Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Transdermal buprenorphine patch-facilitated induction of sublingual buprenorphine in hospitalized patients receiving full agonist opioids: a retrospective cohort study.","authors":"Simon J Ostrowski, Alek Adkins, David Goldfarb, Melissa Kukowski, Darien Stratton, David J Barton, Anthony F Pizon","doi":"10.1080/15563650.2025.2553811","DOIUrl":"https://doi.org/10.1080/15563650.2025.2553811","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment with buprenorphine is challenging to initiate in hospitalized patients receiving full agonist opioids because of the risk of precipitated opioid withdrawal. We describe clinical outcomes of precipitated withdrawal, incidence and rate of buprenorphine prescription at discharge in hospitalized patients undergoing transdermal buprenorphine patch-facilitated buprenorphine induction while receiving full agonist opioids.</p><p><strong>Methods: </strong>This is a retrospective chart review of hospitalized patients in a single academic healthcare system who were started on sublingual buprenorphine for opioid use disorder using a transdermal buprenorphine patch low-dose initiation strategy with overlapping full agonist opioids. The primary outcome was incidence of precipitated opioid withdrawal among those who received at least one dose of sublingual buprenorphine following low-dose initiation. Discharge with a prescription for sublingual buprenorphine was a secondary outcome.</p><p><strong>Results: </strong>Of 288 unique patient encounters with inpatient buprenorphine patch use, 68 met eligibility criteria for inclusion and five of 68 (7.4%, 95% CI: 2.4-16.3%) experienced precipitated opioid withdrawal. Sixty-seven of 68 (99%) patients were discharged with a buprenorphine prescription including 100% of those with precipitated withdrawal. There were no significant associations between incidence of precipitated withdrawal and oral morphine equivalents received prior to sublingual buprenorphine induction, age, sex, history of liver disease, dose or duration of transdermal buprenorphine patch.</p><p><strong>Discussion: </strong>This study supports growing evidence that a transdermal buprenorphine patch-facilitated buprenorphine initiation strategy in hospitalized patients receiving full agonist opioids is well-tolerated. Limitations include its retrospective chart review methodology and incomplete data available to fully characterize precipitated withdrawal.</p><p><strong>Conclusions: </strong>Transdermal buprenorphine-facilitated low dose buprenorphine initiation in hospitalized patients receiving full agonist opioids was well-tolerated in the majority of patients, with 7.4% (95% CI: 2.4-16.3%) developing precipitated withdrawal.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":3.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077196","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":"Cardiovascular toxicity associated with supplement use.","authors":"Justin Corcoran","doi":"10.1080/15563650.2025.2550983","DOIUrl":"https://doi.org/10.1080/15563650.2025.2550983","url":null,"abstract":"<p><strong>Background: </strong>Supplement use is prevalent and appears to be increasing over time. In the United States, regulation by the Food and Drug Administration is limited largely to post-marketing surveillance, raising safety concerns. A variety of supplements have been associated with cardiovascular toxicity, which can occur via adulteration, substitution, or as a result of intrinsic toxicity of the supplement. Cardiovascular toxicity due to supplement use may arise via several different mechanisms, and has been reported with supplements that act as central nervous system stimulants, via poisoning of cardiac ion channels, as a result of cardioactive steroids, and by modulation of the endocrine system.</p><p><strong>Stimulants: </strong>Supplements that act as central nervous system stimulants include those that act directly on adrenoreceptors or indirectly via the release of catecholamines, and include substances such as ephedra, synephrine, and yohimbine. Adverse effects vary depending on the agent and include tachycardia, hypertension, hyperthermia, myocardial infarction, and cardiac arrest.</p><p><strong>Ion channel poisons: </strong>Poisoning of cardiac voltage-gated sodium channels has been reported with supplements that contain or are contaminated with aconitine or grayanotoxins and cause wide complex dysrhythmias. Inhibition of cardiac myocyte voltage-gated potassium channels is associated with berberine, leading to prolongation of the QT interval and polymorphic ventricular tachycardia.</p><p><strong>Cardioactive steroids: </strong>Cardioactive steroids derived from yellow oleander are implicated in serious toxicity and death associated with the weight loss product \"Nuez de la India\" in what appears to be an inadvertent substitution error. Animal-derived cardioactive steroids from the <i>Bufo</i> spp. of toad used as an aphrodisiac also cause clinically significant cardiac toxicity and death.</p><p><strong>Endocrine modulators: </strong>Supplemental use of black licorice induces hypokalemia, and is associated with the development of torsade de pointes.</p><p><strong>Conclusion: </strong>Clinically significant cardiovascular toxicity associated with supplement use is a fortunately rare phenomenon that can occur via multiple mechanisms. Clinicians should maintain awareness that supplements may produce serious and sometimes life-threatening cardiovascular poisoning.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":3.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077185","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":"Molecular identification of <i>Amanita ibotengutake</i> from patient vomit specimens in mushroom poisoning.","authors":"Kosuke Ota, Kengo Taira, Ikuko Ito","doi":"10.1080/15563650.2025.2551835","DOIUrl":"https://doi.org/10.1080/15563650.2025.2551835","url":null,"abstract":"<p><strong>Background: </strong>Mushroom poisoning remains a global public health challenge, with morphological identification accuracy limited to 17%. This study aimed to demonstrate molecular identification from vomit specimens in a patient with mushroom poisoning.</p><p><strong>Methods: </strong>Following a mushroom poisoning incident in Yamagata Prefecture, Japan (September 2018), we collected four vomit specimens from a female patient. Deoxyribonucleic acid analysis targeting the internal transcribed spacer region using polymerase chain reaction and sequencing was performed on three of four specimens, while liquid chromatography-tandem mass spectrometry or toxin quantification was conducted on all four specimens. Species identification was conducted through sequence homology analysis.</p><p><strong>Results: </strong>Polymerase chain reaction amplification of the 185 base pair target sequence was successful from three vomit specimens collected 7 h post-ingestion, yielding identical sequences. Sequence analysis identified <i>Amanita ibotengutake</i> (100% homology), contradicting the initial morphological identification of <i>Amanita pantherina</i>. Liquid chromatography-tandem mass spectrometry detected a total of 0.053 mg ibotenic acid and 0.0043 mg muscimol in vomit specimens, consistent with the patient's neurological symptoms.</p><p><strong>Discussions: </strong>The discrepancy between morphological (<i>Amanita pantherina</i>) and molecular (<i>Amanita ibotengutake</i>) identification demonstrates limitations of conventional methods, particularly significant as these species were considered identical until 2002. Successful deoxyribonucleic acid amplification 7 h post-ingestion, despite technical challenges from gastric degradation, suggests clinical feasibility. This integrated molecular-toxicological approach strengthens scientific understanding of species-specific toxicities and contributes to improved epidemiological investigation of mushroom poisoning.</p><p><strong>Conclusions: </strong>We report the successful molecular identification from patient vomit specimens in a patient with mushroom poisoning. Although limited to a single case, this methodology may contribute to strengthening mushroom poisoning reports in the scientific literature to improve understanding of species-specific toxicities. Further validation in additional cases is needed for broader scientific applications.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067633","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":"Combined routine blood and urine laboratory indicators are efficient predictors of prognosis in patients with acute paraquat poisoning: a retrospective study.","authors":"Yiwei Su, Guangzhen Li, Wenxin Fang, Shihao Tang, Yuquan Chen, Cheng Zhang, Yimin Liu, Zhi Wang","doi":"10.1080/15563650.2025.2528996","DOIUrl":"https://doi.org/10.1080/15563650.2025.2528996","url":null,"abstract":"<p><strong>Introduction: </strong>Acute paraquat poisoning is associated with high mortality, necessitating practical prognostic tools to improve clinical outcomes. This study aimed to develop a composite index using routine blood and urine parameters to predict prognosis and guide personalized treatment strategies.</p><p><strong>Methods: </strong>Data from patients with acute paraquat poisoning hospitalized between January 2009 and June 2024 were divided into training and validation cohorts. Ridge regression analysis was conducted to identify key prognostic factors, and receiver operating characteristic curve analysis was performed to assess predictive performance. Principal component analysis was used to assign relative weights to predictors and construct a composite index, which was subsequently validated in an independent cohort.</p><p><strong>Results: </strong>Ridge regression and receiver operating characteristic curve analyses identified the amount of paraquat ingested, absolute neutrophil count, urine protein concentration, serum bicarbonate concentration, serum creatinine concentration, and blood glucose concentration as independent prognostic factors. The composite index demonstrated an area under the receiver operating characteristic curve of 0.921, with an optimal diagnostic threshold of 4.35. The predictive efficacy of the composite index for death was largely consistent across both the training (<i>n</i> = 268) and validation sets (<i>n</i> = 31). When the score was ≥5, the probability of predicting mortality was 94%.</p><p><strong>Discussion: </strong>The study highlights the utility of routine laboratory parameters in constructing a simple and accurate prognostic tool. Despite its strengths, including high predictive accuracy, limitations such as single-center design and potential biases should be noted. Multicenter prospective validation is recommended to generalize findings and improve early intervention strategies.</p><p><strong>Conclusion: </strong>The combined use of amount of paraquat ingested, absolute neutrophil count, urine protein concentration, serum bicarbonate concentration, serum creatinine concentration, and blood glucose concentration in a composite index provides a reliable tool for early prognosis prediction and personalized management in paraquat poisoning cases.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-12"},"PeriodicalIF":3.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067635","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":"Dynamic myocardial injury and variable hallucination latency in <i>Psilocybe keralensis</i> poisoning: a molecularly confirmed case series from China.","authors":"Zhifan He, Ruixue Tang, Min Feng, Xiaohui Li, Changhong Zhang, Jing Li","doi":"10.1080/15563650.2025.2552438","DOIUrl":"https://doi.org/10.1080/15563650.2025.2552438","url":null,"abstract":"<p><strong>Introduction: </strong>Psychoactive <i>Psilocybe</i> spp. mushrooms pose significant public health risks. We report a cluster of <i>Psilocybe keralensis</i> poisonings in Chengdu, China, highlighting its unique clinical features and cardiovascular complications.</p><p><strong>Case series: </strong>Four patients ingested 16-90 g of wild mushrooms (misidentified as an edible species, but later molecularly confirmed as <i>Psilocybe keralensis</i>). Prodromal symptoms (e.g., dizziness) emerged within 5-20 min, but the onset of hallucinations varied widely (10-180 min). All patients developed hypertension (systolic blood pressure >150 mmHg), with one patient exhibiting rapid blood pressure elevation to 182/110 mmHg at 4 h post-ingestion, which was accompanied by evidence of myocardial injury (peak cardiac troponin T concentration 188.70 pg/mL [reference range <14 pg/mL]) and transient mild skeletal muscle involvement (peaked myoglobin concentration 127.3 ng/mL, which normalized by day 2). Supportive treatment (gastric lavage, intravenous ranitidine, and fluid therapy) led to full recovery without sequelae.</p><p><strong>Discussion: </strong>We observed altered myocardial biomarkers following <i>Psilocybe keralensis</i> poisoning, which signals potential cardiovascular risks.</p><p><strong>Conclusion: </strong>Future clinical research on psilocybin should prioritize cardiovascular comorbidity screening and implement cardiac monitoring for high-risk patients. We believe that public health education should emphasize that both traditional morphological identification methods and folk-based toxicity testing lack scientific basis; it must advocate avoidance of wild mushroom foraging, which is the most reliable prevention strategy.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-5"},"PeriodicalIF":3.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067614","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":"INTOXICATE-US: validation of the INTOXICATE model in an American health care system.","authors":"Aiden Peleg, Svetlana Ross, Caitlin House, Roland Zemla, Michael Chary","doi":"10.1080/15563650.2025.2547885","DOIUrl":"https://doi.org/10.1080/15563650.2025.2547885","url":null,"abstract":"<p><strong>Background: </strong>The INTOXICATE model was developed in the Netherlands to decrease unnecessary intensive care unit admissions for poisoned patients. It reduced admissions by one-third in a retrospective study of patients already admitted to the intensive care unit. This study evaluates the model in the United States.</p><p><strong>Methods: </strong>We conducted a retrospective study of patients older than 12 years in one United States hospital system with a bedside toxicology service from 2023 to 2024. Our primary outcome was the number of patients admitted to the intensive care unit for whom INTOXICATE recommended against admission and who did not require critical care (\"safe downgrades\"). Our secondary outcome was the agreement between INTOXICATE and toxicologists as to which patients under evaluation in the emergency department would need critical care.</p><p><strong>Results: </strong>We screened 112 patients and analyzed 101: 19 (18%) were admitted to the intensive care unit, 16 (16%) to a general medical floor, and 66 (65%) discharged or transferred directly to psychiatry. INTOXICATE identified five (26%) safe downgrades. In the emergency department, INTOXICATE recommended admission to the intensive care unit for 60% of patients, compared to 18% for toxicologists, and had no agreement with toxicologists (Cohen's kappa 0.04; 95% CI: -0.082 to 0.192) Adjusting the threshold of INTOXICATE for recommending admission to the intensive care unit improved agreement (Cohen's kappa 0.55; 95% CI: 0.294 to 0.801) and would have reduced admissions by 22% but also resulted in unsafe downgrades and one death within 30 days.</p><p><strong>Discussion: </strong>For patients already admitted to the intensive care unit, INTOXICATE identified safe downgrades, consistent with prior findings. When applied in the emergency department to predict critical care needs, it tripled admissions and showed poor agreement with toxicologists.</p><p><strong>Conclusion: </strong>More work is needed before INTOXICATE can prognosticate which emergency department patients need critical care as accurately as toxicologists.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":3.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042955","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":"Authors' reply to comment on \"effectiveness and tolerability of methylthioninium chloride (methylene blue) for the treatment of methemoglobinemia: twenty-four years of experience at a single poison center\".","authors":"Robert S Hoffman, Roger Rothenberg, Rana Biary","doi":"10.1080/15563650.2025.2554319","DOIUrl":"https://doi.org/10.1080/15563650.2025.2554319","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031630","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":"Cannabis product exposures reported to Ramathibodi Poison Center, Thailand, during 2018-2022.","authors":"Bootsakorn Paisarnrodjanarat, Sahaphume Srisuma, Puangpak Promrungsri, Theerapon Tangsuwanaruk, Achara Tongpoo, Panee Rittilert, Manutsanun Mayurapong","doi":"10.1080/15563650.2025.2536771","DOIUrl":"https://doi.org/10.1080/15563650.2025.2536771","url":null,"abstract":"<p><strong>Introduction: </strong>Cannabis was a category 5 narcotic in Thailand before legalization for medical use in February 2019. In June 2022, it was removed from the narcotics list.</p><p><strong>Objectives: </strong>To characterize cannabis cases reported to a poison center in Thailand and to analyze the impact of medical and recreational legalization.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from January 2018 to December 2022. The time periods were classified into four timeframes according to regulations: (1) Illegal cannabis law (before February 19, 2019); (2) Medical cannabis law (February 19, 2019-December 14, 2020); (3) Decriminalized cannabis law (December 15, 2020-June 8, 2022); and (4) Recreational cannabis law (since June 9, 2022).</p><p><strong>Results: </strong>There were 1,695 cases with median [IQR] age of 38 years [24-53 years], and 67.2% were males. The proportion of children and adolescents (<20 years old) was higher during the recreational cannabis law period than the illegal cannabis law period (26.1% versus 14.1%, <i>P</i> = 0.013). Common products were cannabis oil (701, 41.4%), smoking products (452, 26.7%), and sweets (211, 12.5%). Common circumstances for cannabis use included: health benefit belief (504, 29.7%), recreational use (502, 29.6%), and curiosity (382, 22.5%). The medical, decriminalized, and recreational cannabis law periods exhibited higher hospitalization rates (82.0%, 91.5% and 96.8%, respectively) than the illegal cannabis law period (68.7%; <i>P</i> = 0.003, <i>P <</i> 0.001, and <i>P <</i> 0.001, respectively).</p><p><strong>Discussion: </strong>Increased availability and accessibility of cannabis products, in combination with lack of knowledge and awareness of its effects may lead to cannabis toxicity and hospitalization. Limitations include the retrospective nature of the study and laboratory confirmation of only one fifth of cases.</p><p><strong>Conclusions: </strong>More children and adolescents were exposed to cannabis during the recreational cannabis law period. In addition, the hospitalization rate increased after cannabis legalization for medical and recreational use.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-10"},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995114","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":"Levamisole associated with linear IgA dermatosis.","authors":"Lena Pointeaux, Damien Boutin, Sandrine Lefeuvre","doi":"10.1080/15563650.2025.2543939","DOIUrl":"https://doi.org/10.1080/15563650.2025.2543939","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995126","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":"Leveraging augmented reality for remote medical toxicology training using an observed clinical case-based simulation: a novel educational approach.","authors":"Ravikar Ralph, Amith Balachandran, Mohan Jambugulam, Lynne Rosenberg, Krupa George, Jachin Velavan, Grace Rebekah, Jennie A Buchanan, Christopher O Hoyte","doi":"10.1080/15563650.2025.2546558","DOIUrl":"https://doi.org/10.1080/15563650.2025.2546558","url":null,"abstract":"<p><strong>Introduction: </strong>Formal medical toxicology training is limited in many resource-constrained regions, including India, where poisonings and envenomations are highly prevalent. There is an urgent need for accessible toxicology education for healthcare providers in these settings. This study evaluates a novel augmented reality-based observed simulation model to remotely teach medical toxicology concepts to physicians-in-training in India.</p><p><strong>Methods: </strong>A toxicology topic relevant to India was selected, and key learning objectives defined. An augmented reality-based module was developed involving a clinical-case simulation with overlaid visuals. The trainer in the United States, streamed the session via an augmented reality headset to learners in India using a virtual communication platform. A user experience survey and pre-/post-tests were conducted immediately before and after the educational session, with knowledge gain analyzed using a paired t-test (<i>P <</i>0.05).</p><p><strong>Results: </strong>One hundred and twenty-four participants attended, comprising third- and fourth-year medical students and interns. The mean post-test score improved significantly from 11.10 (±2.81) to 16.80 (±2.37; maximum score: 20), with a mean increase of 5.70 (±2.91, <i>P <</i>0.001). Qualitative feedback supported augmented reality and simulation as effective remote teaching tools.</p><p><strong>Discussion: </strong>This study demonstrates the feasibility of using an augmented reality and simulation-based remote model to teach medical toxicology. A statistically significant improvement in test scores indicated short-term knowledge gain. Important limitations included the absence of delayed post-testing to assess retention, lack of a comparator group taught using traditional instructional methods, and no use of validated tools to measure immersion and motivation.</p><p><strong>Conclusions: </strong>Augmented reality and simulation-based remote teaching models can serve as effective, immersive, and interactive tools where in-person training is constrained. They offer a much-needed opportunity to link institutions with established medical toxicology programs to physicians in countries lacking formal training, helping bridge critical global education gaps.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-10"},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995130","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}