Journal of Medical Toxicology最新文献

{"title":"The Cost of Antivenom: A Cost Minimization Study using the North American Snakebite Registry.","authors":"Benjamin Herzel, Neev Batavia, Paul Gavaza, Tammy Phan, Emmelyn Samones, Anne-Michelle Ruha, Jakub Furmaga, Christopher Hoyte, Brian J Wolk","doi":"10.1007/s13181-025-01072-x","DOIUrl":"10.1007/s13181-025-01072-x","url":null,"abstract":"<p><p>Envenomation is a global health issue, with over 9,000 encounters managed in the United States yearly. The introduction of immunoglobulin fragment antivenom has reduced the risk of hypersensitivity. This study compares treatment costs of crotaline envenomation using the Fab and F(ab')₂ antivenoms as reported to the North American Snakebite Registry (NASBR), a nationwide surveillance tool.</p><p><strong>Methods: </strong>This was a retrospective analysis of NASBR data between 2018 and 2020. The following data points were assessed: patient demographics (age, gender, race), snake species, type of antivenom used, and treatment costs. Unit costs were estimated based on United States Centers for Medicare and Medicaid Services data. Average (mean) per patient costs from the payer perspective were calculated by multiplying resources by the unit costs. Sensitivity analyses were performed regarding cost variance and snake species. All costs reported in this study are in U.S. dollars.</p><p><strong>Results: </strong>The average total cost of treatment was $31,343 per person, with medications contributing 72% of the total. Average total cost among patients who received Fab treatments was $33,347 per person compared to $19,747 among patients who received F(ab')₂. Antivenom costs accounted for 75% of the total cost in the Fab group and 42% in the F(ab')₂ group. F(ab')₂ required more vials than Fab (median 18 versus 10). Non-antivenom costs such as hospitalizations were higher in the F(ab')₂ group. Using average sale prices increased average total cost to $52,572; Fab remained more expensive.</p><p><strong>Conclusion: </strong>Antivenom is the primary cost driver in snakebite treatment in North America. Treatment with F(ab')₂ resulted in lower overall costs, driven by lower cost of antivenom. F(ab')₂ did not significantly lower overall resource use except for blood product administration.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"320-326"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024558","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":"Membranous Nephropathy after Subcutaneous Mercury Injection.","authors":"Kelly Johnson-Arbor, Sammy Taha","doi":"10.1007/s13181-025-01081-w","DOIUrl":"10.1007/s13181-025-01081-w","url":null,"abstract":"<p><strong>Introduction: </strong>Subcutaneous elemental mercury injection is typically not associated with systemic toxicity. This case report describes a man who developed persistent membranous nephropathy temporally associated with intentional subcutaneous elemental mercury injection.</p><p><strong>Case report: </strong>A 21-year-old man injected elemental mercury into his left forearm after experiencing worsening depression during the COVID-19 pandemic. Several months later, he sought dermatology evaluation due to nodularity at the injection site. He underwent attempted excision of what was presumed to be a left forearm lipoma, but he did not report the history of mercury injection. He subsequently developed proteinuria and was diagnosed with membranous nephropathy. Treatment with rituximab did not improve his condition, and he eventually divulged the history of mercury injection three years after the initial exposure. He underwent surgical excision of the mercury deposits, left forearm flap reconstruction, and chelation with oral succimer. Despite these interventions, his proteinuria and urine protein to creatinine ratio remained persistently elevated, consistent with ongoing membranous nephropathy.</p><p><strong>Discussion: </strong>Renal pathology is associated with mercury toxicity after dermal or inhalational exposure but is rarely reported to occur after subcutaneous injection of elemental mercury. The pathophysiology of mercury-induced membranous nephropathy may involve formation of autoantibodies and cytokines after direct renal tubular injury. Surgical excision is the primary treatment for subcutaneous mercury exposure. Chelation may be considered for patients with evidence of systemic toxicity or ongoing mercury exposure, although the optimal timing of perioperative chelation has not been defined.</p><p><strong>Conclusion: </strong>Significant systemic toxicity, including membranous nephropathy, may occur after subcutaneous mercury injection.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"355-359"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225732","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":"Multisystemic Consequences Following Oclacitinib Maleate (Apoquel^®) Overdose Ingestion in Cats and Dogs.","authors":"Leah D Swanson, Holly A Hommerding, Renee D Schmid, Lynn R Hovda","doi":"10.1007/s13181-025-01076-7","DOIUrl":"10.1007/s13181-025-01076-7","url":null,"abstract":"<p><strong>Introduction: </strong>Pet Poison Helpline^® (PPH), a 24/7 international animal poison control center has observed a significant and rising number of exposures detailing multisystemic signs and adverse outcomes associated with oclacitinib maleate (Apoquel^®) overdoses.</p><p><strong>Methods: </strong>Pet Poison Helpline^® utilizes a proprietary electronic database which was retrospectively reviewed for oclacitinib maleate exposure information from January 2022 to November 2024 through their toxicology consultation service.</p><p><strong>Results: </strong>Market entry and distribution of chewable oclacitinib maleate occurred in October 2023. In the year following, there was a 299% increase in calls to PPH from inadvertent exposure. Of the 417 symptomatic cases reviewed, 63 cases were symptomatic cats, and 354 cases were symptomatic dogs. Multi-system organ involvement, including neurological, gastrointestinal, cardiovascular, renal, hepatic, and ocular signs, as well as laboratory abnormalities were observed.</p><p><strong>Discussion: </strong>Introduction of a chewable formulation in October 2023 likely attributed to a marked increase in exposures. Accompanying this rise in overdose exposures, a notable escalation in multisystemic effects was seen, including neurological, gastrointestinal signs, cardiovascular disturbances, ocular irregularities, renal and hepatic injury, and complete blood count (CBC) hematological abnormalities. Treatment is largely symptomatic and supportive therapy.</p><p><strong>Conclusion: </strong>The increased occurrence of exposures to oclacitinib maleate underscores necessity for additional research of JAK inhibitors in animals to better understand and address oclacitinib maleate toxicosis.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"360-365"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009048","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":"A Case of Angiotensin II Utilization for Refractory Shock in a Polysubstance Overdose.","authors":"Brian W Gilbert, Charles S Wilson, Nicholas Kim, Tessa R Cox, Melissa V Ortiz","doi":"10.1007/s13181-025-01080-x","DOIUrl":"10.1007/s13181-025-01080-x","url":null,"abstract":"<p><p>Amlodipine and quetiapine are widely utilized medications that are generally well-tolerated at therapeutic doses. However, overdoses can lead to severe, life-threatening cardiovascular effects, leading to refractory vasoplegia. The management of poly-ingestion overdoses is challenging and often requires aggressive, multimodal treatment strategies especially when the causative agent is unknown. In this case report, a 38-year-old male intentionally ingested a large amount of amlodipine and quetiapine resulting in refractory shock despite high doses of vasopressors, calcium, and insulin therapy. After conventional therapies failed, the administration of exogenous angiotensin II (Ang II), a vasoconstrictor traditionally used for septic shock, led to a marked improvement in the patient's blood pressure and stabilization of hemodynamics. Sixty minutes after initiation of Ang II, the patient's mean arterial pressure (MAP) improved, allowing for the weaning of other vasopressors and a gradual reduction in insulin therapy. This case highlights the potential role of Ang II as a salvage therapy in polysubstance ingestions when other therapies fail.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"350-354"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187187","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":"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":"10.1007/s13181-025-01075-8","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"301-303"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204967/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Comment on Naloxone Dosing and Hospitalization for Nitazene Overdose: A Scoping Review\".","authors":"Jonathan Berger, Mohamed Jalloh, Alec Severe, Alex Manini","doi":"10.1007/s13181-025-01071-y","DOIUrl":"10.1007/s13181-025-01071-y","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"372-373"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007165","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":"The Value of Medical Toxicologists.","authors":"Paul M Wax, Tracy M Kolian, Anthony F Pizon","doi":"10.1007/s13181-025-01082-9","DOIUrl":"10.1007/s13181-025-01082-9","url":null,"abstract":"<p><p>Poisoning is a major public health issue and one of the leading causes of injury related death in the US. Poisonings result from intentional or unintentional use of prescription drugs or illicit overdose including opioids, inhalation of toxic fumes, ingestion of contaminated food or drinking water, and envenomations. The cost of poisonings to US health care is large, especially when considering the costs of addiction and illicit opioids. As specially trained physicians, medical toxicologists play a major role in the treatment and care of poisoned patients while improving patient care, population health, and health care systems related to chemical exposures and poisonings including prevention. They also play a major role in the opioid epidemic and in caring for patients with opioid use disorder and substance use disorders more broadly. Regardless of these important roles, the recognition and knowledge of the value that medical toxicologists provide to health and the health care system is limited. As reimbursement becomes linked to outcome in a value-based care (VBC) market, medical toxicologists must continue to demonstrate their value to stakeholders. The American College of Medical Toxicology (ACMT) has long recognized the need for medical toxicologists to articulate their value and to advocate for themselves, the profession, and for the patients they serve. To that end, modeling infectious disease (ID) efforts in establishing value for their specialty, this paper outlines the 'value' of medical toxicologists in improving patient outcomes, and their positive impact on population health and health care systems.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"336-342"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326069","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":"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":"10.1007/s13181-025-01073-w","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"366-367"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204964/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biostatistics and Epidemiology for the Toxicologist: Miscellaneous Bias - Confirmation, Non-Response, Survivorship, and Selection.","authors":"Alexandra Ortego, Sanjay Mohan, Mark K Su","doi":"10.1007/s13181-025-01083-8","DOIUrl":"10.1007/s13181-025-01083-8","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"343-345"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326068","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":"Allison R Font, Michael O Khoury, Christopher D Riviello, Michael F Singer","doi":"10.1007/s13181-025-01079-4","DOIUrl":"https://doi.org/10.1007/s13181-025-01079-4","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120032","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}