Journal of Medical Toxicology最新文献_第4页

Diazoxide-Associated Hyperglycemia: A Critical Case Precipitating Hyperosmolar Hyperglycemic State in a Child. 二氮唑相关高血糖症：儿童高渗性高血糖症的危重病例。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2025-01-01 Epub Date: 2024-12-18 DOI: 10.1007/s13181-024-01052-7

Jennifer A Lawson, Brian Schultz

{"title":"Diazoxide-Associated Hyperglycemia: A Critical Case Precipitating Hyperosmolar Hyperglycemic State in a Child.","authors":"Jennifer A Lawson, Brian Schultz","doi":"10.1007/s13181-024-01052-7","DOIUrl":"10.1007/s13181-024-01052-7","url":null,"abstract":"Introduction: Diazoxide is the first-line treatment for children with hyperinsulinemic hypoglycemia (HI). In these cases, diazoxide raises blood glucose levels by suppressing insulin release, preventing hypoglycemia, and potentially devastating end-organ sequelae. Hyperosmolar hyperglycemic state (HHS) is an exceedingly rare side effect of diazoxide. This complication has been described in neonates and in adults, but few children.Case report: An 8-year-old female with genetic duplication of glucokinase, and consequent hyperinsulinemia, presented to the emergency department with evidence of hypovolemic shock secondary to severe dehydration with signs of encephalopathy. Point-of-care glucose was > 600 mg/dL. Additional labs were consistent with HHS complicated by acute kidney injury, sodium 106 mEq/L, potassium 2.5 mEq/L, chloride < 60 mEq/L, carbon dioxide 20 mEq/L, glucose 2105 mg/dL, BUN 107 mg/dL, and creatinine 3.99 mg/dL. The patient received aggressive fluid resuscitation and vasopressor support, and was admitted to the pediatric intensive care unit. A diazoxide level was obtained during admission revealing serum concentration previously shown to be associated with hyperglycemia.Discussion: We posit the patient was predisposed to hyperglycemia based on elevated diazoxide serum concentration. We hypothesize severe dehydration led to renal impairment, which decreased diazoxide clearance, causing worsening hyperglycemia and ultimately, HHS. The differential diagnosis also included diabetic ketoacidosis, surreptitious administration of diazoxide, spontaneous resolution of genetic condition, and malabsorption or excretory crisis but none of these adequately explained the patient's presentation. Regardless, this case highlights the potentially lethal complication of HHS as a side effect of diazoxide therapy.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"93-96"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854481","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

Emergency Department Patients Presenting after Oral versus Inhaled Cannabinoid use: A Retrospective Analysis. 急诊科患者口服和吸入大麻素后的表现：回顾性分析。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2025-01-01 Epub Date: 2024-11-29 DOI: 10.1007/s13181-024-01048-3

Tony Zitek, Christopher Raciti, Alvin Nguyen, Valentina Roa, Edward Lopez, Gregory Oliva, David A Farcy

{"title":"Emergency Department Patients Presenting after Oral versus Inhaled Cannabinoid use: A Retrospective Analysis.","authors":"Tony Zitek, Christopher Raciti, Alvin Nguyen, Valentina Roa, Edward Lopez, Gregory Oliva, David A Farcy","doi":"10.1007/s13181-024-01048-3","DOIUrl":"10.1007/s13181-024-01048-3","url":null,"abstract":"Introduction: Cannabinoid-related emergency department (ED) visits are increasing, yet little has been published about how the route of cannabinoid use (inhaled versus oral) affects ED presentations. We sought to compare ED visits from inhaled versus oral cannabinoid use.Methods: We performed a retrospective cohort study using ED patients with a cannabinoid related diagnosis from January 1, 2020 and May 31, 2023 from a single hospital system in Florida. We performed manual chart review to categorize visits into \"unlikely\", \"possibly\", or \"highly likely\" to be due to acute cannabinoid use. For our primary analysis, we used the \"highly likely\" group to compare the presentations and outcomes of patients who had used oral cannabinoids versus inhaled. Our primary outcome was hospital admission.Results: We deemed 303 patient visits \"highly likely\" to be from acute cannabinoids: 59 (19.5%) inhaled and 244 (80.5%) oral. Zero patients in the inhaled group were admitted compared to 15 (6.2%) in the oral group, a difference of 6.2% (95% CI 3.1-9.2%), p = 0.05. Additionally, 65 (26.7%) of the oral group reported using cannabinoids unintentionally including 8 housekeepers who ate food products left by hotel guests. Comparatively, 4 (6.8%) of the inhaled group unintentionally used cannabinoids (difference 19.9% [95% CI 11.4-28.3]).Conclusions: Most patients who presented to the ED for the effects of acute cannabinoids had used them orally. Compared to patients who had inhaled cannabinoids, those who used them orally required more ED diagnostic resources and were more likely to be admitted to the hospital for additional evaluation or treatment. From a public health perspective, increased regulation of edible cannabinoid products may be needed.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"15-24"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750844","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

In Response to Comment on "Safety of Physostigmine for Pediatric Antimuscarinic Poisoning". 回应对 "小儿抗心绞痛药物中毒的 Physostigmine 安全性 "的评论。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1007/s13181-024-01023-y

Kristine Nañagas, Sarah Huber, Robert Avera, Shannon Penfound, Adam Overberg

引用次数: 0

Entering Medical Toxicology Fellowship from a Non-Traditional Residency Background. 从非传统住院医师背景进入医学毒理学研究员职位。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-08-12 DOI: 10.1007/s13181-024-01028-7

Matthew Robert Dernbach

引用次数: 0

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

The Toxicology Investigators Consortium 2023 Annual Report. 毒理学研究者联盟 2023 年度报告。

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-09-10 DOI: 10.1007/s13181-024-01033-w

Adrienne Hughes, Alexandra Amaducci, Sharan L Campleman, Shao Li, Mari Costantini, Meghan B Spyres, Hannah Spungen, Jessica Kent, Alyssa Falise, Rachel Culbreth, Paul M Wax, Jeffery Brent, Kim Aldy

{"title":"The Toxicology Investigators Consortium 2023 Annual Report.","authors":"Adrienne Hughes, Alexandra Amaducci, Sharan L Campleman, Shao Li, Mari Costantini, Meghan B Spyres, Hannah Spungen, Jessica Kent, Alyssa Falise, Rachel Culbreth, Paul M Wax, Jeffery Brent, Kim Aldy","doi":"10.1007/s13181-024-01033-w","DOIUrl":"10.1007/s13181-024-01033-w","url":null,"abstract":"Since 2010, the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) has maintained the ToxIC Core Registry, a national case registry of in-hospital and clinic patient consultations submitted by medical toxicology physicians. Deidentified patient data entered into the registry includes patient demographics, reason for medical toxicology evaluation, exposure agents, clinical signs and symptoms, treatments and antidotes administered, and mortality. This fourteenth annual report provides data from 7392 patients entered into the Core Registry in 2023 by 36 participating sites comprising 61 distinct healthcare facilities, bringing the total case count to 102331 between 2010 and 2023. Ethanol was the most commonly reported exposure agent class (24.4%), followed by opioids (22.7%), non-opioid analgesics (16.7%), and antidepressants (11.7%). For the first time since the registry's initiation, in 2023, ethanol was the leading agent of exposure. There were 98 fatalities (case fatality rate of 1.3%). Additional descriptive analyses in this annual report were conducted to describe the reasons for medical toxicology consultation by age in 2023, and yearly trends for opioid and psychoactive exposures, physostigmine and rivastigmine treatments, and acetaminophen exposures treated with fomepizole.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"350-380"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289439","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

Intravenous Acetylcysteine: What Should Replace the Prescott "Three-Bag" Protocol? 静脉注射乙酰半胱氨酸：如何取代普雷斯科特 "三袋 "方案？

IF 2.5 4区医学

Journal of Medical Toxicology Pub Date : 2024-10-01 Epub Date: 2024-07-15 DOI: 10.1007/s13181-024-01017-w

Kim-Long R Nguyen, Michael E Mullins

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