Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"<i>In vitro</i> studies of detoxification by intravenous fat emulsions: mechanism of action and preclinical assessment tools.","authors":"Delyan Krastev, Vasil Atanasov, Zahari Vinarov, Slavka Tcholakova, Nikolai Denkov","doi":"10.1080/15563650.2026.2708998","DOIUrl":"10.1080/15563650.2026.2708998","url":null,"abstract":"<p><strong>Introduction: </strong>The use of intravenous fat emulsions for treatment of drug intoxication still follows a trial-and-error approach, due to insufficient understanding of the mechanisms of the process and lack of predictive <i>in vitro</i> tools.</p><p><strong>Methods: </strong>We studied the physicochemical mechanisms of drug extraction from model plasma for seven drugs (bromazepam, bupivacaine, diphenhydramine, mepivacaine, quetiapine, paracetamol and verapamil) with clinical data for the detoxification efficiency of intravenous fat emulsions. Five of the studied drugs were labeled as \"responders,\" due to clinical reports of successful patient detoxification, whereas the other two drugs were \"non-responders,\" as they did not respond to intravenous fat emulsion treatment.</p><p><strong>Results: </strong>For all responders, drug extraction increased significantly with the increase of emulsion concentration, while the drug partition coefficient between model plasma and intravenous fat emulsion (Intralipid^®) remained around or above 10: <i>viz</i>. the concentration of drug in the lipid phase was ten‑fold higher than in its concentration in the model plasma.</p><p><strong>Discussion: </strong>Drug partitioning from the model plasma to the bulk of the emulsion oil droplets was identified as the primary scavenging mechanism, whereas adsorption on the oil-water interface did not influence the process. For the studied seven drugs, it was established that a threshold value of 10 of the drug partition coefficient between model plasma and intravenous lipid emulsion can be successfully used to discriminate between drugs for which intravenous fat emulsions can lead to partitioning, indicating potential clinical efficiency in detoxification.</p><p><strong>Conclusion: </strong>The approach described can be used to guide clinical practice in drug intoxication cases where a specific antidote is not available, expanding the treatment options of patients in intensive care conditions.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"943-954"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702927","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":"Siamese Russell's viper bite: epidemiology, clinical characteristics, and outcomes.","authors":"Phantakan Tansuwannarat, Anyada Chaibundit, Achara Tongpoo, Taksa Vasaruchapong, Sahaphume Srisuma, Satariya Trakulsrichai","doi":"10.1080/15563650.2026.2659252","DOIUrl":"10.1080/15563650.2026.2659252","url":null,"abstract":"<p><strong>Introduction: </strong><i>Daboia siamensis</i> envenoming is a major cause of hematotoxicity and acute kidney injury in Southeast Asia. In Thailand, <i>D. siamensis</i> is a clinically important snake, yet detailed national data on its bites are limited. Hence, we aimed to determine the clinical characteristics, management, and outcomes of <i>D. siamensis</i> bites in Thailand, identify factors associated with acute kidney injury and hemodialysis, and analyze antivenom administration with reference to acute kidney injury and hemodialysis.</p><p><strong>Methods: </strong>We conducted a 10-year retrospective cross-sectional study using data from the Ramathibodi Poison Center Toxic Exposure Surveillance System (2014-2023). All diagnosed <i>D. siamensis</i> bites were reviewed. Definite cases were defined when the snake species was identified via a live specimen, carcass, or photograph.</p><p><strong>Results: </strong>A total of 185 patients were included, with 101 definite cases. Most (82.7%) were male, and the mean (±SD) age was 43.0 ± 16.6 years. Overall clinical manifestations included local effects (20.5%), coagulopathy (89.2%), acute kidney injury (50.3%), thrombocytopenia (31.4%), and rhabdomyolysis (28.1%). Antivenom was administered in 89.2% of cases. The median (IQR) length of hospital stay was 5 (3-7) days. The mortality rate was 3.8%. Tachycardia at presentation, initial proteinuria, and rhabdomyolysis were found to prognosticate the development of acute kidney injury. Metabolic acidosis at presentation and rhabdomyolysis were predictors of the requirement for hemodialysis. In addition, receiving antivenom within two hours may reduce the need for hemodialysis (odds ratio 0.153, 95% CI 0.035-0.674).</p><p><strong>Discussion: </strong>Discrepancies between our findings and those of others on <i>D. siamensis</i> bites may have resulted from geographic variation in the venom composition and/or differences in the study period and population. Although antivenom treatment did not reverse renal injury, it may have prevented progression.</p><p><strong>Conclusions: </strong>Systemic hematotoxicity and nephrotoxicity generally developed after a <i>D. siamensis</i> bite. Several clinical characteristics are potential markers of acute kidney injury and hemodialysis requirement after a <i>D. siamensis</i> bite, and early administration of antivenom may reduce the need for hemodialysis.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"908-916"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848860","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":"Dealing with diagnostic bias and uncertainty: What is the burden of proof in toxicology?","authors":"Mark K Su, Heather Brunette, Marina Frayberg, Sanjay Mohan","doi":"10.1080/15563650.2026.2698028","DOIUrl":"10.1080/15563650.2026.2698028","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"847-849"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564365","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":"Acute cardiovascular complications of sympathomimetic recreational drug use.","authors":"Femke M J Gresnigt","doi":"10.1080/15563650.2026.2701369","DOIUrl":"10.1080/15563650.2026.2701369","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Recreational drug use is rising globally, with significant cardiovascular implications. Sympathomimetic substances such as cocaine, amfetamine(amphetamine)-type stimulants and synthetic cathinones are increasingly associated with emergency department presentations and acute cardiac events. Despite this growing burden, standardized guidance for diagnosing and managing acute sympathomimetic recreational drug-related cardiovascular complications remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A narrative review of the literature was conducted to identify acute cardiovascular complications associated with commonly used recreational drugs. A PubMed search was performed from database inception to 1 March 2024 using combinations of cardiovascular symptoms and cardiovascular complications with terms related to sympathomimetic recreational drug use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;These substances exert potent sympathomimetic effects through catecholamine excess, and cause receptor activation, ion channel interference, and direct myocardial toxicity. Cocaine additionally induces vasospasm and thrombosis via endothelin-1 and causes sodium channel and potassium channel blockade. Amfetamine-type stimulants and synthetic cathinones amplify catecholamine release, contributing to arrhythmia, ischemia, and myocardial injury. Acute cardiovascular manifestations include chest pain, acute coronary syndrome, arrhythmias, cardiomyopathy, and sudden cardiac death. Presentations often mimic classical cardiac syndromes but may be more severe, especially in younger patients without traditional risk factors. Diagnosis begins with detailed history-taking, although self-reported drug use is frequently unreliable. Depending on symptoms, electrocardiography, cardiac biomarkers and echocardiography may be essential for risk stratification and identifying the underlying pathology. Toxicological testing may be considered when clinically indicated and should be interpreted in conjunction with clinical findings. For cocaine associated chest pain patients, risk stratification with the HEART pathway may guide safe discharge in low-risk cases. Management should be individualized based on the specific recreational drug involved and the presenting symptoms. Sedation, antihypertensives, and dual antiplatelet therapy are foundational, with vasodilators when indicated. Beta-blockers with alpha-blocking properties may be beneficial in selected patients. Early drug counselling and referral are critical to reduce recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In most cases, evaluation and management of acute cardiovascular symptoms in patients with suspected sympathomimetic drug use should follow standard guideline-based cardiovascular care. However, specific modifications may be required, including selective use of toxicological testing when it is expected to influence clinical decision-making, early sedation to reduce sympathetic overactivity, and cautiou","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"850-864"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595452","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 large pediatric cohort of colchicine intoxication: prognostic factors and experience with rapid sequence apheresis.","authors":"Selman Kesici, Ozlem Saritas Nakip, Nilay Korgal, Benan Bayrakci","doi":"10.1080/15563650.2026.2657988","DOIUrl":"10.1080/15563650.2026.2657988","url":null,"abstract":"<p><strong>Introduction: </strong>Severe colchicine intoxication often leads to multi-organ failure and death. With no specific antidote and ineffective conventional elimination methods, we hypothesized that rapid sequence apheresis could reduce the intravascular colchicine reservoir. This study describes pediatric colchicine poisoning, focusing on dose-related outcomes and the clinical role of rapid sequence apheresis.</p><p><strong>Methods: </strong>This retrospective observational analysis included children admitted to a tertiary pediatric intensive care unit for colchicine poisoning (2011-2025). Clinical data, ingested dose, organ involvement, and patient characteristics were evaluated. Logistic regression and ROC analyses were used to identify variables associated with disease severity and poor outcomes, including those treated with rapid sequence apheresis.</p><p><strong>Results: </strong>Eighty-four patients were included (median dose: 0.3 mg/kg). Across dose groups (<0.5, 0.5-0.8, and >0.8 mg/kg), higher doses correlated with increased frequency of diarrhea (20.6%, 57.1%, and 57.1%, respectively, <i>P</i> = 0.071) and cardiovascular involvement (20.6%, 50%, and 71.4%, respectively; <i>P</i> = 0.004). Logistic regression showed that diarrhea significantly increased the likelihood of cardiovascular complications (OR: 3.24, <i>P</i> = 0.006). The ROC analysis identified thresholds of >0.39 mg/kg and >24 mg total dose as predictors of cardiovascular toxicity. Seventeen patients (20.2%) underwent rapid sequence apheresis. Despite advanced supportive care, five patients died, including two who ingested <0.5 mg/kg and received rapid sequence apheresis.</p><p><strong>Discussion: </strong>Our findings suggest that higher ingested doses and early gastrointestinal manifestations such as diarrhea may serve as indicators of increased risk for cardiovascular complications in pediatric colchicine intoxication. In addition, clinically significant toxicity may occur at doses lower than traditionally reported thresholds.</p><p><strong>Conclusion: </strong>Pediatric colchicine intoxication may lead to significant cardiovascular complications even at relatively lower doses. Early recognition of high-risk clinical indicators, including gastrointestinal symptoms, leukocytosis, and ingested dose, may facilitate clinical risk stratification and early identification of patients at increased risk of adverse outcomes. Rapid sequence apheresis was used in selected severe cases in our cohort; however, its therapeutic role requires further investigation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"865-871"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848991","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":"Occult brodifacoum poisoning presenting as a massive intramuscular hematoma.","authors":"Guangcai Yu, Shizhen Lv, Jianjian Liu, Zhaozhao Shan, Xiangdong Jian","doi":"10.1080/15563650.2026.2702500","DOIUrl":"10.1080/15563650.2026.2702500","url":null,"abstract":"<p><strong>Introduction: </strong>Brodifacoum induces coagulopathy after absorption, causing severe systemic hemorrhage. Occult hemorrhage may delay diagnosis and treatment.</p><p><strong>Case summary: </strong>A 56-year-old man was referred to our hospital with worsening right thigh swelling for nine days. He had no recent trauma or medications affecting his INR. On admission, laboratory tests revealed an elevated PT of 75 s and INR of 9.05, and serum brodifacoum concentration of 25 µg/L (0.0478 µmol/L). Imaging confirmed a large right thigh hematoma. Forty-three days prior to this presentation, he had presented with life-threatening gastrointestinal bleeding, liver injury, and coagulopathy, which resolved with phytomenadione (Vitamin K₁, 40 mg daily for two days, then 120 mg daily for four days) and supportive care. Eighteen days prior to this presentation, the coagulopathy recurred (PT 60.1 s, INR 6.82), but he declined further vitamin K₁ treatment.</p><p><strong>Images: </strong>Ultrasound and magnetic resonance imaging revealed a large intramuscular hematoma in the right anterior thigh, without cutaneous ecchymosis.</p><p><strong>Conclusion: </strong>Brodifacoum poisoning can cause life-threatening hemorrhages. In some cases, a large intramuscular hematoma may be the only clinical manifestation, resulting from the underlying coagulopathy, and failure to recognize this may delay appropriate management.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"959-961"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552082","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":"Deliberate self-poisoning in four European countries: retrospective analysis of poison centre data.","authors":"Arjen Koppen, Katrin Faber, Laura Hondebrink, Mark Lawrence Zammit, Maren Hermanns-Clausen, Dominique Vodovar","doi":"10.1080/15563650.2026.2680175","DOIUrl":"10.1080/15563650.2026.2680175","url":null,"abstract":"<p><strong>Results: </strong>Within six years, poison centres reported 1,783,858 cases, and one in ten (177,921 cases) involved deliberate self-poisonings. Rates varied across countries, ranging from 8% in France to 23% in the Netherlands. Cases with deliberate self-poisoning remained stable between 2017 and 2020, with an increase observed from 2021 to 2022. Females accounted for 70% of cases, rising to 84% among children/adolescents of 5-17 years. Rates among children/adolescents of 5-17 years increased significantly after 2020 in all countries, largely due to a strong increase among females. Substances involved varied by country, but alcohol, benzodiazepines, and antidepressants dominated in adults, while paracetamol and ibuprofen dominated among children/adolescents of 5-17 years.</p><p><strong>Discussion: </strong>Common trends in deliberate self-poisoning, particularly in different age groups, are highlighted and challenges of cross-national data harmonisation in European poison centres are demonstrated.</p><p><strong>Conclusion: </strong>Deliberate self-poisoning represented a substantial proportion of poisoning cases, with a sharp rise after 2020, especially among children/adolescent females using readily available over-the-counter non-prescription medicines. These findings underscore the need for targeted prevention strategies and demonstrate the value of coordinated data collection. Expanding collaboration across additional countries could enhance monitoring, strengthen trend analyses, and inform public health interventions.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"923-932"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311232","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":"Serum cannabinoid profiles of emergency department patients presenting with cannabinoid hyperemesis syndrome and acute cannabis intoxication.","authors":"David Toomey, Kian Merchant-Borna, Alex J Krotulski, Savannah Baker, Victoria Zhang, Nicholas Nacca","doi":"10.1080/15563650.2026.2703873","DOIUrl":"10.1080/15563650.2026.2703873","url":null,"abstract":"<p><strong>Introduction: </strong>The underlying pathophysiology of cannabinoid hyperemesis syndrome remains poorly understood. Proposed mechanisms include \"hyperintoxication\" with delta-9-tetrahydrocannabinol, accumulation of delta-9-tetrahydrocannabinol metabolites, and differential exposure to non-psychotropic phytocannabinoids. This study sought to examine quantitative differences in serum concentrations of delta-9-tetrahydrocannabinol, delta-9-tetrahydrocannabinol metabolites, delta-8-tetrahydrocannabinol, and common non-psychotropic phytocannabinoids between patients presenting to the emergency department with either acute, symptomatic cannabinoid hyperemesis syndrome or acute cannabis intoxication.</p><p><strong>Methods: </strong>This was a retrospective cohort study performed in the emergency department of a single academic medical center. Subjects were screened based on discharge diagnosis consistent with either cannabinoid hyperemesis syndrome or acute cannabis intoxication and on availability of remnant blood samples. Chart data including emergency department length of stay, disposition, treatment, and labs were abstracted, and blood samples were analyzed via liquid chromatography-triple quadrupole tandem mass spectrometry for serum concentrations of delta-9-tetrahydrocannabinol, delta-8-tetrahydrocannabinol, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol, 11-hydroxy-delta-9-tetrahydrocannabinol, delta-8-carboxy-tetrahydrocannabinol, cannabidiol, cannabigerol, and cannabinol.</p><p><strong>Results: </strong>Fifty subjects were enrolled; thirty-five presented with cannabinoid hyperemesis syndrome and 15 with acute cannabis intoxication. Groups were well matched with regard to baseline demographics, emergency department disposition, and emergency department length of stay. No significant differences were noted in serum concentrations of delta-9-tetrahydrocannabinol, delta-9-tetrahydrocannabinol metabolites, non-psychotropic phytocannabinoids, or their respective ratios.</p><p><strong>Discussion: </strong>While limited by uncontrolled host factors, the results of this study further existing literature arguing against the differential accumulation of psychoactive cannabinoids, non-psychoactive cannabinoids, or their metabolites as causative factors in the development of acute symptomatic episodes of cannabinoid hyperemesis syndrome.</p><p><strong>Conclusion: </strong>There does not appear to be a significant difference in concentrations of psychoactive and non-psychoactive cannabinoids between emergency department patients with symptomatic cannabinoid hyperemesis syndrome and those with acute cannabis intoxication.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"881-887"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595454","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":"Brodifacoum poisoning complicated by intestinal necrosis.","authors":"Qian Hou, Congtao Chen, Aimin Zhang, Wei Zhao, Hengbo Gao, Yingping Tian, Yu Gong, Yaqing An","doi":"10.1080/15563650.2026.2727910","DOIUrl":"https://doi.org/10.1080/15563650.2026.2727910","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043282","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":"Age-related patterns in paediatric paracetamol poisoning: a retrospective cohort study, 2015-2025.","authors":"Miguel Álvarez-Montero, Fiorela Dueñas-López, Ramón Pardo-Puras, Begoña de Miguel Lavisier, José Antonio Ruiz Domínguez, Vega Rey-Mauleón, María de Ceano-Vivas, Elena Ramírez, Alberto M Borobia, Mikel Urroz-Elizalde","doi":"10.1080/15563650.2026.2734136","DOIUrl":"https://doi.org/10.1080/15563650.2026.2734136","url":null,"abstract":"<p><strong>Introduction: </strong>Paracetamol poisoning is a common cause of paediatric drug toxicity, but contemporary data on incidence trends, management, and predictors of toxicity remain limited. This study will evaluate incidence trends, clinical features, management, and dose-concentration relationships in paediatric patients with paracetamol poisoning.</p><p><strong>Methods: </strong>Retrospective cohort study of patients aged ≤16 years evaluated at a tertiary hospital (2015-2025). Cases were identified through serum paracetamol measurements and classified by exposure pattern. Acetylcysteine administration was assessed according to TOXBASE-based institutional criteria. Spearman's correlation between reported dose (mg/kg) and serum concentration was analysed in acute overdoses.</p><p><strong>Results: </strong>A total of 271 cases were included (114 aged ≤9 years; 157 aged 10-16 years). The incidence of identified cases of suspected paediatric paracetamol poisoning increased from 1.11 to 8.68 cases per 10,000 paediatric inhabitants between 2018 and 2025. Adolescents more frequently had intentional overdoses (96.8% versus 0%), higher reported doses (median 212.7 versus 150 mg/kg), and higher serum paracetamol concentrations (median 59.5 versus 30 mg/L [393.9 versus 198.6 µmol/L]) (<i>P <</i> 0.001). Acetylcysteine was administered in 69.2% of cases and was considered inappropriate in 17% of treated patients, predominantly among younger children. Hepatotoxicity (ALT > 3 × ULN and/or bilirubin > 2 × ULN) occurred in 21.4%, and acute liver failure (according to established paediatric criteria) in 9.2%, without significant differences between age groups. In acute overdoses with serum concentrations measured 4-24 h after ingestion, correlation between reported dose and serum concentration was weak in adolescents (ρ = 0.44; <i>P <</i> 0.001) and very weak in younger children (ρ = 0.28; <i>P</i> = 0.04).</p><p><strong>Discussion: </strong>Consistent with previous paediatric toxicology studies, exposure patterns differed by age group, with predominantly accidental exposures in younger children and intentional overdoses in adolescents.</p><p><strong>Conclusion: </strong>Reported ingested dose showed only weak correlation with serum paracetamol concentrations, particularly in younger children. These findings suggest that exposure history alone is insufficient for poisoning risk assessment and should be interpreted alongside sampling time and biochemical evaluation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043321","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}