Journal of Medical Toxicology最新文献_第3页

Attempted Self-Harm with Elemental Thallium Purchased Online: Case Report with Analytical Confirmation. 企图用网购的元素铊自残：案例报告与分析确认。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-08-22 DOI: 10.1007/s13181-024-01034-9

Anthony Spadaro, Andrew Sae Young Lee, Hilda Pineda, Bruce Ruck, Diane P Calello, Howard A Greller, Lewis S Nelson, Mehruba A Parris

{"title":"Attempted Self-Harm with Elemental Thallium Purchased Online: Case Report with Analytical Confirmation.","authors":"Anthony Spadaro, Andrew Sae Young Lee, Hilda Pineda, Bruce Ruck, Diane P Calello, Howard A Greller, Lewis S Nelson, Mehruba A Parris","doi":"10.1007/s13181-024-01034-9","DOIUrl":"10.1007/s13181-024-01034-9","url":null,"abstract":"Introduction: Thallium is a highly toxic metal, with most publications demonstrating poisoning from thallium salts. We report on a patient with elevated serum and urine thallium concentrations from an intentional ingestion of elemental thallium purchased from the internet for self-harm.Case report: The regional poison center was contacted about an 18-year-old man who ingested a fragment from a 100-gram bar reported to be elemental thallium. Serial serum and urine thallium concentrations were obtained. Prussian blue was started on hospital day (HD) 2. A metal fragment was seen on abdominal x-ray and removed via colonoscopy on HD3. The ingested fragment was analyzed via inductively coupled plasma mass spectrometry (ICP-MS) and found to be 87.0% elemental thallium. The initial serum thallium concentration obtained on HD1 was 423.5 mcg/L (reference range < 5.1 mcg/L), which subsequently decreased to 4.5 mcg/L, 29 days after the ingestion. An initial random urine thallium concentration obtained on HD 3 was 1850.5 mcg/g creatinine (reference range < 0.4 mcg/g creatinine). The patient remained hospitalized for 23 days and, when seen in follow-up, had not developed any signs or symptoms of thallium toxicity.Discussion: Elemental thallium ingestion is a rare toxicologic exposure, with limited published clinical and analytical experience to guide management. This case report describes a patient with ingestion of elemental thallium who developed elevated serum and urine thallium concentrations and was treated with Prussian blue. Despite having elevated serum and urine thallium concentrations consistent with previous fatal exposures, more evidence is needed to understand the differences between elemental thallium and thallium salts.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"416-421"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036054","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}

引用次数: 0

Neurologic Deficits Following Oral Misuse of the Nasal Decongestant Propylhexedrine. 口服误用鼻腔减充血剂丙氧芬后出现神经功能缺损。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI: 10.1007/s13181-024-01025-w

Keahi M Horowitz, Emma Cassidy, Courtney Temple

{"title":"Neurologic Deficits Following Oral Misuse of the Nasal Decongestant Propylhexedrine.","authors":"Keahi M Horowitz, Emma Cassidy, Courtney Temple","doi":"10.1007/s13181-024-01025-w","DOIUrl":"10.1007/s13181-024-01025-w","url":null,"abstract":"Introduction: Propylhexedrine is an over-the-counter nasal decongestant used recreationally for amphetamine-like effects. Prior reports have associated intravenous misuse with brainstem dysfunction and diplopia. This is a case of propylhexedrine ingestion resulting in neurological impairment with associated MRI findings.Case report: A 21-year-old man presented with neurologic symptoms after ingesting propylhexedrine extracted from a 250 mg nasal inhaler into a lemon juice solution following recommendations from an online forum. He also followed recommendations to simultaneously ingest 1 g L-arginine to theoretically mitigate the risk of vasoconstriction. He developed flushing and euphoria before falling asleep. He awoke 12 h later with dizziness, intractable vomiting, diplopia, ataxia, dysmetria, and spontaneous horizontal nystagmus. Magnetic resonance imaging (MRI) revealed T2 enhancement concerning for vasogenic edema of the right posterior limbs of the internal capsule extending into the midbrain, cerebellar peduncles, and cerebellar white matter. Workup for primary vascular or autoimmune etiologies was unrevealing. Expanded drug testing was positive for mitragynine and THC. Blood analyzed via liquid chromatography quadrupole time-of-flight mass spectrometry was positive for propylhexedrine. On hospital day 6, the patient was discharged to physical rehabilitation with unresolved dysmetria and ataxia.Discussion: Recreational oral misuse of propylhexedrine may be associated with neurologic injury. MRI findings in this case demonstrated vasogenic edema suggesting vasospasm as a possible etiology. Serum testing confirmed the presence of propylhexedrine. Although testing was also positive for mitragynine and THC, these have not been associated with similar neurologic deficits or MRI findings.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"427-429"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893611","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}

引用次数: 0

Investigating a Novel Two-Bag N-Acetylcysteine Regimen for Acetaminophen Toxicity. 研究治疗对乙酰氨基酚毒性的新型双囊 N-乙酰半胱氨酸疗法

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-07-11 DOI: 10.1007/s13181-024-01010-3

Kathryn A Glass, Zachary R Stoecker, Jenna LeRoy, Casey L Palmer, Jordan Stipek, Sean Boley

{"title":"Investigating a Novel Two-Bag N-Acetylcysteine Regimen for Acetaminophen Toxicity.","authors":"Kathryn A Glass, Zachary R Stoecker, Jenna LeRoy, Casey L Palmer, Jordan Stipek, Sean Boley","doi":"10.1007/s13181-024-01010-3","DOIUrl":"10.1007/s13181-024-01010-3","url":null,"abstract":"Background: Acetaminophen toxicity remains one of the most common causes of liver failure and is treated with a course of n-acetylcysteine (NAC). This exceptionally effective medication is traditionally administered using a complicated three-bag protocol that is prone to administration errors.Objective: We aimed to assess whether switching to a novel two-bag protocol (150 mg/kg over 1 h followed by 150 mg/kg over 20 h) reduced administration errors while not increasing liver injury or anaphylactoid reactions.Methods: This was a retrospective chart review of hospital encounters for patients with acetaminophen toxicity, comparing outcomes before and after the change from a three-bag protocol to a two-bag protocol at two affiliated institutions. The primary outcome was incidence of medication errors with secondary outcomes including acute liver injury (ALI) and incidence of non-anaphylactoid allergic reactions (NAAR). The study was approved by the health system's Institutional Review Board.Results: 483 encounters were included for analysis (239 in the three-bag and 244 in the two-bag groups). NAAR were identified in 11 patients with no difference seen between groups. Similarly, no differences were seen in ALI. Medication administration errors were observed significantly less often in the two-bag group (OR 0.24) after adjusting for confounders.Conclusion: Transitioning to a novel two-bag NAC regimen decreased administration errors. This adds to the literature that two-bag NAC regimens are not only safe but also may have significant benefits over the traditional NAC protocol.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"381-388"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590536","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}

引用次数: 0

Delta-8 Tetrahydrocannabinol Exposures Reported to US Poison Centers: Variations Among US States and Regions and Associations with Public Policy. 向美国毒物中心报告的 Delta-8 四氢大麻酚暴露：美国各州和地区之间的差异以及与公共政策的关联。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-08-21 DOI: 10.1007/s13181-024-01030-z

Gary A Smith, Alice Burgess, Jaahnavi Badeti, Natalie I Rine, Christopher E Gaw, Leah K Middelberg, Henry A Spiller, Hannah L Hays

{"title":"Delta-8 Tetrahydrocannabinol Exposures Reported to US Poison Centers: Variations Among US States and Regions and Associations with Public Policy.","authors":"Gary A Smith, Alice Burgess, Jaahnavi Badeti, Natalie I Rine, Christopher E Gaw, Leah K Middelberg, Henry A Spiller, Hannah L Hays","doi":"10.1007/s13181-024-01030-z","DOIUrl":"10.1007/s13181-024-01030-z","url":null,"abstract":"Introduction: This study investigated exposures involving ∆8-tetrahydrocannabinol (∆8-THC) reported to US poison centers (PCs), including variation among states and regions. It evaluated whether the ∆8-THC exposure rate was lower among states with ∆8-THC regulations and states where cannabis (∆9-THC) use was legal.Methods: National Poison Data System data for ∆8-THC exposures in 2021-2022 were analyzed, including comparisons of state and regional population-based exposure rates.Results: There were 4,925 exposures involving ∆8-THC as the primary substance reported to US PCs from January 1, 2021, to December 31, 2022, with 69.8% of these reported in the US South. The rate of exposure per 100,000 US population increased by 79.2% from 0.53 in 2021 to 0.95 in 2022. In 2022, the mean rate of ∆8-THC exposures in states where cannabis use was illegal was 1.64 per 100,000 population (95% CI: 1.08-2.20) compared with 0.52 (95% CI: 0.29-0.76) in states where cannabis use was legal (P = 0.0010). In 2022, the mean rate of ∆8-THC exposures in states where ∆8-THC was unregulated was 1.36 per 100,000 population (95% CI: 0.95-1.77) compared with 0.17 (95% CI: 0.06-0.27) in states where ∆8-THC was banned (P < 0.0001).Conclusions: The rate of ∆8-THC exposures reported to US PCs increased by 79% from 2021 to 2022, with the US South accounting for more than two-thirds of exposures. The rate of ∆8-THC exposures reported to PCs was significantly lower among states where ∆8-THC was banned and among states where cannabis use was legal. Consistent regulation of ∆8-THC across all states should be adopted.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"389-400"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017745","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}

引用次数: 0

Biostatistics and Epidemiology for the Toxicologist: Likelihood Ratios. 毒理学家的生物统计学和流行病学：似然比。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1007/s13181-024-01026-9

Gar Ming Chan, Mark K Su

引用次数: 0

20 Years of JMT: The Vital Role of Journals to Explain Things to Others and Ourselves. JMT 20 年：期刊在向他人和自己解释事物方面的重要作用。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-09-10 DOI: 10.1007/s13181-024-01036-7

Mark B Mycyk

引用次数: 0

Comment on "Safety of Physostigmine for Pediatric Antimuscarinic Poisoning". 就 "物理斯的明治疗小儿抗心绞痛药中毒的安全性 "发表评论。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-07-30 DOI: 10.1007/s13181-024-01022-z

Kyle D Pires, Lewis R Goldfrank

引用次数: 0

Medical Toxicology vs. Emergency Medicine and Internal Medicine - Are We Really Full of Case Reports? 医学毒理学与急诊医学和内科学--我们真的满脑子都是病例报告吗？

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-09-20 DOI: 10.1007/s13181-024-01031-y

Jason B Hack, Kevin F O'Brien

{"title":"Medical Toxicology vs. Emergency Medicine and Internal Medicine - Are We Really Full of Case Reports?","authors":"Jason B Hack, Kevin F O'Brien","doi":"10.1007/s13181-024-01031-y","DOIUrl":"10.1007/s13181-024-01031-y","url":null,"abstract":"Introduction: Case reports are perceived as having diminished value relative to other study designs. It has been said that medical toxicology (MT) is based largely upon case report literature and thought to be unique in this regard. We sought to quantify recent MT publication of case reports compared with top periodicals from emergency medicine (EM) and internal medicine (IM) journals.Methods: A retrospective review examined 5 years of articles in 6 U.S.-based medical journals-MT (Journal of Medical Toxicology, Clinical Toxicology), EM (Annals of Emergency Medicine, Journal of Emergency Medicine), and IM (JAMA Internal Medicine, New England Journal of Medicine) was performed using on-line resources. Every article in each issue was categorized into Case report vs. Research and Analysis articles vs. Excluded. \"Case report\" was defined as one (or ≤ 5) individual patients, one patient's data, etc. Total articles per issue were reported after removing Excluded items.Results: Between 2018 and 2022, these 6 periodicals published 522 issues; with 2644 case reports; and 8246 total included articles. Comparison of MT case reports vs. EM revealed a significant difference and odds (Odds Ratio = 1.7, (95% CI: [1.49, 2.03], p < 0.001); MT compared with IM was not significantly different (Odds Ratio = 1.1, (95% CI: [0.96, 1.30], p = 0.150). The percent of case reports increased in the IM and EM journals compared with a relative decrease in the MT journals. Cumulative case report precents were consistently greater in EM and IM than in MT.Conclusion: In the past 5 years, MT journals published fewer and had a declining trend of case reports compared with leading EM and IM journals. Future research is needed to determine the effect on MT practice resulting from the diminished body of case report literature.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"401-406"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289437","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}

引用次数: 0

Analytically Confirmed Intentional Overdose of the Antidepressant Vortioxetine. 经分析确认的抗抑郁药物伏替西汀故意过量。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-08-06 DOI: 10.1007/s13181-024-01027-8

Adam Daneshmend, Allon Gould, Simon Hudson, John Robert Howard Archer, Paul Ivor Dargan, David Michael Wood

{"title":"Analytically Confirmed Intentional Overdose of the Antidepressant Vortioxetine.","authors":"Adam Daneshmend, Allon Gould, Simon Hudson, John Robert Howard Archer, Paul Ivor Dargan, David Michael Wood","doi":"10.1007/s13181-024-01027-8","DOIUrl":"10.1007/s13181-024-01027-8","url":null,"abstract":"Introduction: Vortioxetine is an antidepressant with a multimodal mechanism of action. It is used as a treatment option for patients with major depressive episodes. There have only been two previously reported non-fatal overdoses of vortioxetine; neither of these were analytically confirmed There has also been one case of serotonin syndrome potentially related to vortioxetine and two deaths where vortioxetine was detected. We report here a non-fatal analytically confirmed case of vortioxetine overdose.Case report: A 32-year-old male presented to the emergency department (ED) 12-13 h after oral ingestion of 1,260 mg of vortioxetine and 350 mg of diazepam. A family member reported that he had been drowsy after the overdose, but his level of consciousness and observations (heart rate, blood pressure and temperature) were normal on review by the pre-hospital emergency services and on arrival to the ED. During a period of observation, he did not develop any features of serotonin syndrome or any other significant toxicity. Toxicological analysis of a blood sample taken in the ED detected vortioxetine (plasma concentration 457 ng/mL 10 h after ingestion) and sub-therapeutic concentrations of diazepam and pregabalin.Discussion: Despite having a plasma vortioxetine concentration nearly 15-times therapeutic vortioxetine concentrations, this patient did not develop any significant toxicity. In particular he did not develop any clinical or biochemical features of serotonin toxicity that would be expected with this class of antidepressant. Additional reporting of analytically confirmed vortioxetine overdoses will allow clinicians and licensing authorities to further understand the safety of this medication in overdose.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"422-426"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897644","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}

引用次数: 0

The American College of Medical Toxicology Annual Scientific Meeting: A Look Back and the Path Forward. 美国医学毒理学学院科学年会：回顾过去，展望未来。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-09-12 DOI: 10.1007/s13181-024-01035-8

Maryann Mazer-Amirshahi, Paul Wax, Adrienne Dunavin, Mark B Mycyk, Lewis S Nelson

引用次数: 0