Journal of Medical Toxicology最新文献

{"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":"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":"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}

{"title":"Pediatric Exposures Associated with Caffeine Energy Products Reported to United States Poison Centers, 2011-2023.","authors":"Timothy R Thompson, Hannah L Hays, Sandhya Kistamgari, Natalie I Rine, Motao Zhu, Henry Xiang, Gary A Smith","doi":"10.1007/s13181-025-01057-w","DOIUrl":"10.1007/s13181-025-01057-w","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated the characteristics and trends of pediatric exposures to caffeine energy products reported to US poison centers METHODS: National Poison Data System data for caffeine energy product single-substance exposures during 2011-2023 among individuals < 20 years old were analyzed.</p><p><strong>Results: </strong>There were 32,482 caffeine energy product exposures reported to US poison centers with a 17.3% exposure rate increase during 2011-2023. Most exposures were among < 6-year-olds (69.6%), males (56.7%), or involved liquid formulations (57.5%). Most (80.7%) were not treated in a healthcare facility; however, 1.6% were medically admitted. Teenagers 13-19 years old were more likely to be medically admitted (OR = 12.74, 95% CI: 10.40-15.60) or have a serious medical outcome (OR = 18.83, 95% CI: 16.88-21.01) than children < 13 years old. Solid energy product formulations were more likely to be associated with a serious medical outcome (OR = 1.98, 95% CI: 1.81-2.17) or medical admission (OR = 5.23, 95% CI: 4.31-6.36) than other types of formulations. During the study period, exposure rates increased for liquid (34.5%) and powder/granules (632.9%) product formulations but decreased for solids (-51.5%). Among liquid formulation subcategories, the exposure rate for beverages increased (46.5%) and that for shots decreased (-86.1%).</p><p><strong>Conclusions: </strong>Although most pediatric exposures to caffeine energy products reported to US poison centers were associated with no or minimal clinical effects, serious medical outcomes and medical admissions occurred. The product formulations that drove the 17% increase in the exposure rate changed during the study period. Opportunities exist to reduce the adverse effects of caffeine energy products among the pediatric population.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"241-252"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074871","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":"Andrew Sheen, Samantha Gaetani, Veronica Groff, Erin Ryan","doi":"10.1007/s13181-025-01063-y","DOIUrl":"10.1007/s13181-025-01063-y","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"290-293"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492413","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":"Preliminary PUPPYS: An Objective Clinical Assessment Tool to Measure Opioid Withdrawal in the Emergency Department.","authors":"Corey Hazekamp, Grace Bomann, Anthony Scoccimarro","doi":"10.1007/s13181-024-01056-3","DOIUrl":"10.1007/s13181-024-01056-3","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"284-286"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256094","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":"Naloxone Dosing and Hospitalization for Nitazene Overdose: A Scoping Review.","authors":"Jonathan C Berger, Alec D Severe, Mohamed S Jalloh, Alex F Manini","doi":"10.1007/s13181-025-01059-8","DOIUrl":"10.1007/s13181-025-01059-8","url":null,"abstract":"<p><strong>Introduction: </strong>Nitazene compounds are high potency, synthetic opioids, recently detected in the United States illicit opioid supply. This is a scoping review to summarize the available body of literature on naloxone and hospitalization reports in response to nitazene compound overdose.</p><p><strong>Methods: </strong>This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for Scoping Reviews. PubMed, ProQuest, and Google Scholar were accessed. Articles were limited to full-text peer-reviewed publications appearing in scholarly journals between January 2018 and December 2024. Total naloxone dose (in mg, primary outcome) and total length of stay (LOS, in hours, secondary outcome) were recorded.</p><p><strong>Results: </strong>Of 109 articles screened, 103 were excluded (44 non-human; 35 no nitazene exposure, 9 no naloxone administered, 9 post-mortem data only, 3 non-overdose, 2 non-English, and 1 full text unavailable), leaving 6 articles included. Data were described on 19 distinct patients with nitazene compound overdose (meto-, isoto-, proto-, and eto-nitazene), all of whom had naloxone data, and 10 of whom had LOS data. Median total naloxone doses were the following: metonitazene 6.00mg; etonitazene 3.06mg; isotonitazene 3.00mg; protonitazene 1mg (p=0.4). Mean hospital LOS were the following: metonitazene 360 hours; etonitazene 122.25 hrs; isotonitazene 32.67 hrs; protonitazene 20 hrs.</p><p><strong>Conclusion: </strong>This scoping review reveals a paucity of data on nitazene compound overdoses and identifies a gap in our current opioid crisis response. Most nitazene cases reviewed involved hospitalization, had high naloxone dosing, and relatively long LOS. Differences in naloxone dose and hospital LOS could underscore the unpredictable and potent nature of these substances.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"276-283"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189284","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":"Commentary on Tianeptine Exposures Reported to United States Poison Centers, 2015-2023.","authors":"William Rushton, Jessica Rivera, Scott Harris","doi":"10.1007/s13181-025-01058-9","DOIUrl":"10.1007/s13181-025-01058-9","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"294-295"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256049","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}