Clinical toxicology (Philadelphia, Pa.)最新文献

{"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}

{"title":"Corneal nerve loss associated with nitrous oxide neurotoxicity.","authors":"Joseph B Stockwell, Sophie E Waller, Christopher Lycett, Maria Markoulli, Betty S Chan, Arun V Krishnan","doi":"10.1080/15563650.2025.2547884","DOIUrl":"https://doi.org/10.1080/15563650.2025.2547884","url":null,"abstract":"<p><strong>Introduction: </strong>Nitrous oxide is an inhaled anaesthetic used recreationally that is neurotoxic. Corneal nerve parameters were assessed in patients with nitrous oxide toxicity.</p><p><strong>Methods: </strong>Four individuals underwent clinical, electrophysiological and corneal confocal microscopy assessment. Corneal images were analysed with automated software and compared to healthy controls.</p><p><strong>Results: </strong>Two patients had prolonged heavy use of nitrous oxide ≥ two years. In both patients, there was a reduction in inferior whorl corneal nerve fibre length (6.3 mm/mm² of cornea, 9.8 mm/mm² of cornea, respectively versus healthy controls: mean 19.4 ± 9.0 mm/mm² of cornea), and reduced inferior whorl corneal nerve fibre density (8.3 fibres/mm² cornea, 2.5 fibres/mm² of cornea, respectively versus healthy controls: mean 27.5 ± 11.1 fibres/mm² of cornea. Conversely, patients three and four had shorter, intense exposure and normal corneal nerve parameters (inferior whorl corneal nerve fibre density 20.8 fibres/mm² of cornea and 23.4 fibres/mm² of cornea, and corneal nerve fibre length 14.5 fibres/mm² of cornea and 19.6 fibres/mm² of cornea_, respectively).</p><p><strong>Discussion: </strong>We demonstrated corneal nerve changes with long-term use of nitrous oxide, but preservation of corneal nerve indices with shorter duration of exposure.</p><p><strong>Conclusion: </strong>Corneal nerve assessment may be a marker of neurological injury from nitrous oxide.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-4"},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995104","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":"Bedside mixing of calcium gels for dermal hydrofluoric acid treatment leads to precipitate formation and loss of dissolved calcium.","authors":"Colleen P Cowdery, Steve C Kazmierczak, John A Thompson","doi":"10.1080/15563650.2025.2519323","DOIUrl":"10.1080/15563650.2025.2519323","url":null,"abstract":"<p><strong>Introduction: </strong>Hydrofluoric acid is a weak acid with the potential for local and systemic fluoride toxicity. Standard care for dermal exposures includes the application of a topical calcium gel. If a commercially produced 2.5% calcium gel is not available, bedside mixing of one is recommended. We sought to determine whether bedside mixing of a calcium gel can reliably produce a suitable product for the treatment of this exposure.</p><p><strong>Methods: </strong>A survey was sent to the medical directors of America's Poison Centers^® to collect information on current treatment recommendations for dermal hydrofluoric acid exposures. Following this, bedside mixing of a 2.5% calcium gel was attempted with seven brands of water-based gels and one brand of petroleum-based gel. Each brand of gel was mixed in a 3:1 mL ratio with 10% calcium salt solutions (calcium gluconate or calcium chloride) in an attempt to create a 2.5% calcium gel solution. Mixtures were photographed and assessed visually for viscosity and precipitations and were analyzed for final calcium concentration.</p><p><strong>Results: </strong>Five of seven water-based gels exhibited a rapid loss of gel-like viscosity and immediate development of gross precipitates upon mixing with calcium-containing salts. The mean calcium concentrations in these non-viscous, precipitate-containing mixtures were lower than the expected 2.5% for both calcium gluconate and calcium chloride mixtures. The petroleum-based gel failed to produce a usable mixture when combined with water-based calcium salt solutions.</p><p><strong>Discussion: </strong>For the majority of gel brands tested in this study, the recommended practice of mixing a 2.5% calcium gel using 10% calcium salt solutions and water-based gels resulted in immediate precipitate formation, loss of gel viscosity, and a reduction in dissolved calcium concentration.</p><p><strong>Conclusions: </strong>The standard recommendation of mixing a calcium gel at the bedside may result in the production of a non-viscous mixture with a calcium concentration lower than the expected 2.5%.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"675-680"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532746","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":"Adsorption of antidepressant and cardiovascular drugs to activated charcoal: amitriptyline, bupropion, minoxidil, propranolol, and venlafaxine.","authors":"Hunter B Wood, Stella M Trickett, Joseph T Dosch, Dazhe J Cao, Stefanie A Sydlik","doi":"10.1080/15563650.2025.2532625","DOIUrl":"10.1080/15563650.2025.2532625","url":null,"abstract":"<p><strong>Background: </strong>Overdoses involving antidepressant and cardiovascular drugs account for 21.9% of non-opioid overdose-related fatalities in the United States. Activated charcoal is commonly used for gastrointestinal decontamination, but data regarding its adsorption efficacy for several clinically relevant drugs remain limited.</p><p><strong>Objective: </strong>We aimed to evaluate the adsorption of amitriptyline, bupropion, minoxidil, propranolol, and venlafaxine to activated charcoal by fitting adsorption isotherm data.</p><p><strong>Methods: </strong>Kinetics and adsorption isotherm experiments were conducted using simulated gastric fluid (pH 1.2) and simulated intestinal fluid (pH 6.8). Freundlich and Langmuir isotherm equations were fitted to experimental data to model adsorption behavior. Drug-specific activated charcoal-to-drug ratios required to achieve ≥95% adsorption were identified.</p><p><strong>Results: </strong>All five drugs were adsorbed effectively to activated charcoal although adsorption efficiencies varied by pH. Maximal adsorption capacities of all drugs were higher in simulated intestinal fluid compared to simulated gastric fluid. In simulated intestinal fluid, ≥95% of bupropion was adsorbed at a 10:1 activated charcoal-to-drug ratio, while this level was not reached in simulated gastric fluid even at a 12:1 ratio. Amitriptyline and propranolol reached ≥95% adsorption at ratios below 10:1. Venlafaxine and minoxidil required higher ratios of activated charcoal ratios to reach maximal adsorption. Activated charcoal had a higher drug-binding capacity in simulated intestinal fluid, but binding was stronger in simulated gastric fluid. Bupropion was adsorbed more in simulated intestinal fluid overall, though efficiency decreased at higher concentrations.</p><p><strong>Discussion: </strong>A single 50 g dose of activated charcoal at 10:1 ratio may be inadequate for clinically significant overdoses of bupropion, minoxidil, and venlafaxine, especially for immediate release bupropion for which gastric adsorption may be important.</p><p><strong>Conclusions: </strong>This study supports the use of activated charcoal for gastrointestinal decontamination in overdoses involving amitriptyline, bupropion, minoxidil, propranolol, and venlafaxine. However, drug-specific differences in adsorption behavior suggest a need for refined dosing strategies, particularly in cases involving drugs with lower binding efficiencies.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"666-674"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824796","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":"Two fatalities from sodium azide ingestion: delayed enhanced elimination was not effective.","authors":"Nicholas Husak, Alexander Sidlak, Rachael Westover, Stanislaw Haciski, Michael Abesamis","doi":"10.1080/15563650.2025.2528995","DOIUrl":"10.1080/15563650.2025.2528995","url":null,"abstract":"<p><strong>Background: </strong>Ingestion of sodium azide can lead to severe toxicity, including the development of refractory shock. No antidote has been identified. Enhanced elimination has demonstrated variable outcomes in prior reports.</p><p><strong>Case reports: </strong>We present two fatal cases of sodium azide toxicity. The first patient, a 27-year-old man, ingested approximately 5 g of sodium azide and developed hypotension 1 h after ingestion. Orogastric lavage was performed, and vasopressors were started. Hemodialysis was performed 13 h after ingestion. Despite stabilization, he developed recurrent cardiac arrest and died. The second patient, a 19-year-old man, presented 2 h after the intentional ingestion of 40 mL of 5% (2 g) sodium azide. This patient was started on vasopressors and had plasma exchange performed, after which vasopressor requirements were reduced. Shortly after, however, the patient experienced recrudescence of shock and ultimately succumbed to toxicity.</p><p><strong>Discussion: </strong>Despite aggressive supportive measures, decompensation refractory to supportive measures occurred in both patients. Enhanced elimination techniques were attempted, albeit not immediately, and the delay in initiating hemodialysis and plasma exchange may have limited any potential benefit.</p><p><strong>Conclusions: </strong>Enhanced elimination did not appear to alter the course of toxicity in these two patients who ingested at least 2 g of sodium azide.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"681-683"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755627","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":"Synthetic cathinones in Belgium: a cluster of poly-drug intoxications involving α-pyrrolidinoisohexiophenone (α-PiHP).","authors":"Margot Balcaen, Nik De Brabanter, Nick Verougstraete, An-Sofie Decavele, Olivier Heylen, Cathelijne Lyphout, Kathleen Croes, Maarten Degreef","doi":"10.1080/15563650.2025.2523528","DOIUrl":"10.1080/15563650.2025.2523528","url":null,"abstract":"<p><strong>Background: </strong>Synthetic cathinones, known as 'gravel' or 'bath salts', include α-pyrrolidinoisohexiophenone and its analogues α-pyrrolidinovalerophenone and α-pyrrolidinohexanophenone; often referred to as 'flakka' on the street or 'zombie drug' in media reports. Documented motivation for use includes libido enhancement and appetite suppression. Since its international scheduling, α-pyrrolidinoisohexiophenone has gained prevalence in European Union countries where α-pyrrolidinovalerophenone previously dominated.</p><p><strong>Methods: </strong>Three Belgian hospitals in adjacent regions reported intoxications involving α-pyrrolidinoisohexiophenone to the national early warning system. This triggered a retrospective analysis of a convenience cluster of 39 cases. Toxicological screening was performed using standardised laboratory protocols. Patient data, encompassing demographics, drug use patterns, and clinical symptoms, were obtained from routine hospital records.</p><p><strong>Results: </strong>α-Pyrrolidinoisohexiophenone was analytically confirmed in 37 urine samples. The distinction between α-pyrrolidinoisohexiophenone and α-pyrrolidinohexanophenone was not possible for two blood samples. Urine samples quantification, (<i>n</i> = 16), revealed α-pyrrolidinoisohexiophenone concentrations ranging from 1.0 μg/L to 1,366.0 μg/L. A variety of clinical symptoms were recorded, including anxiety, aggression, suicidal thoughts, psychosis, babbling, and decreased consciousness.</p><p><strong>Discussion: </strong>Symptoms in this cluster matched those from previous synthetic cathinone intoxications. No correlation was found between α-pyrrolidinoisohexiophenone presence and intoxication severity. Synthetic cathinones remain popular due to their availability, low cost, and potency at doses as low as 5-10 mg, likely fuelling continued development of new analogues.</p><p><strong>Conclusion: </strong>The cluster of patients with poly-drug intoxications involving α-pyrrolidinoisohexiophenone in Belgium highlights the challenges posed by synthetic cathinones. Symptoms such as agitation, hallucinations and aggression align with those seen in prior cases of bath salts, although they cannot be solely attributed to α-pyrrolidinoisohexiophenone due to the presence of multiple other substances. We provide insight into α-pyrrolidinoisohexiophenone poisoning and emphasize the need for active information sharing to improve healthcare responses and awareness of the risks associated with synthetic drugs.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"626-632"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586169","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":"Fatal levamisole-associated multifocal inflammatory leukoencephalopathy following levamisole-adulterated cocaine use.","authors":"Mathilde Rustin, Marie Lecronier, Julien Mayaux, Maxens Decavèle","doi":"10.1080/15563650.2025.2528997","DOIUrl":"10.1080/15563650.2025.2528997","url":null,"abstract":"<p><strong>Introduction: </strong>Levamisole, an antihelmintic, has increasingly been used as a cocaine adulterant. We report a fatal case of levamisole-associated multifocal inflammatory leukoencephalopathy in a 49-year-old female with a history of cocaine use and present findings from magnetic resonance imaging, brain biopsies and hair analysis.</p><p><strong>Case summary: </strong>The patient was admitted in a comatose state following intentional drug use. Hair analysis revealed significant exposure to both levamisole and cocaine. Despite supportive care and methylprednisolone therapy, the patient's neurological condition deteriorated, leading to death.</p><p><strong>Images: </strong>Magnetic resonance imaging revealed extensive supratentorial leukoencephalopathy with periventricular and subcortical damage. Brain biopsy confirmed macrophage infiltration and demyelination, consistent with acute disseminated encephalomyelitis-like histopathological features, and provided further insight into the pathological mechanism.</p><p><strong>Conclusion: </strong>Levamisole-associated multifocal inflammatory leukoencephalopathy can result in irreversible neurological damage and should be considered in patients with a history of cocaine use presenting with coma or neurological symptoms.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"687-689"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593757","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":"The need for detailed reporting of kratom alkaloids.","authors":"Mallory K Pullman, Christopher R McCurdy, Stephen J Cutler","doi":"10.1080/15563650.2025.2522898","DOIUrl":"10.1080/15563650.2025.2522898","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"690-691"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610936","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 narrative review of toxicity after exposure to true morel (<i>Morchella</i> genus) and false morel (<i>Gyromitra</i> genus) mushroom ingestions.","authors":"Mark William Simon, David Kuai, Michael Yeh, Luke Yip","doi":"10.1080/15563650.2025.2524618","DOIUrl":"10.1080/15563650.2025.2524618","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The clinical presentations associated with &lt;i&gt;Morchella&lt;/i&gt; spp. (true morel) and &lt;i&gt;Gyromitra&lt;/i&gt; spp. (false morel) mushroom ingestions are incompletely characterized. The objective of this review is to describe the clinical presentations reported after &lt;i&gt;Morchella&lt;/i&gt; spp. and &lt;i&gt;Gyromitra&lt;/i&gt; spp. ingestions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a narrative review to identify studies reporting toxicity in humans from &lt;i&gt;Morchella&lt;/i&gt; spp. and &lt;i&gt;Gyromitra&lt;/i&gt; spp. The literature search was performed in two stages. First, a search of Medline, Embase, PubMed, Scopus, and Agricultural & Environmental Science electronic databases was performed. The search strategy employed a combination of controlled vocabulary terms and free-text terms. Terms such as \"morel,\" \"true morel,\" \"false morel,\" \"morchella,\" \"gyromitra,\" and \"lorchel\" were utilized in conjunction with keywords related to toxicity. Duplicate articles were removed. Second, a manual search of the references for the included articles was performed. Inclusion criteria were peer-reviewed human reports of mushroom ingestion in all languages up to 31 December 2024, with sufficient description of three components: acute ingestions to &lt;i&gt;Morchella&lt;/i&gt; spp. or &lt;i&gt;Gyromitra&lt;/i&gt; spp., clinical manifestations, and medical outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 84 articles that met the inclusion criteria. The articles described 201 and 52 individual &lt;i&gt;Gyromitra&lt;/i&gt; spp. and &lt;i&gt;Morchella&lt;/i&gt; spp. ingestions, respectively. The mortality rate in these articles was 28.9% for &lt;i&gt;Gyromitra&lt;/i&gt; spp. and 7.7% for &lt;i&gt;Morchella&lt;/i&gt; spp. The clinical presentation after &lt;i&gt;Morchella&lt;/i&gt; spp. ingestion was primarily neurologic (65.4%), most commonly dizziness and/or unsteadiness/ataxia (51.9%), without any reported seizures, with a median onset of 12 h (IQR: 9-12 h). Gastrointestinal (50.0%) effects were less common and often early, with a median onset of 2.3 h (IQR: 1.1-9 h). Hepatic effects were uncommon (17.3%) and only present when other organ systems were involved. No fatalities from &lt;i&gt;Morchella&lt;/i&gt; spp. ingestion were reported until 2024. However, three articles published in 2024 report multiple cases of critical illness and fatality after &lt;i&gt;Morchella&lt;/i&gt; spp. ingestion. The clinical presentation of &lt;i&gt;Gyromitra&lt;/i&gt; spp. ingestions was primarily gastrointestinal (88.1%) and often delayed with a median onset of 9 h (IQR: 6-12 h). Hepatic (53.7%) and neurologic (51.7%) effects were also commonly reported. Seizures were only reported in 13.9% of &lt;i&gt;Gyromitra&lt;/i&gt; spp. ingestions and mostly in fatal cases (82.1%) later in the disease course. Hemolysis was reported in only a minority of &lt;i&gt;Gyromitra&lt;/i&gt; spp. (2.5%) ingestions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;&lt;i&gt;Morchella&lt;/i&gt; spp. ingestions were most frequently associated with a constellation of neurologic symptoms, including dizziness, unsteadiness, and ataxia. Approximately half of the patients displayed g","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"609-618"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995112","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}