Journal of Medical Toxicology最新文献

{"title":"Trends in Fomepizole Use for Acetaminophen Poisoning in the United States; 2013-2024.","authors":"Mitchell D'Aloia, Dale Smith, Randy Boley, Emily Schamber, Dillon Thorpe, Trevonne M Thompson, Neeraj Chhabra","doi":"10.1007/s13181-025-01091-8","DOIUrl":"10.1007/s13181-025-01091-8","url":null,"abstract":"<p><strong>Background: </strong>Fomepizole has been suggested as adjunctive therapy for severe acetaminophen poisoning though clinical efficacy is unknown. We sought to determine trends in the use of fomepizole for acetaminophen poisoning.</p><p><strong>Methods: </strong>This is a cross-sectional analysis of hospitalized patients with acetaminophen poisoning from January 2013 through December 2024, using Epic Cosmos, a research database of 298 million patients nationally. We identified encounters involving acetaminophen poisoning by International Classification of Diseases, version 10 (ICD-10-CM) code. Data extracted included administration of N-acetylcysteine (NAC) and fomepizole, demographic data, and outcomes of death and liver transplantation. Data were analyzed using descriptive statistics to identify trends and multivariable logistic regression to determine associations with death.</p><p><strong>Results: </strong>There were 114,111 hospital encounters involving acetaminophen poisoning with 64,957 (56.92%) receiving NAC, and 1,552 (1.36%) receiving fomepizole. In 2013, 0.44% of NAC-treated acetaminophen poisoning cases also received fomepizole. This rose to 6.27% in 2024. From 2013 to 2019, the proportion of NAC-treated acetaminophen cases receiving fomepizole was stable, but from 2019 to 2024, there was a 1029.64% increase in fomepizole use. Regression modeling indicated increased odds for death (OR = 5.88, aOR = 5.32 [95% CI: 4.52, 6.27]) among those who received fomepizole in addition to NAC, indicating increased fomepizole use in patients with severe toxicity.</p><p><strong>Conclusion: </strong>Fomepizole use in acetaminophen poisoning has risen dramatically since 2019, particularly among patients at highest risk for death and liver transplantation. It is of critical importance to determine the efficacy of fomepizole for acetaminophen poisoning.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"404-408"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760359","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":"Patient Centered Outcomes Research in Medical Toxicology.","authors":"Rachel Culbreth, Maryann Mazer-Amirshahi, Mark B Mycyk, Alyssa Falise, Jeffrey Brent, Kim Aldy, Paul Wax","doi":"10.1007/s13181-025-01092-7","DOIUrl":"10.1007/s13181-025-01092-7","url":null,"abstract":"<p><p>In recent years, medical toxicology research has evolved from relying heavily on case reports and case series to more rigorous methodologies, including randomized controlled trials and high-quality systematic reviews. Engaging patients as partners in research is increasingly recognized as a promising approach to generate evidence that is trusted, meaningful, and useful to clinicians, policymakers, as well as patients and community members. The American College of Medical Toxicology (ACMT) recently conducted a patient engagement project to promote meaningful research engagement with patients who have lived experiences with overdoses. This review intends to provide an overview of patient-centered outcomes research (PCOR) for the field of medical toxicology, which includes study design considerations, planning for recruitment of patients and stakeholders, and supporting sustainable partnerships.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"414-420"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764987","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 \"Vasopressor Use, Critical Care Management and Outcomes in Dihydropyridine Calcium Channel Blocker Toxicity\".","authors":"Amar Chakraborty, Jenna LeRoy, Sean Boley","doi":"10.1007/s13181-025-01085-6","DOIUrl":"10.1007/s13181-025-01085-6","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"439-440"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600734","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: Variable Toxicity by β-Blocker Class in Intentional Overdoses Reported to U.S. Poison Centers.","authors":"C James Watson, Michael C Monuteaux, Katherine B Tang, Michele M Burns","doi":"10.1007/s13181-025-01094-5","DOIUrl":"10.1007/s13181-025-01094-5","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"446"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957721","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 Mind-Blowing Ingestion: Intentional Plastic Explosive Consumption Resulting in Seizures.","authors":"Seth Jones, Irene Li, Jasmine Gale, Elliott Fox, Stacy Weisberg, Stephanie Carreiro","doi":"10.1007/s13181-025-01084-7","DOIUrl":"10.1007/s13181-025-01084-7","url":null,"abstract":"<p><strong>Introduction: </strong>C4 is a plastic explosive commonly used in military applications, and is predominantly composed of cyclonite or RDX (Royal Demolition Explosive). C4 toxicity is a documented but not commonly known cause of altered mental status and recurrent seizures.</p><p><strong>Case reports: </strong>We describe two cases of military personnel who ingested C4 as part of a hazing ritual who presented to the emergency department with witnessed seizure, tremor and petechial rash. One of the patients had a second witnessed seizure within hours of ingestion. They were treated with intravenous benzodiazepines acutely, then with levetiracetam for 48 hours. Both patients were observed in the intensive care unit and discharged with no neurologic sequelae.</p><p><strong>Discussion: </strong>C4 is a common military-grade explosive containing cyclonite which functions as a non-competitive, reversible GABAA antagonist and a rare but clinically significant cause of altered mental status and seizures when ingested. Management is primarily supportive with airway protection and treatment with GABAergic medication.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"434-438"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600733","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":"Humanities and Medical Toxicology: A Reflection.","authors":"Matthew Robert Dernbach","doi":"10.1007/s13181-025-01097-2","DOIUrl":"10.1007/s13181-025-01097-2","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"421-424"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199755","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":"Fab or F(ab')₂ Antivenom: Which Should we use for North American Crotalids?","authors":"Mackenzie McKnight, Michael E Mullins","doi":"10.1007/s13181-025-01098-1","DOIUrl":"10.1007/s13181-025-01098-1","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"443-445"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080762","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":"Antivenom Choice in the Management of Snake Envenomation.","authors":"Meghan B Spyres, Anne-Michelle Ruha","doi":"10.1007/s13181-025-01100-w","DOIUrl":"10.1007/s13181-025-01100-w","url":null,"abstract":"","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"375-376"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12511495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137880","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":"Analysis of Acute Hypersensitivity Reactions by Antivenom Type and Geographic Location in the North American Snake Bite Registry (NASBR).","authors":"Timlin Glaser, Rachel Culbreth, Erica L Liebelt, Anne-Michelle Ruha, Spencer Greene, Sharan Campleman, Meghan B Spyres","doi":"10.1007/s13181-025-01078-5","DOIUrl":"10.1007/s13181-025-01078-5","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding acute hypersensitivity reactions (AHRs) to the snakebite antivenoms Crotalidae Polyvalent Immune Fab (ovine) (Fab) and Crotalidae Immune F(ab')₂ (equine) (Fab2) supports no differences. However, larger studies may not account for geographic differences. Recent data suggest a correlation with alpha-gal syndrome (AGS). This study investigates the incidence of AHRs in patients receiving Fab2, Fab, or both, with a focus on U.S. states with higher AGS prevalence.</p><p><strong>Methods: </strong>This is an analysis of native pit viper envenomations reported to the Toxicology Investigators Consortium (ToxIC) North American Snakebite Registry (NASBR) between January 1, 2018, and December 31, 2023. Patients administered Fab2 or Fab on index hospitalization were included. High-AGS and low-AGS regions were defined according to epidemiologic data. The primary outcome was incidence of AHRs after administration of antivenom overall and in high-AGS vs. low-AGS states. Bivariate statistical tests and 95% confidence intervals (CI) for proportions were computed.</p><p><strong>Results: </strong>A total of 1051 patients were identified. Fab2 was administered in 439 cases, and Fab was administered in 722 cases for a total of 1161 cases. Fifty AHRs were analyzed. AHRs were more common with Fab2 (6.6%; 95% CI: 4.6%, 9.3%) compared to Fab (2.9%; 95% CI: 1.9%, 4.4%) in the overall NASBR population (p = 0.004). In low-AGS states, there were 25/421 (5.9%; 95% CI: 4.1%, 8.6%) Fab2 AHRs vs. 16/569 (2.8%; 95% CI: 1.7%, 4.5%) Fab AHRs (p = 0.02). In high-AGS states, the Fab2 group had 4/18 (22.2%; 95% CI: 9.0%, 45.2%) AHRs vs. 5/153 (3.3%; 95% CI: 1.4%, 7.4%) in the Fab group (p = 0.008).</p><p><strong>Conclusion: </strong>In this ToxIC NASBR study, administration of Fab2 was associated with a higher incidence of AHRs compared to Fab. The difference was especially notable in states with a higher prevalence of AGS.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"312-319"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063831","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":"Blood Cells as a Cellular Biomarker for Mitochondrial Function in a Experimental Model of Acute Carbon Monoxide Poisoning with Treatment.","authors":"Devesh Bungatavula, John C Greenwood, Frances S Shofer, Guthrie Buehler, Shih-Han Kao, Matthew Kelly, Samuel S Shin, Johannes K Ehinger, Todd J Kilbaugh, David H Jang","doi":"10.1007/s13181-025-01077-6","DOIUrl":"10.1007/s13181-025-01077-6","url":null,"abstract":"<p><strong>Introduction: </strong>Carbon monoxide (CO) is a leading cause of environmental poisoning in the United States with substantial mortality and morbidity. The mechanism of CO poisoning is complex and includes hypoxia, inflammation, and mitochondrial dysfunction. Currently both biomarkers and therapies for CO poisoning are limited and require new approaches.</p><p><strong>Methods: </strong>Rats (~ 300 g) were divided into four groups of ten rodents per group (exposure): Control (room air), CO-400 (400 ppm), CO-1000 (1000 ppm) and CO-2000 (2000 ppm). Rodents received the assigned exposure through a secured tracheotomy tube over 120 min followed by 30 min of re-oxygenation at room air for a total of 150 min. Five additional rodents in each group were administered a succinate prodrug (NV354) at the start of exposure for the duration of the experiment until the reoxygenation period as separate experiments. Cortical brain tissue and whole blood were obtained for mitochondrial respiration. Stored plasma and snap frozen tissue stored at -80^oC were used to obtain protein quantification with Western Blotting.</p><p><strong>Results: </strong>All animals in the Sham, CO-400, and CO-1000 groups survived until the end of the exposure period; no animals in the CO-2000 groups survived the exposure and were counted as attrition. We observed a dose-dependent decrease in key respiratory states in both isolated brain mitochondria and peripheral blood mononuclear cells (PBMCs), and, PBMCs respiration more positively correlated with isolated brain mitochondria when compared to carboxyhemoglobin (COHb). There was no significant difference in mitochondrial respiratory states in animals treated with NV354 compared to the untreated group.</p><p><strong>Conclusions: </strong>The primary findings from this study include: (1) A dose-dependent decrease with key respiration states with higher concentrations of CO; (2) PBMCs had a higher correlation to isolated brain mitochondria respiration when compared to COHb; and (3) there was no treatment effect with the use of NV354.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":" ","pages":"327-335"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024555","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}