Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Intentional xylazine poisoning: a nationwide French poison control center study.","authors":"Olivier Denis, Amandine Douvinet, Bruno Mégarbane, Jérôme Langrand, Morgane Cellier, Laurène Dufayet","doi":"10.1080/15563650.2026.2645153","DOIUrl":"10.1080/15563650.2026.2645153","url":null,"abstract":"<p><strong>Introduction: </strong>Xylazine, an α₂-adrenergic agonist used as a veterinary sedative, has emerged as an adulterant of illicit opioids, contributing to fatal overdoses in North America and has recently been detected in Europe. In France, despite alarmist media reports, data on xylazine exposures are scarce.</p><p><strong>Methods: </strong>We retrospectively reviewed intentional xylazine exposures reported to the eight French poison control centers from January 2010 to December 2024. Cases were extracted from the French National Database of Poisonings. Inclusion required intentional use; severity was assessed using the Poison Severity Score.</p><p><strong>Results: </strong>Nineteen intentional exposures were identified: seventeen in the context of a suicide attempt, one homicidal, and one recreational. Mean age was 36.4 years; sex ratio 2.6 (male/female). For the cases occurring in the context of a suicide attempt, eleven involved xylazine alone, and six in combination with other drugs (mainly ketamine or fentanyl). Three fatalities occurred (16%), and six patients developed severe clinical features (Poisoning Severity Score 3), including coma, bradycardia, and hypotension. The single recreational case involved a fentanyl/xylazine mixture with full recovery.</p><p><strong>Discussion: </strong>Over a 14-year period, intentional xylazine poisonings reported to French Poison Control Centers were uncommon, mainly occurring in the context of a suicide attempt, and often linked to occupational access to veterinary sedatives. These data do not support community or recreational spread. Nonetheless, observed cases confirm xylazine's life-threatening potential.</p><p><strong>Conclusion: </strong>This retrospective analysis highlights the rarity of reported xylazine exposures in French poison centre data, strengthened toxicological surveillance and coordination between Poison Control Center and drug-checking networks are needed to detect any shift toward broader use and guide prevention efforts.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"796-800"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679873","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":"Correction.","authors":"","doi":"10.1080/15563650.2026.2688607","DOIUrl":"10.1080/15563650.2026.2688607","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"846"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261350","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":"Evaluation of oral fluid microsampling as a urine surrogate matrix in substance use disorder care: clinical applicability and analytical performance.","authors":"Pauline Thiebot, Virgile Clergue Duval, Neila Djaker, Alexandre Kononov, Thomas Schiestel, Florence Vorspan, Nicolas Auzeil, Laurence Labat","doi":"10.1080/15563650.2026.2657990","DOIUrl":"10.1080/15563650.2026.2657990","url":null,"abstract":"<p><strong>Introduction: </strong>Toxicological monitoring in addiction treatment centres routinely relies on urine analysis to assess substance use, abstinence, and opiate agonist therapy adherence. However, collecting urine presents two major limitations: potential privacy concerns due to supervised collection, and delays caused by the need for spontaneous urination. Oral fluid has been proposed as an alternative matrix to address these issues, despite its shorter detection window. This study evaluates the clinical applicability and analytical performance of oral fluid toxicological screening, using volumetric absorptive microsampling device, in patients with substance use disorders in an addiction treatment centre.</p><p><strong>Methods: </strong>Fifty paired urine and oral fluid samples were collected. First, urine immunoassays were compared with oral fluid screening by high-performance liquid chromatography hyphenated to high resolution mass spectrometry to assess drug detectability, focusing on amfetamines, benzodiazepines, buprenorphine, cannabis, cocaine, ecstasy, methadone, and opiates. The mass spectrometry screening results from both matrices were then compared, and the analysis was extended to pharmaceuticals.</p><p><strong>Results: </strong>Forty-five (90%) patients rated the method change acceptable or very acceptable, compared to 14 (28%) who rated urine collection as acceptable or somewhat acceptable. Screening agreement between matrices exceeded 88%. Benzodiazepines were among the least detectable in oral fluid. On the contrary, for cocaine and cannabis, detection windows appeared longer in oral fluid.</p><p><strong>Discussion: </strong>Oral fluid collection offers clear advantages in terms of patient acceptability and ease of supervision, with the benefit of reducing the risk of sample adulteration compared to urine. High-resolution mass spectrometry provides the sensitivity required for reliable toxicological monitoring while remaining cost-competitive compared with multiple immunoassays. This approach is particularly suitable for frequent users and patients on chronic treatments.</p><p><strong>Conclusion: </strong>Oral fluid microsampling has reliable toxicological results, combined with practical collection, patient satisfaction, reduced costs, and a lower risk of sample adulteration, highlights its clinical value. Although detection windows may differ from urine and turnaround times are longer than immunoassays, oral fluid remains a robust option for monitoring both drugs of abuse and prescribed treatments in this population.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"788-795"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848854","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 toxicity of <i>hyoscyamus niger</i> (henbane) in children: a five-year experience in a pediatric intensive care unit.","authors":"Kıvanç Terzi, Fatma Gül Ersan, Özlem Sarıtaş Nakip","doi":"10.1080/15563650.2026.2655383","DOIUrl":"10.1080/15563650.2026.2655383","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric poisoning is a major global public health concern, with plant-derived intoxications constituting a substantial proportion of cases. <i>Hyoscyamus niger</i> (henbane) contains tropane alkaloids responsible for antimuscarinic toxicity. This study aims to evaluate the clinical characteristics, management, and outcomes of pediatric henbane poisoning cases and to highlight prevention strategies.</p><p><strong>Methods: </strong>This retrospective observational study was conducted in the pediatric intensive care unit of Ağrı Training and Research Hospital between January 2018 and April 2023. Patients aged one month to 18 years diagnosed with henbane poisoning were included. Poisoning severity was classified according to the International Programme of Chemical Safety/European Association of Poison Control Centres and Clinical Toxicologists, Poisoning Severity Score. Demographics, clinical features, laboratory data, interventions, and outcomes were analyzed. Statistical analyses were performed, with <i>P <0.05</i> considered significant.</p><p><strong>Results: </strong>A total of 68 patients (35 males, 51.5%; median age 63.5 months) were included. Severe cases had significantly higher rates of seizures (10/28, 35.7% versus 0/40, 0%; <i>P <0</i>.001), sedation requirement (14/28, 50.0% versus 0/40, 0%; <i>P <0</i>.001), and acute kidney injury (19/28, 67.9% versus 4/40, 10.0%; OR: 8.44, 95% CI: 2.79-25.59; <i>P <0</i>.001). Agitation (55/68, 80.9%) and mydriasis (58/68, 85.3%) were the most common symptoms and clinical findings. Tachycardia was significantly associated with acute kidney injury (25/54, 46.3% versus 2/14, 14.3%; OR: 5.17, 95% CI: 1.06-5.25, <i>P =</i> 0.031). No patients received physostigmine therapy. All patients recovered fully.</p><p><strong>Discussion: </strong>Henbane poisoning in children causes neuropsychiatric and systemic signs of antimuscarinic toxicity, mainly agitation, hallucinations, and sinus tachycardia. Severe cases may lead to seizures and acute kidney injury, possibly due to reduced renal perfusion.</p><p><strong>Conclusion: </strong>Severe henbane poisoning in children requires sedation, can cause seizures, and may lead to acute kidney injury. Tachycardia is a potential indicator of renal injury.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"769-774"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848913","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 features of toxic encephalopathy in a cohort of 129 patients with acute diquat poisoning.","authors":"Zejin Ou, Xin Li, Ying Li, Yunchao Chen, Ziyi Wang, Zhaohuan Luo, Zhenhong Long, Hao Zhou, Jianwu Dai, Tianqiong Wu, Tailing Liu, Zhiqian Yang, Chengye Sun, Yiwei Su, Linwei Tian, Yanmei Ruan, Zhi Wang","doi":"10.1080/15563650.2026.2654539","DOIUrl":"10.1080/15563650.2026.2654539","url":null,"abstract":"<p><strong>Introduction: </strong>Diquat-induced toxic encephalopathy remains inadequately understood.</p><p><strong>Methods: </strong>Data on patients with acute diquat poisoning were retrospectively collected from May 2017 to May 2023. The diagnosis was confirmed qualitatively by ultra-high performance liquid chromatography quadrupole-time of flight mass spectrometry. A follow-up study was designed to explore the long-term health effects of diquat poisoning.</p><p><strong>Results: </strong>A total of 129 patients with acute diquat poisoning were included in this study. Thirty-four patients died (27 of whom developed toxic encephalopathy) following a median dose of diquat (200 g/L) 190 mL (IQR:100-200 mL). Forty-five patients were diagnosed with toxic encephalopathy, mainly involving the brainstem, bilateral cerebellar peduncles, and basal ganglia. The development of toxic encephalopathy was associated with a significantly higher risk of death (odds ratio = 16.5; 95%CI: 6.2-43.8; <i>P </i><0.001). Twenty-five of the 95 survivors were enrolled in a follow-up study. The main persistent features were peripheral nerve injuries in 20%, suspected peripheral nerve injuries in 40%, and reduced compound muscle action potential in 84%; chronic-phase encephalopathy occurred in 28%. Transcriptomic analysis revealed significant changes in the expression profiles of neuroregulatory factors, including inhibin-βA and sonic hedgehog.</p><p><strong>Discussion: </strong>Toxic encephalopathy represented an important organ injury caused by acute diquat poisoning, which was strongly associated with an increased risk of death. Peripheral nerve injuries were also common at follow-up. Several limitations should be noted, including the lack of diquat concentrations, the small sample size, the short follow-up duration, and the single-center design.</p><p><strong>Conclusions: </strong>Thirty-four of 129 (26.4%) patients died from diquat poisoning. Toxic encephalopathy was diagnosed in 45 of 129 (34.9%) patients, and its development was associated with a significantly higher risk of death. Follow-up revealed peripheral nerve injuries in 20% of patients, and chronic-phase encephalopathy in 28%.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"755-768"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on the effects of hyperbaric oxygen dosing on the delayed neuropsychiatric sequalae of carbon monoxide poisoning.","authors":"Noah Berland, Adam Blumenberg","doi":"10.1080/15563650.2026.2689705","DOIUrl":"10.1080/15563650.2026.2689705","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"842-843"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"We need a standardized North American acetylcysteine dosing regimen for the treatment of paracetamol (acetaminophen) poisoning\" and the response of Mullins and colleagues.","authors":"Chris Humphries, James W Dear","doi":"10.1080/15563650.2026.2678368","DOIUrl":"10.1080/15563650.2026.2678368","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"743-745"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255530","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":"Rhabdomyolysis, renal failure and chronic neurologic deficits after prolonged immobilization from use of a 7-hydroxymitragynine product.","authors":"Alyrene Dorey, Roy Gerona, Jacob Bell, Ross Ellison, Michael Moss","doi":"10.1080/15563650.2026.2688230","DOIUrl":"10.1080/15563650.2026.2688230","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"839-840"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341900","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":"Low-dose versus standard-dose antivenom for neuroparalytic krait envenomation: a randomized pilot study.","authors":"Siva Jyothika, Prannoy George Mathen, Ripudaman Sharma, Neeraj Singla, Navneet Sharma, Ashok Kumar Pannu","doi":"10.1080/15563650.2026.2655938","DOIUrl":"10.1080/15563650.2026.2655938","url":null,"abstract":"<p><strong>Introduction: </strong>The common krait (<i>Bungarus caeruleus</i>) is a leading cause of neuroparalytic snake envenomation in South Asia. Current guidelines recommend escalation from 10 to 20 vials of polyvalent antivenom if neurotoxicity persists, despite limited evidence supporting this strategy.</p><p><strong>Methods: </strong>This open-label, randomized pilot study was conducted in North India, enrolling patients with krait envenomation who presented with neurotoxic paralysis but without respiratory failure. Patients were assigned to receive either 10 vials or 20 vials of polyvalent antivenom. The primary outcome was time to recovery from neurotoxic paralysis. Secondary outcomes included the need for invasive mechanical ventilation, time from enrolment to intubation, duration of mechanical ventilation, and in-hospital mortality.</p><p><strong>Results: </strong>Of 97 patients screened, 53 underwent randomization (26 assigned to the 10-vial group and 27 to the 20-vial group). Baseline characteristics, severity of neurotoxic paralysis, laboratory parameters, and time from bite to enrolment (median 5 hours) were similar between groups. The median time to recovery from neurotoxic paralysis was 42.5 hours (IQR, 29.8-54.3) in the 10-vial group and 45.0 hours (IQR, 35.5-59.5) in the 20-vial group (median difference, -5.0 hours; 95% CI, -15.5 to 5.5; <i>P</i> = 0.24); Kaplan-Meier analysis showed no significant between-group difference (log-rank <i>P</i> = 0.38). Invasive mechanical ventilation was required in 34.6% of patients in the 10-vial group and 22.2% in the 20-vial group (risk ratio, 1.34; 95% CI, 0.77 to 2.31). Among ventilated patients, the median time to intubation and duration of mechanical ventilation were similar between groups. One death occurred in the 10-vial group.</p><p><strong>Discussion: </strong>Routine escalation of antivenom dosing may not be necessary in krait neurotoxicity with close respiratory monitoring and supportive care.</p><p><strong>Conclusions: </strong>Among patients with neuroparalytic krait envenomation who presented without respiratory failure, a 10-vial antivenom regimen was associated with clinical outcomes comparable to those with a 20-vial regimen.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"780-787"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731173","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":"Response to: comment on \"A prospective pharmacokinetic study of chlordiazepoxide in patients admitted to an intensive care unit or a high dependency unit after treatment of alcohol withdrawal symptoms\".","authors":"Nanna Reiter, Tonny Studsgaard Petersen, Charlotte Uggerhøj Andersen, Kim Dalhoff, Christian S Meyhoff","doi":"10.1080/15563650.2026.2702499","DOIUrl":"10.1080/15563650.2026.2702499","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"844-845"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687588","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}