Journal of Medical Toxicology最新文献

{"title":"Toxicity and Adverse Effects in Clozapine-Related Presentations to a Medical Toxicology Service in Western Sydney.","authors":"Pramod Chandru,&nbsp;Naren Gunja","doi":"10.1007/s13181-023-00963-1","DOIUrl":"10.1007/s13181-023-00963-1","url":null,"abstract":"<p><strong>Background: </strong>Clozapine is an anti-psychotic agent, reserved for treatment-resistant schizophrenia, with demonstrated efficacy in an otherwise therapeutically challenging patient population. We aimed to review the full spectrum casemix of clozapine presentations to our tertiary toxicology service.</p><p><strong>Methods: </strong>In this retrospective study, we reviewed consecutive clozapine related toxicity presentations to a tertiary medical toxicology inpatient and consultation service-including deliberate self-poisoning (DSP), adverse drug reaction (ADR), recreational use, and therapeutic misadventure over a 10-year period from 2011 to 2021. Data were extracted for demographics, ingested dose, exposure characteristics, and patient outcome.</p><p><strong>Results: </strong>We identified 83 patients with clozapine-related presentations over the 10-year period. Twenty-two patients were excluded. Of the remaining 61 patients, 28 patients presented with DSP, 20 patients with accidental overdose, and 13 patients with an ADR; no patients presented with recreational use. It was noted that ADRs were largely idiosyncratic reactions and not always related to dose adjustments. In the context of therapeutic misadventure and DSP, we noted that a lower mean dose achieved a higher poison severity score (PSS) in clozapine-naive patients when compared to those patients on regular clozapine.</p><p><strong>Conclusions: </strong>The presentation of clozapine-related toxicity differs depending on the modality of ingestion, whether DSP, accidental, or as a result of ADR. Patients naive to clozapine therapy tend to experience higher PSS with lower doses ingested either in a deliberate self-poisoning or accidental ingestion context. This is likely due to tolerance to the sedative properties of clozapine. No patients manifested clinical toxicity greater than 8 hours after ingestion, with an observation period of 6 hours accurately identifying toxicity in most patients.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10071893","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":"Cell-Free DNA as a Biomarker in a Rodent Model of Chlorpyrifos Poisoning Causing Mitochondrial Dysfunction.","authors":"Shih-Han Kao,&nbsp;Frances S Shofer,&nbsp;John C Greenwood,&nbsp;Oladunni Alomaja,&nbsp;Abhay Ranganathan,&nbsp;Sarah Piel,&nbsp;Clementina Mesaros,&nbsp;Samuel S Shin,&nbsp;Johannes K Ehinger,&nbsp;Todd J Kilbaugh,&nbsp;David H Jang","doi":"10.1007/s13181-023-00956-0","DOIUrl":"10.1007/s13181-023-00956-0","url":null,"abstract":"<p><strong>Introduction: </strong>Organophosphates (OPs) are a major public health problem worldwide due to ease of access and high toxicity lacking effective biomarkers and treatment. Cholinergic agents such as OPs and carbamates are responsible for many pesticide-related deaths. While the inhibition of AChE is thought to be the main mechanism of injury, there are other important pathways that contribute to the overall toxicity of OPs such as mitochondrial dysfunction. An existing gap in OP poisoning are biomarkers to gauge severity and prognosis. Cell-free DNA (cfDNA) are novel biomarkers that have gained increased attention as a sensitive biomarker of disease with novel use in acute poisoning. This study investigates alterations in cerebral mitochondrial function in a rodent model of chlorpyrifos poisoning with the use of cfDNA as a potential biomarker.</p><p><strong>Methods: </strong>Twenty rodents were divided into two groups: Control (n = 10) and Chlorpyrifos (n = 10). Chlorpyrifos was administered through the venous femoral line with a Harvard Apparatus 11 Elite Syringe pump (Holliston, MA, USA) at 2 mg/kg. Animals were randomized to receive chlorpyrifos versus the vehicle (10% DMSO) for 60 min which would realistically present an acute exposure with continued absorption. At the end of the exposure (60 min), isolated mitochondria were measured for mitochondrial respiration along with measures of acetylcholinesterase activity, cfDNA, cytokines and western blot.</p><p><strong>Results: </strong>The Chlorpyrifos group showed a significant decrease in heart rate but no change in the blood pressure. There was a significant increase in bulk cfDNA concentrations and overall decrease in mitochondrial respiration from brain tissue obtained from animals in the Chlorpyrifos group when compared to the Control group with no difference in acetylcholinesterase activity. In addition, there was a significant increase in both IL-2 and IL-12 in the Chlorpyrifos group.</p><p><strong>Conclusions: </strong>In our study, we found that the total cfDNA concentration may serve as a more accurate biomarker of OP exposure compared to acetylcholinesterase activity. In addition, there was an overall decrease in cerebral mitochondrial function in the Chlorpyrifos group when compared to the Control group.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10274636","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 Toxicology Investigators Consortium 2022 Annual Report.","authors":"Alexandra M Amaducci,&nbsp;Sharan L Campleman,&nbsp;Shao Li,&nbsp;Dana L Karshenas,&nbsp;Meghan B Spyres,&nbsp;Lynn A Farrugia,&nbsp;A Min Kang,&nbsp;Rachel E Culbreth,&nbsp;Paul M Wax,&nbsp;Jeffrey Brent,&nbsp;Kim Aldy","doi":"10.1007/s13181-023-00962-2","DOIUrl":"10.1007/s13181-023-00962-2","url":null,"abstract":"<p><p>Since 2010, medical toxicology physicians from the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) have provided reports on their in-hospital and clinic patient consultations to a national case registry, known as the ToxIC Core Registry. De-identified 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 thirteenth annual report provides data from 7206 patients entered into the Core Registry in 2022 by 35 participating sites comprising 52 distinct healthcare facilities, bringing the total case count to 94,939. Opioid analgesics were the most commonly reported exposure agent class (15.9%), followed by ethanol (14.9%), non-opioid analgesic (12.8%), and antidepressants (8.0%). Opioids were the leading agent of exposure for the first time in 2022 since the Core Registry started. There were 118 fatalities (case fatality rate of 1.6%). Additional descriptive analyses in this annual report were conducted to describe the location of the patient during hospitalization, telemedicine consultations, and addiction medicine treatments.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112476","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":"Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection.","authors":"Ari B Filip,&nbsp;Christopher W Farnsworth,&nbsp;Michael E Mullins,&nbsp;Bridgit O Crews,&nbsp;Jeffrey A Kraut","doi":"10.1007/s13181-023-00967-x","DOIUrl":"10.1007/s13181-023-00967-x","url":null,"abstract":"<p><strong>Introduction: </strong>Ethylene glycol (EG) is a frequently considered toxicant in poisoned patients. Definitive diagnosis relies on gas chromatography (GC), but this is unavailable at most hospitals. A glycerol dehydrogenase (GDH)-based assay rapidly detects EG. A rapid turnaround time and wide availability of necessary instrumentation suggest this method could facilitate the rapid detection of EG.</p><p><strong>Methods: </strong>This is a prospective, observational analysis of banked, remnant serum samples submitted to the laboratory of a large, multi-hospital healthcare system. Samples were submitted over a 12-month period for the explicit purpose of testing for suspected EG ingestion. All samples underwent GC and the GDH-based assay.</p><p><strong>Results: </strong>Of the 118 analyzed samples, 88 had no EG detected by GC, and 30 were \"positive.\" At the manufacturer's threshold of 6 mg/dL EG, there was 100% (95%CI; 88.7-100) positive percent agreement (PPA) and 98% (92.1-99.6) negative percent agreement (NPA). Adjusted to a threshold of 9 mg/dL, both the PPA and NPA were 100%. Deming regression of the observed concentrations revealed a slope of 1.16 (1.01 to 1.32) and intercept of -5.3 (-8.9 to -1.7).</p><p><strong>Conclusions: </strong>The GDH assay provides a sensitive and specific method for the detection and quantification of EG that is comparable to a GC-based method. More widespread use of this rapid, inexpensive assay could improve the care of patients with suspected toxic alcohol exposure. Further study is needed to evaluate the test performance in real-time patient treatment decisions.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10258699","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":"Correction to: A Multi-Omic Mosaic Model of Acetaminophen Induced Alanine Aminotransferase Elevation.","authors":"Andrew A Monte,&nbsp;Alexis Vest,&nbsp;Julie A Reisz,&nbsp;Danielle Berninzoni,&nbsp;Claire Hart,&nbsp;Layne Dylla,&nbsp;Angelo D'Alessandro,&nbsp;Kennon J Heard,&nbsp;Cheyret Wood,&nbsp;Jack Pattee","doi":"10.1007/s13181-023-00957-z","DOIUrl":"10.1007/s13181-023-00957-z","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522543/pdf/13181_2023_Article_957.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9688609","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":"Assessing the Role of Initial Serum Calcium Concentration in Patients with Ethylene Glycol Poisoning.","authors":"Michael J Hodgman,&nbsp;Jeanna M Marraffa,&nbsp;Brian G Wiener,&nbsp;Mary Ann Howland,&nbsp;Christine Stork,&nbsp;Maria Mercurio-Zappala,&nbsp;Mark Su","doi":"10.1007/s13181-023-00958-y","DOIUrl":"10.1007/s13181-023-00958-y","url":null,"abstract":"<p><strong>Introduction: </strong>Assays for ethylene glycol (EG) with a rapid turn-around time are not routinely available. Clinicians must rely on historical features and readily available clinical tests, combined with clinical acumen, to guide the initial management of suspected EG poisoning. Hypocalcemia has been suggested as a clue supporting the diagnosis of EG poisoning in patients presenting with an unexplained high anion gap metabolic acidosis (HAGMA). A previous small study challenged this assumption.</p><p><strong>Methods: </strong>This was a retrospective case series of one state's poison control system of confirmed EG-poisoned patients between September 2017 and April 2021. The definition of EG poisoning was based on suspected EG ingestion and a serum EG concentration > 5 mg/dL. Patients who were suspected to have EG toxicity but did not have a confirmed EG concentration or the EG concentration was less than 5 mg/dL were excluded. Routine laboratory studies were recorded for all patients. Comparisons between serum calcium on presentation to presenting blood pH, bicarbonate, anion gap, and creatinine were assessed for correlation.</p><p><strong>Results: </strong>There was no correlation between the presenting calcium and either pH or creatinine. There was a weak positive correlation between the initial serum calcium and anion gap, a weak negative correlation between the initial serum calcium and bicarbonate.</p><p><strong>Conclusion: </strong>On hospital presentation, hypocalcemia was not associated with EG poisoning, even in patients with a HAGMA. A normal serum calcium on presentation does not exclude the diagnosis of EG poisoning.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9879230","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":"Christopher P Mitchell,&nbsp;Elizabeth G Shanahan","doi":"10.1007/s13181-023-00959-x","DOIUrl":"https://doi.org/10.1007/s13181-023-00959-x","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9935113","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":"Poison Centers and Pediatric Environmental Health Specialty Units: Productive Two-Way Partnerships.","authors":"Alan D Woolf, Carl R Baum, Michele Burns","doi":"10.1007/s13181-023-00942-6","DOIUrl":"10.1007/s13181-023-00942-6","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9705101","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":"Total CroFab and Anavip Antivenom Vial Administration in US Rattlesnake Envenomations: 2019-2021.","authors":"Nicklaus Brandehoff,&nbsp;Alicia Dalton,&nbsp;Claire Daugherty,&nbsp;Richard C Dart,&nbsp;Andrew A Monte","doi":"10.1007/s13181-023-00941-7","DOIUrl":"https://doi.org/10.1007/s13181-023-00941-7","url":null,"abstract":"<p><strong>Introduction: </strong>In 2018, Anavip became available for the treatment of rattlesnake envenomations in the USA. No comparisons between the treatment characteristics of patients have been made since Anavip and CroFab have both been widely available. The objective of this study was to compare the number of antivenom vials administered of CroFab and Anavip during the treatment of rattlesnake envenomations in the USA.</p><p><strong>Methods: </strong>This was a secondary analysis of rattlesnake envenomations utilizing the North American Snakebite Registry (NASBR) from 2019 through 2021. Frequencies and proportions were used to summarize demographics and baseline clinical characteristics. The primary outcome was total antivenom vials administered during treatment. Secondary outcomes included the number antivenom administration events, total treatment time, and hospital length of stay.</p><p><strong>Results: </strong>Two hundred ninety-one rattlesnake envenomations were analyzed; most occurred in the Western USA (n = 279, 96 %). One hundred one patients (35%) received only CroFab, 110 (38%) received Anavip only, and 80 (27%) received both products. The median number of vials used was 10 for CroFab, 18 for Anavip, and 20 for both antivenoms. More than one antivenom administration was necessary in thirty-nine (39%) patients that received only CroFab and 76 (69%) patients that received Anavip only. The median total treatment time was 5.5 hours for CroFab, 6.5 for Anavip, and 15.5 hours when both antivenoms were administered. All antivenom groups had a median hospital length of stay of 2 days.</p><p><strong>Conclusions: </strong>Rattlesnake envenomated patients in the Western USA treated with CroFab had fewer antivenom vials and fewer antivenom administrations compared to patients treated with Anavip.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9706767","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 Principles for the Toxicologist: The \"Testy\" Test Characteristics Part II: Positive Predictive Value and Negative Predictive Value.","authors":"Christy Williams, Barbara Elena Sahagún, Mark K Su","doi":"10.1007/s13181-023-00953-3","DOIUrl":"10.1007/s13181-023-00953-3","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065242","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}