors used, temporally related ischemic complications were uncommon.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005106","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":"The Impact of Glucagon-Like Peptide-1 Receptor Agonists on Pharmacokinetics and Toxicokinetics: Is a New Diagnostic and Therapeutic Framework Needed?","authors":"James D Whitledge, Joseph Kennedy, C James Watson, Carin Malley, Karen Simone, Mark Neavyn","doi":"10.1007/s13181-025-01075-8","DOIUrl":"https://doi.org/10.1007/s13181-025-01075-8","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000003","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":"Comment on \"Tianeptine Exposures Reported to United States Poison Centers, 2015-2023\".","authors":"James B Leonard, Perry E Rosen, Christopher J Counts","doi":"10.1007/s13181-025-01073-w","DOIUrl":"https://doi.org/10.1007/s13181-025-01073-w","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986514","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":"Biostatistics and Epidemiology for the Toxicologist: Types of Information Bias (Part II).","authors":"Sanjay Mohan, Elise Perlman, Mark K Su","doi":"10.1007/s13181-025-01067-8","DOIUrl":"10.1007/s13181-025-01067-8","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"287-289"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597238","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: Sterile Solution Shortage.","authors":"Maryann Mazer-Amirshahi, Erin R Fox, Andrew Stolbach","doi":"10.1007/s13181-025-01060-1","DOIUrl":"10.1007/s13181-025-01060-1","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"296-297"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189175","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":"Acute Acetaminophen Hepatotoxicity And Platelet Dysfunction.","authors":"Michael L Ekaney, Trenton A Pritt, Neha Attal, Christine M Murphy, Iain H McKillop","doi":"10.1007/s13181-025-01065-w","DOIUrl":"10.1007/s13181-025-01065-w","url":null,"abstract":"<p><strong>Introduction: </strong>Acetaminophen (APAP) overdose remains a common cause of liver injury, primarily due to its toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI). This study sought to investigate APAP-induced platelet aggregation in vitro, and the implication of CYP2E1 in the metabolism of APAP and hepatic cell toxicity.</p><p><strong>Methods: </strong>Co-cultures of platelets and hepatic cells that do not (HepG2) and do express CYP2E1 (HepG2^E47) were exposed to APAP (0-20 mM), NAPQI (0-250 µM), APAP in the absence/presence of inhibitors of glutathione (50 μM buthionine sulphoximine (BSO)), or APAP in the absence/presence of inhibitors CYP2E1 (chlormethiazole (CMZ, 100 µM), or 4-methylpyrazole (4-MP, 5 mM)). Platelet aggregation, cell viability and reactive oxygen species (ROS) were analyzed. Changes in platelet aggregation was determined in platelets directly exposed to APAP/NAPQI.</p><p><strong>Results: </strong>Exposure to APAP decreased platelet aggregation under co-culture conditions but not in platelet-only cultures. Conversely, NAPQI exposure decreased platelet aggregation in both co-culture and platelet-only conditions. Both APAP and NAPQI reduced cell viability in HepG2 and HepG2^E47 cells, with BSO enhancing APAP toxicity, while 4-MP mitigated it. Acetaminophen exposure led to ROS production in HepG2^E47 cells, with no effect of CMZ and 4-MP.</p><p><strong>Conclusions: </strong>Acetaminophen exposure impacts platelet aggregation in co-cultures of platelets and HepG2/HepG2^E47 cells with increased ROS production in HepG2^E47 cells and 4-MP preventing APAP-induced cytotoxicity in HepG2^E47 cells. While APAP had no direct effect on platelets, NAPQI exposure acted to decrease platelet aggregation. These findings enhance our understanding of the mechanisms of APAP-induced hepatotoxicity and the potential role of APAP-induced hepatocellular toxicity in platelet aggregation.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"229-240"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515760","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":"Welcome to the 2025 ACMT Annual Scientific Meeting.","authors":"Charlotte E Goldfine, Joseph E Carpenter, Maryann Mazer-Amirshahi, Adrienne Dunavin, Stephanie Abston","doi":"10.1007/s13181-025-01064-x","DOIUrl":"10.1007/s13181-025-01064-x","url":null,"abstract":"<p><p>These are the selected abstracts for the 2025 American College of Medical Toxicology (ACMT) Annual Scientific Meeting, which will take place from April 4-6, 2025, in Vancouver, Canada. This year's accepted abstracts include original research studies, including contributions from the Toxicology Investigators Consortium (ToxIC), and clinically significant case reports highlighting unique toxicologic phenomena. These presentations reflect the continued growth and impact of toxicology research, providing attendees with valuable insights into emerging trends, novel treatment strategies, and evolving best practices in the field.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"112-113"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143502016","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":"Variations in Octreotide Dosing in Published Reports of Sulfonylurea Toxicity: A Systematic Review, 1988-Present.","authors":"Erin Ryan, William Rushton","doi":"10.1007/s13181-024-01054-5","DOIUrl":"10.1007/s13181-024-01054-5","url":null,"abstract":"<p><strong>Background: </strong>Octreotide is commonly used to treat hypoglycemia due to sulfonylurea toxicity, but optimal dosing for this indication is not well defined.</p><p><strong>Methods: </strong>We performed a systematic review to identify cases in the medical literature of octreotide use for sulfonylurea poisoning. Literature published on octreotide and sulfonylureas between octreotide's FDA approval on 10/21/1988 and 8/15/2024 was reviewed.</p><p><strong>Results: </strong>Eighty unique patient cases (66 adults/adolescents and 14 pediatric patients) from 61 sources were included in the final analysis. These included 41 octreotide dosing strategies that differed in dose, frequency, and/or route of administration. Subcutaneous dosing, primarily within the range of 50-100 mcg per dose at a frequency of every 6-8 h, was the most common regimen in adults while intravenous dosing of 1 mcg/kg was most prevalent in pediatrics. There were no significant differences in duration of therapy or total dose of octreotide in adults with intermittent subcutaneous vs intravenous dosing. Treatment of hypoglycemia and maintenance of euglycemia was similar among all routes of administration. Infusions had similar durations but higher total doses of octreotide. Higher intermittent bolus doses were associated with shorter durations of therapy. Intentional exposures were associated with higher doses and longer duration of treatment with octreotide. Three adverse reactions to octreotide were reported. Except for 2 cases, all patients survived without any long-term complications.</p><p><strong>Conclusion: </strong>Despite widespread variation in octreotide dosing and administration, our report showed similar efficacy and safety with various octreotide dosing practices.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"260-275"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006909","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":"Getting the Most Out of Your Meeting Abstract: An Editor's Perspective.","authors":"Mark B Mycyk","doi":"10.1007/s13181-025-01066-9","DOIUrl":"10.1007/s13181-025-01066-9","url":null,"abstract":"<p><p>The meeting abstract is an important step in the process of disseminating new knowledge. The invitation to present an abstract at a scientific meeting is the first opportunity for an investigator to showcase their findings to an audience outside of their institution. The constructive feedback and generous insights from expert peers are valuable when preparing a manuscript for eventual submission to a journal. Knowing how to get the most out of a meeting abstract presentation is essential to scholars engaged in scientific discovery.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"109-111"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573273","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 Outbreak of Synthetic Cannabinoid-Adulterated Tianeptine Products in New Jersey - Case Series.","authors":"Christopher J Counts, Anthony V Spadaro, Trevor A Cerbini, Alex J Krotulski, Sara E Walton, Howard A Greller, Lewis S Nelson, Bruce E Ruck, Oliver Hung, Barry Logan, Diane P Calello","doi":"10.1007/s13181-025-01068-7","DOIUrl":"10.1007/s13181-025-01068-7","url":null,"abstract":"<p><strong>Background: </strong>Tianeptine, an atypical antidepressant not approved in the United States, is readily purchased from unregulated markets such as the internet and gas stations. We became aware of a cluster of 34 patients in New Jersey who became ill following ingestion of the tianeptine containing-product Neptune's Fix, the rate of which (4.6 cases per month) far exceeded the background rate for this substance of 0.5 cases per year.</p><p><strong>Methods: </strong>We retrospectively identified tianeptine exposures reported to the New Jersey Poison Information and Education System (NJPIES) prior to June 2023 to determine the background rate of tianeptine exposure. From June 2023- February 2024 we prospectively surveilled tianeptine exposures reported to NJPIES, recorded demographic and clinical information, and recruited samples for testing. Six samples of the ingested products were obtained and analyzed using gas chromatography mass spectrometry (GC-MS) and liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS). Whole blood samples from two patients were tested for tianeptine and synthetic cannabinoids.</p><p><strong>Results: </strong>During the period of interest, NJPIES received 41 exposure calls, with 37 reporting acute toxicity in 34 unique patients, two reporting chronic tianeptine use, and two reporting withdrawal. Among the 37 exposures resulting in acute toxicity, commonly reported effects included altered mental status, tachycardia, hypotension, and seizures. 43% (n = 16) were intubated, and 65% (n = 24) were admitted to the ICU. Analytical testing of six samples identified variable product composition, containing various xenobiotics including tianeptine, kava alkaloids, natural cannabinoids, and the synthetic cannabinoids MDMB-4en-PINACA and ADB-4en-PINACA. MDMB-4en-PINACA was detected in one of the two patient blood specimens.</p><p><strong>Conclusions: </strong>These cases represent a marked increase in tianeptine exposures compared with the poison center's historical average. Analytical testing revealed variable product composition, including the presence of synthetic cannabinoids. Clinicians should be aware that tianeptine containing products are widely available, unregulated, and can be adulterated.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"253-259"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657514","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}