Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Minimum tetrahydrocannabinol dose that produces severe symptoms in children.","authors":"Robert G Hendrickson, Keahi M Horowitz, Colleen P Cowdery","doi":"10.1080/15563650.2025.2562305","DOIUrl":"https://doi.org/10.1080/15563650.2025.2562305","url":null,"abstract":"<p><strong>Introduction: </strong>More than one-half of the United States have legalized medical or retail cannabis. Pediatric exploratory ingestions commonly involve children who ingest edible tetrahydrocannabinol products. Cannabis product package sizes and contents vary considerably. Determining the rate of severe symptoms in children who ingest specific doses of tetrahydrocannabinol products may help guide education and regulation.</p><p><strong>Methods: </strong>We searched the Oregon Poison Center records for a three-year period and included cases that were human, age <6 years old, ingestion, and single-substance edible tetrahydrocannabinol products. Exclusion criteria were incomplete symptom or outcome data, no follow up, and cases without a reliable report of the dose ingested.</p><p><strong>Results: </strong>One-hundred thirty-two cases met inclusion and exclusion criteria. Sixty-one children had tetrahydrocannabinol ingestions that were >30 mg, 28% of whom developed severe symptoms and 84% had moderate/major effects. Central nervous system depression was reported in 66% and respiratory depression was reported in 17% of patients who ingested >30 mg of tetrahydrocannabinol.</p><p><strong>Discussion: </strong>These data may be helpful in developing risk reduction education to mitigate harms from pediatric exploratory ingestions of tetrahydrocannabinol edibles.</p><p><strong>Conclusion: </strong>Children who ingest >30 mg tetrahydrocannabinol in edibles had a higher risk of respiratory depression, central nervous system depression, hypotension, and severe symptoms.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dazed and confused: variability in reported and measured tetrahydrocannabinol content in cannabis edibles.","authors":"Laura Lee Beneke, Patrick B Kyle, J Barnes Benton, Matthew Maready","doi":"10.1080/15563650.2025.2559183","DOIUrl":"https://doi.org/10.1080/15563650.2025.2559183","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing popularity of edible cannabis products for both recreational and medicinal use has raised concerns regarding the accuracy of product labeling, particularly regarding Δ8-tetrahydrocannabinol and Δ9-tetrahydrocannabinol content. This study aimed to evaluate the accuracy of package-labeled tetrahydrocannabinol content in cannabis edibles by comparing it to laboratory-measured Δ8-tetrahydrocannabinol and Δ9-tetrahydrocannabinol amounts.</p><p><strong>Methods: </strong>A total of 12 cannabis edible packages, purchased from local dispensaries and convenience stores in Jackson, Mississippi, were analyzed using gas chromatography-mass spectrometry to quantify cannabidiol, Δ8-tetrahydrocannabinol and Δ9-tetrahydrocannabinol content.</p><p><strong>Results: </strong>The results revealed significant discrepancies, with products containing Δ8-tetrahydrocannabinol and Δ9-tetrahydrocannabinol contents ranging from 288 mg less to 5,491 mg more than those advertised on the packaging and no cannabidiol detected. Additionally, the advertised versus measured contents of Δ8-tetrahydrocannabinol differed by 1,542 mg, 719 mg, and 5,491 mg in three products of the same brand.</p><p><strong>Discussion: </strong>These discrepancies highlight a persistent lack of standardization and quality control in the cannabis edible industry, which could have serious implications for consumer safety, especially in pediatric cases of unintentional ingestion.</p><p><strong>Conclusion: </strong>Measured amounts of Δ8-tetrahydrocannabinol and Δ9-tetrahydrocannabinol were inconsistent with package labels. We believe that these findings emphasize the need for stricter regulatory oversight and standardized testing methods to ensure accurate labeling and mitigate risks associated with cannabis edibles.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardio-pulmonary arrest in a patient revived with naloxone following reported use of 7-hydroxymitragynine.","authors":"Mallory K Pullman, Siva Rama Raju Kanumuri, Juan Francisco Leon, Stephen J Cutler, Christopher R McCurdy, Abhisheak Sharma","doi":"10.1080/15563650.2025.2565428","DOIUrl":"https://doi.org/10.1080/15563650.2025.2565428","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe lead poisoning from an old ceramic carafe exacerbated by an acidic beverage.","authors":"Katrin Romanek, Florian Eyer","doi":"10.1080/15563650.2025.2564208","DOIUrl":"https://doi.org/10.1080/15563650.2025.2564208","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A technical report of downstream cerebrospinal fluid lavage for tranexamic acid intrathecal toxicity.","authors":"Callum Dewar, Danielle Dang, Melissa Meister, April Cournoyer, Emily Gunnells, Dan Dinescu, Mohammed Al-Dulaimi, Mahesh Shenai, Nilesh Vyas","doi":"10.1080/15563650.2025.2564886","DOIUrl":"https://doi.org/10.1080/15563650.2025.2564886","url":null,"abstract":"<p><strong>Introduction: </strong>Iatrogenic tranexamic acid central nervous system toxicity resulting from intrathecal injection is a rare event with a high case fatality rate. This technical report documents the success of downstream cerebrospinal fluid lavage in a patient presenting in status epilepticus following inadvertent intrathecal tranexamic acid injection.</p><p><strong>Technique: </strong>The combination of external ventricular drain and lumbar drain placement was utilized for near continuous cerebrospinal fluid lavage to treat intrathecal tranexamic toxicity. Warmed sterile preservative-free normal saline is irrigated in eight 10 mL aliquots over 20 min (total 80 mL/20 min) every hour for 22 h through the external ventricular drain, with simultaneous aspiration through the lumbar drain to maintain consistent cerebrospinal fluid volume and pressure. No elevations in intracranial pressure recordings were noted during the 22 h lavage period and resulted in seizure control and normalization of the patient's neurologic examination.</p><p><strong>Discussion: </strong>The implementation of downstream lavage through two points of cerebrospinal fluid access may lead to reduction in mortality rates of tranexamic acid and other central nervous system toxicities. Though demanding on neurosurgery team resources, continuous cerebral spinal fluid lavage had the potential to be a lifesaving technique.</p><p><strong>Conclusion: </strong>This regimen can be considered for these rare but life-threatening cases of tranexamic acid neurotoxicity in which the risks of hemorrhage and infection is outweighed by the potential benefits of cerebrospinal fluid dilution.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of pesticide exposures reported to the Moroccan Poison Control and Pharmacovigilance Center between 1980 and 2021.","authors":"Imane Iken, Rhalem Naima, Hanane Chaoui, Narjis Badrane, Mohammed Abdessadek, Abdelmajid Soulaymani, Rachida Soulaymani","doi":"10.1080/15563650.2025.2555979","DOIUrl":"https://doi.org/10.1080/15563650.2025.2555979","url":null,"abstract":"<p><strong>Introduction: </strong>Acute pesticide exposure is a major concern in Morocco. Pesticides include herbicides, rodenticides, insecticides, and may include unapproved or illegally imported and/or utilized substances. Pesticides can be hazardous and acute intentional exposures can cause death. This study aims to assess the disease burden associated with pesticide exposure as reported to the Moroccan Poison Control and Pharmacovigilance Center, and to identify risk factors for mortality.</p><p><strong>Materials and methods: </strong>We performed a retrospective analysis of all pesticide exposure cases reported to our poison center between 1980 and 2021. Data were collected through passive and active surveillance. We collected substance data, demographic data, signs and symptoms of toxicity, Poisoning Severity Score and assessed risk factors for exposures and death. Analyses were performed using Excel and SPSS.</p><p><strong>Results: </strong>We identified 26,136 cases over 42 years (annual average: 594 with a notable increase over time). We could not identify a specific substance in 72% of cases. When a substance was identified, malathion (18%), alpha-chloralose (17%), and metal phosphides (12%) were the most common. Intentional exposures and exposures to metal phosphides had higher mortality risks.</p><p><strong>Discussion: </strong>Morocco has a high burden of pesticide-related exposures and certain substances and demographics are higher risk. Targeted interventions and regulations may improve disease burden. The true incidence is likely undercounted.</p><p><strong>Conclusion: </strong>In this analysis, we found exposures to pesticides were common and certain substances were more likely to cause death, with metal phosphides and organophosphate insecticides appearing to be most lethal.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of the Tanta University Risk Model for predicting clinical outcomes in ICU patients with acute drug poisoning.","authors":"Guangyao Yang, Qifang Shi, Ying Xu","doi":"10.1080/15563650.2025.2555970","DOIUrl":"https://doi.org/10.1080/15563650.2025.2555970","url":null,"abstract":"<p><strong>Introduction: </strong>The Tanta University Risk Model has been externally validated for predicting intensive care unit admission in patients with acute poisoning, but its performance for intensive care unit outcomes has not been evaluated.</p><p><strong>Methods: </strong>Adult patients with acute drug poisoning admitted to the intensive care unit were identified from the Medical Information Mart for Intensive Care IV database. Model performance for prolonged intensive care unit stay and 30 day mortality was evaluated using area under the receiver operating characteristic curve, sensitivity, and specificity.</p><p><strong>Results: </strong>Among 1,329 patients, the median intensive care unit stay was 1.70 days, and the 30 day mortality was 6.5%. Stays of 2 days, 4 days, and 7 days or longer occurred in 38.8%, 15.5%, and 6.7% of patients, respectively. The model performed best for predicting stays of 7 days or longer (area under the curve = 0.837, 95% CI: 0.790-0.884) and moderately for 30 day mortality (area under the curve = 0.709, 95% CI: 0.645-0.774).</p><p><strong>Conclusion: </strong>The Tanta University Risk Model predicts intensive care unit outcomes in acute drug poisoning, particularly prolonged stays of 7 days or longer, supporting its use as a practical clinical decision tool.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-4"},"PeriodicalIF":3.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selenium poisoning from consumption of contaminated wheat: a case series from rural Maharashtra, India.","authors":"Himmatrao Saluba Bawaskar, Pramodini Himmatrao Bawaskar","doi":"10.1080/15563650.2025.2558208","DOIUrl":"https://doi.org/10.1080/15563650.2025.2558208","url":null,"abstract":"<p><strong>Introduction: </strong>We report acute alopecia linked to selenium-contaminated wheat in rural Maharashtra, India. After local media reported sudden hair loss in 18 villages, we investigated two villages - Machindrakhed and Bhondgaon. Five individuals were evaluated.</p><p><strong>Case series: </strong>The wheat samples distributed through the Public Distribution System were analyzed and had selenium concentrations of 13.6-14.7 mg/kg (normal: 0.1-1.9 mg/kg). All five patients had consumed Public Distribution System wheat. Symptoms began within 48 h and included vomiting, diarrhea, and fever on the 4th day, followed by scalp tingling, itching, severe hair loss, and dystrophic finger- and toenails. Hair regrew within 5-6 weeks after cessation of wheat consumption. Elevated selenium concentrations were noted in the urine (<i>n</i> = 5) and blood (<i>n</i> = 3), but other metals were not detected. Washing selenium-contaminated wheat with alkaline water reduced selenium concentrations.</p><p><strong>Discussion: </strong>Because selenium dissolves more readily in alkaline soils, we determined that alkaline washing significantly reduced selenium concentrations in contaminated wheat and may represent a low-cost, household-level mitigation strategy.</p><p><strong>Conclusions: </strong>Selenium poisoning occurred in 18 villages in the Buldhana district in India due to contaminated wheat distributed by the Public Distribution System.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body packers and body stuffers: cocaine intoxications reported to French poison centers (January 1, 2020-December 31, 2024).","authors":"Katharina von Fabeck, Mathieu Glaizal, Nicolas Simon","doi":"10.1080/15563650.2025.2546562","DOIUrl":"https://doi.org/10.1080/15563650.2025.2546562","url":null,"abstract":"<p><strong>Introduction: </strong>Cocaine use has increased significantly over the past three decades. This study aimed to analyze cases of cocaine intoxication involving body packing and body stuffing, focusing on symptomatology, treatment, and clinical outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was performed of cases of cocaine poisoning recorded in the French national poison center database over a five-year period (2020-2024). Extracted data included demographics, amount and route of cocaine concealment, number of pellets, clinical presentation, management, outcomes, location of arrest, and packaging type. An ordinal logistic regression was conducted to identify factors associated with poisoning severity, using the Poisoning Severity Score as the dependent variable.</p><p><strong>Results: </strong>Among 2,534 cases of cocaine intoxication, 146 involved body packers or body stuffers: 73 body packers and 73 body stuffers. The male-to-female ratio for body packers was 3.3:1, and for body stuffers, it was 72:1, with only one female. The median age of body packers was 25.5 years (range: 17-62 years) and for body stuffers, 28.2 years (range: 16-58 years). Body packers ingested between one and 190 pellets, while body stuffers ingested between one and ten pellets, each containing cocaine 1-15 g. Symptoms included gastrointestinal, cardiovascular, neurological, and respiratory effects. One death occurred among body packers, and two among body stuffers. Age was a significant predictor of severity, with older individuals at higher risk of severe outcomes.</p><p><strong>Discussion: </strong>Cocaine intoxication in body packers and stuffers presents serious health risks. Body packers ingested larger quantities with more secure packaging, while body stuffers ingested smaller amounts but used less secure methods, often due to law enforcement urgency. Despite differences in ingestion patterns, both groups showed similar symptoms, with older body packers more likely to experience severe effects.</p><p><strong>Conclusion: </strong>While severe complications were rare, cocaine intoxication in both body packers and stuffers can be fatal, highlighting ongoing public health risks related to cocaine trafficking and the need for timely medical intervention.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pupillary dynamics as a marker of acute cannabis inhalation.","authors":"Ashley Brooks-Russell, Suneeta Godbole, Michael J Kosnett, Sarah Limbacher, Prem S Subramanian, Timothy Brown, Julia Wrobel","doi":"10.1080/15563650.2025.2543066","DOIUrl":"https://doi.org/10.1080/15563650.2025.2543066","url":null,"abstract":"<p><strong>Introduction: </strong>Acute cannabis use has been found to affect pupil size and pupillary dynamics. Law enforcement may consider ocular changes in their examinations to determine drug impairment and the source, including from cannabis. A limited number of studies have used pupillometer technology to provide an objective measure of pupillary changes associated with cannabis use. The purpose of the study was to examine the sensitivity and specificity of pupil size and dynamics, measured with a pupillometer, associated with recent cannabis inhalation.</p><p><strong>Methods: </strong>Participants (<i>n</i> = 126) completed a pupillometer assessment, using the NeurOptics PLR-3000 at three times. Of the 126 participants, 95 completed assessments at baseline, and at 40 min and 100 min following 15 min of <i>ad libitum</i> inhalation of self-provided cannabis flower or concentrate products. Thirty-one participants completed the same assessments without using cannabis. Sensitivity, specificity and accuracy were calculated for pupil size and dynamics measures associated with recent cannabis use versus no use, for both post-use time points. Least absolute shrinkage and selection operator models were used to identify the combination of ocular metrics that were most predictive and parsimonious.</p><p><strong>Results: </strong>Following cannabis use, the pupillary measure with the highest area under the curve was percent change in pupil size, which decreased after cannabis use, with an area under the curve of 0.73 at 40 min and 0.75 at 100 min following cannabis use. Considering variables together in a least absolute shrinkage and selection operator model did not meaningfully improve prediction over individual measures.</p><p><strong>Discussion: </strong>Consistent with some prior studies, we did not find that cannabis use was associated with substantial and consistent change in the maximum pupil size (measured in darkness) relative to controls. However, diminished pupil dynamics, such as constriction in response to light and recovery dilation, were more predictive of recent cannabis use, consistent with limited prior studies.</p><p><strong>Conclusions: </strong>Pupillary dynamics, when measured with an objective test, may contribute to providing an indication of recent cannabis inhalation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":3.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}