Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Unexpected naloxone response in pediatric olanzapine massive monointoxication.","authors":"Jules Lagrou, Nadine Annino, Mariem Ben Yaghlane, Carolyne Bidat, Xavier Delavenne, Jean Escal","doi":"10.1080/15563650.2026.2748427","DOIUrl":"https://doi.org/10.1080/15563650.2026.2748427","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229798","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":"Comment on evaluating clinical characteristics and outcomes associated with body stuffers presenting to the emergency department.","authors":"Aslı Bahar Uçar","doi":"10.1080/15563650.2026.2750471","DOIUrl":"https://doi.org/10.1080/15563650.2026.2750471","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229802","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":"Key agricultural pesticides responsible for acute pesticide poisoning in rural Sri Lanka - data to guide policy decisions.","authors":"Manjula Weerasinghe, Ayanthi Karunarathne, Michael Eddleston","doi":"10.1080/15563650.2026.2747401","DOIUrl":"https://doi.org/10.1080/15563650.2026.2747401","url":null,"abstract":"<p><strong>Introduction: </strong>Acute pesticide poisoning is a major public health problem among agricultural communities in low-and middle-income countries. Using recent surveillance data, this analysis identifies key pesticides responsible for acute poisoning in Sri Lanka to inform timely, evidence-based policy interventions, with relevance to similar agricultural settings.</p><p><strong>Methods: </strong>We analyzed interim data from two prospective studies in rural Sri Lanka: 1) a suicide surveillance system (Oct 2023-Apr 2025) and 2) a community-based cohort of 1,200 pesticide sprayers (Jan-Dec 2024). Self-poisoning deaths were identified through police, coroner, and household follow-up data, while occupational poisoning was monitored through bimonthly cohort follow-up. Descriptive analyses were identified the pesticides and active ingredients responsible for poisoning events.</p><p><strong>Results: </strong>Of 1,040 suicides identified, 236 (22.7%) involved pesticide ingestion; a single pesticide was confirmed in 184 (78.0%) of deaths. Insecticides accounted for 165/184 (89.7%) deaths, predominantly the carbamate carbosulfan (120/184, 65.2%; 95% Confidence Intervals (CI) 58.3-72.1) and organophosphorus profenofos (20/184, 10.9%; 95% CI 6.4-15.4), with a small proportion involving illegal pesticides (13/184, 7.1%) or herbicides (19/184, 10.3%). Pesticide sprayers reported 1,311 incidents of acute occupational pesticide poisoning, with 856 events occurring after use of a single identified pesticide. Insecticides were the most frequently implicated, led by profenofos (167/856, 19.5%; 95% CI 16.9-22.1), followed by herbicides, including pretilachlor (125/856, 14.6%; 95% CI 12.2-17.0) and glyphosate (81/856, 9.5%; 95% CI 7.5-11.5).</p><p><strong>Discussion: </strong>These findings show that most pesticide poisoning is concentrated in two insecticides: carbosulfan and profenofos. Their continued prominence despite earlier regulatory actions suggests ongoing pesticide substitution and highlights the need for strengthened surveillance and targeted regulation.</p><p><strong>Conclusion: </strong>Carbosulfan and profenofos now account for most pesticide suicides in Sri Lanka, while profenofos is also the leading cause of acute occupational pesticide poisoning. These findings highlight the need for ongoing surveillance and timely regulatory review.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229824","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":"Voluntary levamisole intoxication: a rare case of reversible neurological toxicity without cocaine co-ingestion.","authors":"Océane Coué, Gael Le Roux, Jeremy Lecot, Guillaume Rieul, Nicolas Fabresse, Anne Cady, Florian Reizine","doi":"10.1080/15563650.2026.2743751","DOIUrl":"https://doi.org/10.1080/15563650.2026.2743751","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198840","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":"Comment on safety of acetylcysteine.","authors":"Milton Tenenbein","doi":"10.1080/15563650.2026.2740049","DOIUrl":"https://doi.org/10.1080/15563650.2026.2740049","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167809","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 MDMB-4en-PINACA toxicity following use of an electronic vaping device.","authors":"Ahmed Osman, Lauren Starbrook, Mark Pucci","doi":"10.1080/15563650.2026.2743727","DOIUrl":"https://doi.org/10.1080/15563650.2026.2743727","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169431","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":"Comment on: \"over-the-counter drug poisoning among pediatric and adolescent patients presenting to emergency departments: a nationwide analysis of the COVID-19 impact\".","authors":"Didem Tatar, Ercan Yılmaz, Nezihe Köker Özer","doi":"10.1080/15563650.2026.2741680","DOIUrl":"https://doi.org/10.1080/15563650.2026.2741680","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140373","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":"Comparison of cooling methods for drug-induced hyperthermia in a pre-hospital and emergency department setting: a systematic review.","authors":"G D van Dijken, I Muradin, C den Haan, S J Rietjens, A E Hoek, D Dekker, D W de Lange, Femke M J Gresnigt","doi":"10.1080/15563650.2026.2738599","DOIUrl":"https://doi.org/10.1080/15563650.2026.2738599","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Hyperthermia is a medical condition characterized by elevated body temperature above 39.0 °C due to imbalanced heat production and dissipation. Stimulant drugs such as cocaine and amfetamines, as well as intense physical exertion, commonly induce hyperthermia. In severe cases, hyperthermia presents life-threatening complications requiring immediate temperature reduction interventions. Management involves various cooling modalities that differ in efficacy and practicality within pre-hospital and emergency department settings. This systematic review evaluates and compares the efficacy of cooling modalities for managing drug-induced hyperthermia suitable for pre-hospital and emergency department settings. Due to the paucity of data on drug-induced hyperthermia, studies examining exercise-induced hyperthermia were also included to provide additional evidence on cooling efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search for cooling efficiency studies across PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, APA PsycINFO, and SportDiscus from inception until October 2025, without language restrictions was conducted. Randomized controlled trials, observational studies, and case-based studies were included. Quality assessment utilized the GRADE approach for certainty of evidence, while the Newcastle-Ottawa Scale and RoB 2.0 assessed risk of bias. Meta-analysis was performed when feasible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search identified 6,920 citations, with 71 studies included in this systematic review comprising 1,932 patients treated with 12 different cooling modalities. Analysis demonstrated that an ice water immersion cooling rate of (0.169 ± 0.027 °C/min) and cold water immersion cooling rate of (0.162 ± 0.037 °C/min) achieved the highest cooling rates. Meta-analyses confirmed that cold water and ice water immersion were more effective than passive cooling. Ice water-soaked sheets or towels had a cooling rate of (0.121 ± 0.030 °C/min) and room temperature immersion a cooling rate of (0.089 ± 0.020 °C/min) produced adequate cooling rates, while all other cooling modalities proved inadequate as standalone treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Due to paucity of data on cooling methods specifically for drug-induced hyperthermia, this study incorporates data from exertional hyperthermia to inform treatment recommendations. Both populations share similar demographics and involve exertion as a primary or contributing factor, supporting the clinical relevance of this approach. However, important pathophysiological differences exist; in case of exertional heat stroke hyperthermia related to exertion improves as physical activity ceases, while stimulant-induced hyperthermia persists despite cessation of activity due to ongoing central drug effects. Although sedation can reduce physical activity in intoxicated patients, these patients often present with concurrent medical compl","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-18"},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130205","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":"Development and internal validation of an emergency department mortality prediction score for older adults with acute poisoning.","authors":"Jae Hee Lee, Duk Hee Lee","doi":"10.1080/15563650.2026.2740742","DOIUrl":"https://doi.org/10.1080/15563650.2026.2740742","url":null,"abstract":"<p><strong>Introduction: </strong>Poisoning in older adults is an increasing clinical toxicology problem because age-related physiologic vulnerability, polypharmacy, intentional self-poisoning, and exposure to highly toxic substances can complicate early risk assessment. Existing severity scores lack age-specific validation and often require variables unavailable during initial emergency department assessment.</p><p><strong>Methods: </strong>This retrospective observational study used data from six hospitals participating in the fall/slip, self-harm/suicide, and poisoning divisions of the Emergency Department-Based Injury In-depth Surveillance system maintained by the Korea Disease Control and Prevention Agency. Patients aged 65 years or older who presented with acute poisoning between January 2020 and December 2024 were included. The outcome was all-cause mortality, defined as emergency department death or in-hospital death. Candidate predictors included age; sex; Alert, Voice, Pain, Unresponsive scale; vital signs; poisoning substance category; self-harm/suicidal intent; and alcohol-related presentation. A multivariable logistic regression model was internally validated using five-fold cross-validation and bootstrap optimism correction.</p><p><strong>Results: </strong>Among 1,774 patients, overall mortality was 7.2% (127/1,774). The full model had an apparent area under the receiver operating characteristic curve of 0.895, five-fold cross-validated value of 0.860, optimism-corrected value of 0.877, area under the precision-recall curve of 0.472, and Brier score of 0.049. Predictors associated with mortality included older age, impaired mental status, lower systolic blood pressure, higher pulse rate, lower body temperature, high-risk poisoning substances, and self-harm/suicidal intent. The five-item bedside warning score had area under the receiver operating characteristic curve of 0.834; among patients with a score of ≥3, mortality was 27.5%.</p><p><strong>Discussion: </strong>The full model provides individualized probability estimation, whereas the bedside score provides immediate warning-level risk stratification.</p><p><strong>Conclusion: </strong>An initial-assessment model and a five-item bedside score stratified mortality risk in older adults with acute poisoning. External validation is required before broader implementation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130203","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":"Acquired 11β-hydroxylase deficiency adrenal hyperplasia associated with the use of etomidate and/or its analogues through e-cigarettes - a review of 76 cases in Hong Kong.","authors":"Shan Liu, Man-Li Tse","doi":"10.1080/15563650.2026.2727908","DOIUrl":"https://doi.org/10.1080/15563650.2026.2727908","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Etomidate and its analogues have been abused via vaping (e-cigarettes) in Hong Kong since 2023. Clinical effects including acute neurological effects, associated injuries, hypokalaemia, menstrual disturbances, and hyperpigmentation had been reported. This study aims to examine the clinical effects and associated adrenal dysfunction resulting from etomidate abuse through the inhalation (vaping) route.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective case series study utilised the Hong Kong Poison Control Centre database. Suspected etomidate abuse cases from 1 January 2023 to May 31, 2025 were identified from the database, by searching for \"etomidate\" as the poison name or for urine toxicology results positive for etomidate and/or analogues. Cases in which etomidate was prescribed during hospital admission were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventy-six cases were included, consisting of 1) Our poison centre's toxicology clinic cases, referred by social worker to us (5 cases) and 2) Our poison centre's \"etomidate abuse\" consultation/reporting database, consisting of suspected etomidate abusers managed by frontline clinicians of different units and consulted/reported to us (71 cases). Concerning the adrenal dysfunction, clinical features of mineralocorticoid excess (hypokalaemia, low aldosterone/renin levels), apparent glucocorticoid deficiency (low cortisol levels), adrenal androgen excess (virilisation, menstrual disturbances, elevated androstenedione and testosterone levels) and adrenocorticotropic hormone excess (hyperpigmentation, bilateral adrenal hyperplasia, elevated adrenocorticotropic hormone levels) were observed. Three associated deaths were reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Etomidate abuse results in an acquired form of 11β-hydroxylase deficiency adrenal hyperplasia with clinical features similar to the congenitaladrenal hyperplasia due to 11β-hydroxylase deficiency. For etomidate abusers, reversibility of hypokalaemia, low blood cortisol, and elevated ACTH had been observed in our study in a small subset of our cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The adrenal dysfunction in etomidate abuse manifest as an acquired 11β-hydroxylase deficiency adrenal hyperplasia, which is a pentad of mineralocorticoid excess, apparent glucocorticoid deficiency, virilisation, adrenocorticotropic hormone excess, and adrenal hyperplasia. Potentially life-threatening acute presentations include trauma sustained during the acute intoxication and severe hypokalemia. Cessation of etomidate abuse remains the cornerstone of managing the adrenal dysfunction, while glucocorticoid replacement should be considered on individual basis. In view of the local prevalence of etomidate abuse, we suggest that etomidate abuse should be considered as an important differential diagnosis in teenage and young adult patients presenting with features suggestive of congenital adrenal hyperplasia due to 11β-hydroxylase def","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130185","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}