Journal of Medical Toxicology最新文献

{"title":"Biostatistics and Epidemiology for the Toxicologist - Testing for Independence between Two Variables: The Chi-Square Test.","authors":"Natalie M Bertrand, Mark K Su","doi":"10.1007/s13181-026-01143-7","DOIUrl":"10.1007/s13181-026-01143-7","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"406-408"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421798","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":"Responsiveness of the 2024-2030 ACMT Research Agenda to New Funding Priorities and Research Environment.","authors":"Rachel Culbreth, Neeraj Chhabra, Stephanie Carreiro, Mark B Mycyk, Paul Wax, Maryann Mazer-Amirshahi","doi":"10.1007/s13181-026-01138-4","DOIUrl":"10.1007/s13181-026-01138-4","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"347-350"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774236","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 ACMT Network of Medical Toxicology Clinics (NMTC): A Proposed Collaboration of Medical Toxicologists to Meet National Emergency Preparedness Needs.","authors":"Matthew Robert Dernbach, Tyler Lopachin, John W Downs, Nicholas Nacca, Paul Wax, Ziad Kazzi","doi":"10.1007/s13181-026-01142-8","DOIUrl":"10.1007/s13181-026-01142-8","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"398-402"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031705","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":"Medical Toxicology is the Overdose Specialty: Implications for the Dimensions and Continuum of Overdose Care.","authors":"Matthew Robert Dernbach","doi":"10.1007/s13181-026-01140-w","DOIUrl":"10.1007/s13181-026-01140-w","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"403-405"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959600","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":"Apixaban Overdose with Massive Bleeding and Anti-Xa Levels.","authors":"Rebecca Kusko, Jami Hagemann, Daniel McCabe, Joshua Trebach","doi":"10.1007/s13181-026-01137-5","DOIUrl":"10.1007/s13181-026-01137-5","url":null,"abstract":"<p><strong>Introduction: </strong>While use of factor Xa inhibitors has increased, there are relatively few cases of overdose reported. Clinically relevant bleeding is often absent, and the behavior of drug levels in overdose is not fully agreed on.</p><p><strong>Case report: </strong>A 70-year-old male presented after a polysubstance overdose including at least 250 mg of apixaban with massive gastrointestinal (GI) hemorrhage and parafalcine and tentorial subdural hematoma. He was treated with 1 gram tranexamic acid (TXA), anti-inhibitor coagulant complex (FEIBA), and massive transfusion. No further episodes of bleeding were observed. Anti-Xa levels were trended until undetectable.</p><p><strong>Discussion: </strong>Bleeding from an overdose of factor Xa inhibitors is a relatively rare occurrence; however, this case illustrates that life threatening hemorrhage can occur and may require aggressive supportive care. Anti-Xa levels demonstrated a first order pattern of elimination even at markedly supratherapeutic concentrations, consistent with several prior case reports.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"392-397"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674352","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":"Dexmedetomidine in The Treatment of Toxicologic Conditions in The Emergency Department: A Dual-Center Retrospective Observational Cohort Study.","authors":"Kevin Baumgartner, Amar Chakraborty, David B Liss, Sarah Berg, Miya Smith, Taylor Kaser, Rachel Ancona, Julianne C Yeary, Samantha C Lee, Jon B Cole","doi":"10.1007/s13181-026-01145-5","DOIUrl":"10.1007/s13181-026-01145-5","url":null,"abstract":"<p><strong>Introduction: </strong>Dexmedetomidine has been used to treat toxicologic conditions, but high-quality data on its use for this indication in the emergency department setting are lacking. We sought to characterize the use of dexmedetomidine in this context.</p><p><strong>Methods: </strong>We conducted a dual-center retrospective cohort study of patients treated with dexmedetomidine in two academic emergency departments. We included patients who received dexmedetomidine in the emergency department and had a toxicologic condition, as adjudicated by a medical toxicologist on chart review. We abstracted data from the electronic medical record. We conducted multilevel logistic regression to explore factors associated with intubation after the initiation of dexmedetomidine.</p><p><strong>Results: </strong>We screened 1,081 patients and included 320. The most common toxicologic conditions were ethanol withdrawal (20%) and acute poisoning by sympathomimetics (19.7%). Culprit xenobiotics were primarily ethanol and substances of misuse. Median nadir heart rate and mean arterial pressure after dexmedetomidine initiation were normal, and there was no substantial change in nadir hemodynamic parameters after dexmedetomidine administration, although there was an increase in vasopressor administration (6.6% to 11.9%). Among patients who were not intubated when dexmedetomidine was initiated (n = 200), the frequency of intubation was 21.5% (95% CI 16-28). On multilevel logistic regression, antipsychotic administration was associated with increased odds of intubation (adjusted odds ratio 2.52, 95% CI 1.15-5.51).</p><p><strong>Conclusion: </strong>Dexmedetomidine was primarily used to treat emergency department patients with intoxication or withdrawal from ethanol and substances of misuse. The frequency of intubation in spontaneously breathing patients after the initiation of dexmedetomidine was 21.5%. Further prospective research is needed to evaluate dexmedetomidine in the treatment of toxicologic conditions.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"364-374"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421759","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":"Developing Longitudinal Post-Overdose Care: A Call to Action.","authors":"Matthew Robert Dernbach, Ziad Kazzi, Paul M Wax","doi":"10.1007/s13181-026-01136-6","DOIUrl":"10.1007/s13181-026-01136-6","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"351-356"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645605","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":"Botulism Type F, a Rare Type of Botulism that Can Masquerade as a Posterior Fossa Stroke.","authors":"Marwa Elamin, Raahim Bashir, Matthew Kolbeck, Vincent Calleo, Jenny A Meyer, Timothy Beutler","doi":"10.1007/s13181-026-01139-3","DOIUrl":"10.1007/s13181-026-01139-3","url":null,"abstract":"<p><strong>Background: </strong>Botulism is a rare, life-threatening condition caused by potent neurotoxins that inhibit the release of acetylcholine into the neuromuscular junction, resulting in cranial nerve palsies, flaccid paralysis, and respiratory compromise. Most cases are caused by type A and B toxins produced by Clostridium botulinum.</p><p><strong>Case report: </strong>Here, we describe a 41-year-old woman who presented with acute onset binocular diplopia, nausea/vomiting, slurred speech, and unsteady gait, symptoms that resemble a posterior fossa stroke. The patient was initially admitted to the stroke service; however, her symptoms quickly progressed to flaccid quadriparesis with generalized areflexia, fixed and dilated pupils, and respiratory failure requiring intubation, raising concerns for neuromuscular junction disorders. Stool and rectal swabs were sent for botulinum toxin screening. Repetitive nerve stimulation showed decremental compound muscle action potential (CMAP) response with 3 Hz stimulation, mild incremental response to exercise, and incremental response with 50 Hz stimulation, findings suggestive of presynaptic pathology. The CDC was contacted and the patient received botulinum antitoxin on the second day of hospitalization. Positive PCR testing on rectal swab was reported on day 4, and the patient was ultimately diagnosed with Type F botulism, an exceedingly rare variant of the disease typically associated with Clostridium baratii. The patient was extubated after two weeks. No source of the toxin was identified.</p><p><strong>Discussion: </strong>This rare type of botulism Type F (less than 1% of all botulism cases) is characterized by a more rapid progression of symptoms compared to typical Type A/B botulism and might present clinically like a posterior circulation stroke. Therefore, maintaining high clinical suspicion for neuromuscular disorders (especially in patients presenting with stroke-like symptoms of the posterior fossa) and early administration of antitoxin are critical factors for mitigating disease severity and improving clinical outcomes.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"387-391"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031765","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":"Articles You Might Have Missed.","authors":"Cameron A Burke, Julian C Goding, Linda M Johnson, Aaron J Prugar","doi":"10.1007/s13181-026-01141-9","DOIUrl":"https://doi.org/10.1007/s13181-026-01141-9","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308438","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":"Comparison of Pediatric and Adult Glucagon-Like Peptide-1 Receptor Agonist Exposures Reported To United States Poison Centers, 2017-2024.","authors":"Anjali Senthilkumar, Hannah L Hays, Sandhya Kistamgari, Natalie I Rine, Allison L Rhodes, Christopher E Gaw, Gary A Smith","doi":"10.1007/s13181-026-01128-6","DOIUrl":"10.1007/s13181-026-01128-6","url":null,"abstract":"<p><strong>Introduction: </strong>As glucagon-like peptide-1 receptor agonist (GLP-1) use has increased among children, a better understanding of the related adverse effects in this population is needed.</p><p><strong>Methods: </strong>National Poison Data System data from 2017 to 2024 were analyzed to compare characteristics and trends of exposures involving GLP-1s reported to United States (US) poison centers (PCs) among children 6-17 years old with those of adults.</p><p><strong>Results: </strong>There were 13,924 single-substance GLP-1 exposures reported to US PCs from 2017 to 2024. The rate of exposures per one million US population increased by 1,830.8% from 0.97 in 2017 to 18.79 in 2024, including a 4,805.0% increase among children 6-17 years old from 0.04 in 2017 to 1.97 in 2024, with the majority of the increase occurring after 2021. Most exposures (91.7%) were associated with no or mild effects, while moderate effects were observed in 8.0% and major effects occurred in 42 exposures; there were two deaths. Children 6-17 years old were more likely (RR: 2.66, 95% CI: 1.73-4.11) to be admitted than adults, and children 12-17 years old were more likely (RR: 1.68, 95% CI: 1.08-2.63) to experience a more serious medical outcome than adults. Children 6-17 years old with at least one clinical effect experienced vomiting (88.2%) more commonly than adults (61.3%) (RR: 1.44, 95% CI: 1.34-1.55). Additionally, exposures among children 6-17 years old were more likely to be attributable to intentional misuse (RR: 8.12, 95% CI: 6.47-10.17) than among adults.</p><p><strong>Conclusions: </strong>This study provides national-level, real-world findings that may help inform clinical practice.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"263-274"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355568","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}