Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Establishing the value of call-handling metrics in a United Kingdom Poisons Information Centre.","authors":"Pardeep S Jagpal","doi":"10.1080/15563650.2026.2732064","DOIUrl":"https://doi.org/10.1080/15563650.2026.2732064","url":null,"abstract":"<p><strong>Introduction: </strong>Poisons Information Centres in the United Kingdom have experienced increased enquiry volume over the past five years, accompanied by declining answer rates, together indicating increasing operational pressure on Specialists in Poisons Information. Accurate measurement of enquiry handling time is essential for understanding workload and informing workforce planning; however, the validity of routinely collected operational metrics has not been evaluated.</p><p><strong>Methods: </strong>We undertook a service evaluation to compare automated timestamps from the national enquiry-logging system with manually recorded handling times. Handling time was defined as the sum of 'talk', 'hold' and 'documentation' time. Data were self-collected across 48 call handling shifts, involving 821 enquiries. For each enquiry, manually recorded handling time was compared with the system-generated duration to assess alignment and, if applicable, to quantify the magnitude and direction of any discrepancy.</p><p><strong>Results: </strong>Automated timestamps did not provide an accurate measure of total handling time, with bidirectional errors observed across Specialists in Poisons Information irrespective of experience. System-generated durations typically underestimated true handling time by approximately 20%, equating to a cumulative discrepancy of 30-80 min per shift. The median manually determined handling time for an incoming enquiry was 538 s, with 78% of time spent talking to the enquirer and 22% on documentation. Handling times were substantially longer for hospital-originated enquiries (828 s). The median case handling time also increased linearly with increasing case severity.</p><p><strong>Discussion: </strong>Growing enquiry volume and reduced answer rates motivated assessment of automated timestamp data, which underestimated true handling time. Wide variability indicated routine metrics may lack validity for describing workload or informing operational decisions.</p><p><strong>Conclusion: </strong>Automated timestamping substantially underestimates true enquiry handling time and may misrepresent workloads in Poison Information Centres. Accurate measurement of handling time is essential for modelling capacity, determining safe staffing levels and ensuring that national performance targets remain achievable.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043256","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":"Fresh frozen plasma as an adjunctive therapy in acute organophosphate poisoning: a systematic review and meta-analysis.","authors":"Omar De Santi, Marcelo J Orellana, Cecilia A Di Niro, Vanina Greco","doi":"10.1080/15563650.2026.2732065","DOIUrl":"https://doi.org/10.1080/15563650.2026.2732065","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Organophosphate poisoning is a leading cause of pesticide-related morbidity and mortality globally, particularly in low- and middle-income countries. Standard treatment with atropine and oximes has well-recognized limitations, and fresh frozen plasma has been proposed as an adjunctive therapy through exogenous butyrylcholinesterase supplementation. However, its clinical efficacy remains uncertain. This systematic review and meta-analysis evaluate the efficacy and safety of fresh frozen plasma as an adjunctive therapy in acute organophosphate poisoning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis following PRISMA guidelines. We searched PubMed, Cochrane Library, Science Direct, Google Scholar, Europe PMC, Trip Database, LILACS, IMSEAR, and trial registries from inception to July 2025 for randomized controlled trials comparing adjunctive fresh frozen plasma with standard therapy alone in hospitalized patients with acute symptomatic organophosphate poisoning. Pairs of reviewers independently screened studies, extracted data, assessed risk of bias using the Cochrane RoB2 tool, and evaluated certainty of evidence using GRADE. The primary outcome was mortality. Secondary outcomes included length of hospital stay, need for mechanical ventilation, atropine requirements, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seven randomized controlled trials (total &lt;i&gt;n&lt;/i&gt; = 421) were included. Meta-analysis of six studies (&lt;i&gt;n&lt;/i&gt; = 369) showed no statistically significant mortality reduction with fresh frozen plasma (risk ratio 0.58; 95% confidence interval 0.27-1.25; I&lt;sup&gt;2&lt;/sup&gt; = 17%; very low certainty). Fresh frozen plasma was associated with a shorter hospital stay (mean difference -1.89 days; 95% confidence interval -3.68 to -0.11; I&lt;sup&gt;2&lt;/sup&gt; = 77%; very low certainty) and a reduced need for mechanical ventilation (risk ratio 0.80; 95% confidence interval 0.66-0.96; I&lt;sup&gt;2&lt;/sup&gt; = 9%; low certainty). Atropine requirement data were heterogeneously reported and not suitable for meta-analysis. Non-severe adverse events were infrequent, primarily urticaria (risk ratio 3.59; 95% confidence interval 0.60-21.44; low certainty).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The available evidence suggests that adjunctive fresh frozen plasma may reduce the need for mechanical ventilation and shorten hospital stay in acute organophosphate poisoning, but it did not demonstrate a significant mortality benefit. These findings are limited by the small number of trials, methodological heterogeneity, and a generally high risk of bias across studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Adjunctive fresh frozen plasma may offer modest benefits in reducing ventilator dependence and hospitalization duration in acute organophosphate poisoning, with a manageable safety profile. However, current evidence is of low to very low certainty and insufficient to support routine use. Larger, high-quality randomiz","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-13"},"PeriodicalIF":3.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019485","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 kidney injury following ingestion of <i>Amanita</i> section <i>Roanokenses</i> in Yunnan, China: a five-case clinico-toxicological series.","authors":"Jiaju Zhong, Haowen Jing, Jipin Li, Lu Liu, Haijiao Li, Hongshun Zhang, Mingxuan Yuan, Zhiyuan Liu, Chengye Sun, Qunmei Yao","doi":"10.1080/15563650.2026.2727913","DOIUrl":"https://doi.org/10.1080/15563650.2026.2727913","url":null,"abstract":"<p><strong>Introduction: </strong><i>Amanita</i> section <i>Roanokenses</i> is a major cause of mushroom-related acute kidney injury in China, but detailed clinico-toxicological case series remain scarce. We retrospectively analyzed five acute kidney injury cases attributed to this section in Yunnan, China, from 2018 to 2025.</p><p><strong>Case presentations: </strong>Five patients developed gastrointestinal symptoms 4-31 h after ingestion, followed by oliguria and a rapid rise in serum creatinine, consistent with Kidney Disease: Improving Global Outcomes stage 1-3 acute kidney injury. All received supportive treatment, and four underwent continuous renal replacement therapy (2-7 sessions). All patients recovered and were discharged after 11-27 days. The implicated mushrooms were identified by morphological and molecular methods as two <i>A. neoovoidea</i>, one <i>A. pseudoporphyria</i>, and two undescribed <i>Amanita</i> species within section <i>Roanokenses</i>. The nephrotoxin 2-amino-4,5-hexadienoic acid was detected in all specimens at concentrations ranging from 0.07 to 3.24 mg/g dry weight.</p><p><strong>Discussion: </strong>This series integrates clinical course, species identification, and quantitative toxin profiling. Recognition of this toxidrome may aid early differentiation from amatoxin poisoning and support timely initiation of renal replacement therapy.</p><p><strong>Conclusion: </strong><i>Amanita</i> section <i>Roanokenses</i> poisoning is a distinct nephrotoxic syndrome characterized by early gastrointestinal symptoms, delayed acute kidney injury, detectable 2-amino-4,5-hexadienoic acid, and favorable renal outcomes with prompt treatment.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-5"},"PeriodicalIF":3.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993524","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":"Hyperbilirubinemia following an acetaminophen (paracetamol) overdose in a patient with undiagnosed gilbert syndrome.","authors":"Blake Haws, Taft Knowles, Ann M Arens","doi":"10.1080/15563650.2026.2727909","DOIUrl":"https://doi.org/10.1080/15563650.2026.2727909","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964125","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":"Evaluating clinical characteristics and outcomes associated with body stuffers presenting to the emergency department: a five-year retrospective analysis from a United States poison center.","authors":"Joshua Rabotnick, Margaret H Rabotnick, Andrew King, Varun Vohra","doi":"10.1080/15563650.2026.2729695","DOIUrl":"10.1080/15563650.2026.2729695","url":null,"abstract":"<p><strong>Introduction: </strong>\"Body stuffing\" refers to the ingestion of illicit drugs, often to evade law enforcement or prosecution. Management presents a clinical challenge, often centered around determining appropriate observation duration for asymptomatic or symptomatically resolved patients. To better guide clinical decision-making, this study aims to evaluate clinical characteristics, outcomes, and the efficacy of an often-implemented monitoring duration associated with body stuffers.</p><p><strong>Methods: </strong>We performed a five-year retrospective analysis of body stuffing cases reported to a single United States poison center from 1 January 2019 to 31 December 2023. All ages and sexes were included. Non-ingestion routes and cases where emergency department care was not pursued were excluded. Outcomes included time to new symptom onset and development of new symptoms after emergency department presentation, frequency of symptoms, specific drug(s) and drug wrapping details, and hospital length of stay. Categorical variables were summarized as frequencies and percentages and continuous variables used the median and interquartile range (IQR).</p><p><strong>Results: </strong>Ninety-four cases were included for final analysis. Most cases involved males (70/94, 74.5%) and most (39/67, 58.2%) involved patient observation and monitoring in the emergency department for ≤ 6 hours. Wrappers consisted mainly of plastic or cellophane (74/114, 64.9%). Opioids were most frequently ingested (56/114, 49.1%). Patients were symptomatic in 57/94 (60.6%) of cases. New symptoms developed in 12/94 (12.8%) of patients <i>after</i> initial emergency department presentation, with only 2/94 (2.1%) previously asymptomatic patients developing symptoms >6 hours after emergency department presentation.</p><p><strong>Discussion: </strong>This study supports the six hour observation period, with some exceptions. Case outliers underscore the limitations of a six hour observation period and the need for clinical judgement in body stuffer cases.</p><p><strong>Conclusion: </strong>Most body stuffers do not develop new or progressive symptoms after presentation within six hours, supporting but not definitively validating the commonly recommended six hour observation time. A modified observation period may be warranted in certain cases.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":3.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922506","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 case of acute on chronic acrylamide poisoning with shock and neurologic toxicity.","authors":"Ruixiao Zhang, Songmei Wang, Yuqin Wang, Maozeng Wei, Zeqing Chen, Leping Shao, Qiaojie Bi","doi":"10.1080/15563650.2026.2727912","DOIUrl":"https://doi.org/10.1080/15563650.2026.2727912","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908629","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":"Parenteral iron overdose: a scoping review.","authors":"Hung-Hsiang Chen, Shih-Hao Wu, Han-Wei Mu, Dong-Zong Hung","doi":"10.1080/15563650.2026.2727916","DOIUrl":"https://doi.org/10.1080/15563650.2026.2727916","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Parenteral iron formulations are increasingly used worldwide for the treatment of iron deficiency anemia, yet clinical guidance for managing parenteral iron overdose is limited. Existing risk assessment and management frameworks, including the widely cited serum iron concentration threshold of 500 µg/dL, are derived primarily from oral iron poisoning and may not be directly applicable to parenteral exposures. This scoping review aims to map the existing literature on parenteral iron overdose, summarize exposure patterns, clinical presentations, laboratory findings, therapeutic interventions, and outcomes, and identify knowledge gaps to inform future clinical practice and research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA extension for scoping reviews. Embase, Ovid MEDLINE, and Cochrane CENTRAL were searched through 31 December 2025, supplemented by Google Scholar and citation searching. Eligible studies described human reports of parenteral iron overdose or supratherapeutic repeated administration with sufficient original clinical detail. Two reviewers independently screened studies and extracted data, with disagreements resolved by a third reviewer. Findings were synthesized descriptively, and recurring patterns were identified through thematic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventeen reports comprising 49 patients, published between 1995 and 2025, met the inclusion criteria. Most reports were single-patient case reports (14/17, 82.4%), and nearly half were conference abstracts (8/17, 47.1%), reflecting an evidence base composed predominantly of low-volume, case-level data. Exposures clustered into acute single-dose overdose (12/29 classifiable cases, 41.4%) and subacute cumulative overexposure (17/29, 58.6%). Iron sucrose and iron dextran predominated among acute reports, whereas ferric hydroxide polymaltose complex predominated among subacute cases (76.5%). Serum iron concentration did not consistently correspond to clinical severity: several cases with concentrations between 825 and greater than 2,000 µg/dL remained asymptomatic, whereas one case with a concentration of approximately 112 µg/dL developed shock, disseminated intravascular coagulation, and multiorgan failure. Liver toxicity was reported mainly in subacute cumulative cases (82.4%) but in none of the acute cases. Chelation practice varied widely: four acute overdose patients recovered without chelation despite serum iron concentrations of 1,301-1,830 µg/dL, whereas asymptomatic patients in other reports received prolonged chelation. Overall, 48 of the 49 included patients survived.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The findings converge on three recurring themes. Parenteral iron overdose appears to represent a heterogeneous clinical syndrome distinct from classic oral iron poisoning, with phenotypes ranging from asymptomatic hyp","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-15"},"PeriodicalIF":3.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908672","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":"Predicting SILENT after lithium poisoning: a multicenter cohort study and pragmatic risk stratification model.","authors":"Álvaro Pineda-Torcuato, Antonio F Caballero-Bermejo, August Supervia, Emilio Salgado, Ruadhan O'Laoi, Carolina Sánchez, Francisca Córdoba, Neus Rodríguez Farré, Natalia Sanz-López, Héctor Hernández Ontiveros, Blanca Andrea Gallardo Sánchez, Paula Romero Gallardo, Victoria Lobo-Antuña, Benjamín Climent, Sandra Mora Azabal, Alberto Cózar-Llistó, Marina Vergara Ortiz, Mikel Urroz-Elizalde, Valle Molina Samper, Pablo Navarro Román, Xavier Canseco Suárez, Francisco J Callado Moro, Cormack Kennedy, María Del Pilar Gómez Jiménez, M Àngels Gispert-Ametller, Macarena Lucila Míguez Del Águila, Isabel Llopis Sanmillán, Luca Cioccari, Beatriz Martín Pérez, Susanna Vert García, Andrea Terron Sánchez, Guillermo Burillo-Putze, Edith Gutiérrez, Santiago Nogué-Xarau, Jordi Puiguriguer-Ferrando, Belén Ruiz-Antorán","doi":"10.1080/15563650.2026.2693677","DOIUrl":"https://doi.org/10.1080/15563650.2026.2693677","url":null,"abstract":"<p><strong>Introduction: </strong>The Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) is a rare but potentially devastating complication of lithium poisoning. Current evidence rests on case reports and small series, leaving its true incidence, risk factors, and follow-up tools poorly defined.</p><p><strong>Methods: </strong>Retrospective, international, multicenter cohort of adults evaluated for lithium poisoning (2015-2022) across 23 tertiary hospitals in Spain, Ireland, and Switzerland. SILENT was defined as persistent neurological sequelae attributed to lithium toxicity documented at 60 days. A parsimonious multivariable logistic regression model was built from routinely available clinical variables and assessed by ROC analysis and internal split-sample validation.</p><p><strong>Results: </strong>Among 644 episodes, SILENT was identified in 49 (7.6%); predicted probabilities were available for 456 episodes (39 SILENT cases). Affected patients were older and more often had acute-on-chronic poisoning, early neurological manifestations, and greater clinical severity. Serum lithium concentrations were not associated with SILENT. The model-age, poisoning type, neurological findings (ataxia/myoclonus), Poisoning Severity Score, and peak urea-showed good discrimination (AUC 0.813; 95% CI 0.743-0.882) and acceptable internal validation (AUC 0.730; 95% CI 0.572-0.888). A sensitivity-oriented threshold (P≥0.0475) yielded a high negative predictive value (98.2%), supporting its use to prioritize post-discharge neurological follow-up.</p><p><strong>Discussion: </strong>SILENT occurred more frequently than case-based literature suggests and followed a recognizable presentation pattern. Serum lithium alone did not predict long-term sequelae. The model, based on routine variables, may offer a pragmatic tool for early risk stratification.</p><p><strong>Conclusion: </strong>SILENT is not an exceptional outcome after lithium poisoning and cannot be predicted by serum lithium alone. A simple clinical prediction model may identify patients warranting structured neurological follow-up. External validation is required before implementation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-10"},"PeriodicalIF":3.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901612","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":"Etiology of methemoglobinemia in the National Poison Data System®: an observational study.","authors":"Taylor Wahrenbrock, Andrew Chambers, Michael Wheeler, Brandon K Wills, Emily Kershner","doi":"10.1080/15563650.2026.2722076","DOIUrl":"https://doi.org/10.1080/15563650.2026.2722076","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Methemoglobinemia is a recognized complication of exposure to numerous xenobiotics. Identifying xenobiotics most often linked to this condition can guide diagnosis and treatment. This study aims to summarize substances associated with methemoglobinemia using data from the National Poison Data System&lt;sup&gt;®&lt;/sup&gt; (NPDS&lt;sup&gt;®&lt;/sup&gt;) in order to identify more contemporary causes of methemoglobinemia. The primary objective is to identify the most frequent causative xenobiotics. Secondary objectives include describing xenobiotics linked to methylene blue treatment, deaths, and age-related patterns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cross-sectional analysis of NPDS&lt;sup&gt;®&lt;/sup&gt; database was queried from January 1, 2019, through November 30, 2025, by searching for cases in which methemoglobin was coded as a clinical outcome. Cases involving nonhuman exposures, unrelated effects, insufficient follow-up, unidentified products, viral illnesses, or xenobiotics not supported as causative agents of methemoglobinemia were excluded. Data collected included age, sex, implicated xenobiotic, reason for exposure, methylene blue administration, and outcome. Three trained reviewers abstracted and validated all cases. Descriptive statistics were used, reporting proportions for categorical variables and medians with interquartile ranges for continuous variables. Some xenobiotics were collated into larger groups, such as pharmaceutical and non-pharmaceutical nitrates/nitrites. Non-pharmaceutical nitrates/nitrites were defined as those coded amyl or butyl nitrates/nitrites (street drugs), intentional suicidal ingestions, or as intentional misuse or intentional abuse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We screened 2,535 cases and excluded 1,290, leaving 1,245 for analysis. The median patient age was 43 years (IQR 25-60 years) and 50.5% (629) were female. Non-pharmaceutical nitrates/nitrites were the leading xenobiotic associated with methemoglobinemia at 31% (392), followed by dapsone at 26% (328), phenazopyridine at 15% (187), and local anesthetics at 10% (121). Overall, of the 96 fatalities, 56% (50) were associated with non-pharmaceutical nitrate/nitrite exposures. The most common culprit xenobiotics in cases administered methylene blue were non-pharmaceutical nitrates/nitrites. In children younger than six years, nitrate/nitrite exposures were pharmaceutical in origin, whereas in older age groups they were predominantly non-pharmaceutical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This study identified non-pharmaceutical nitrates/nitrites as the most common xenobiotics associated with methemoglobinemia, methylene blue treatment, and mortality. Other classic xenobiotics such as dapsone, phenazopyridine, and local anesthetics were frequently treated but rarely fatal. Xenobiotics not typically linked to methemoglobinemia, such as acetaminophen and rasburicase, also appeared among the top ten causes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;N","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-7"},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883323","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":"Diffuse alveolar haemorrhage as a rare complication of high-dose methotrexate toxicity.","authors":"Adeline Ngo Su-Yin, Daryl Tan Chen Lung","doi":"10.1080/15563650.2026.2718885","DOIUrl":"https://doi.org/10.1080/15563650.2026.2718885","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883277","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}