Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Midodrine exposure trends and outcomes reported to United States poison centers: 2000-2023.","authors":"David Kuai, Daniel Philip Nogee, Stephanie Kieszak, Andrew Geller, Michael Yeh, Amy Schnall","doi":"10.1080/15563650.2025.2546073","DOIUrl":"10.1080/15563650.2025.2546073","url":null,"abstract":"<p><strong>Introduction: </strong>Midodrine is an oral alpha-1 adrenergic agonist used to treat orthostatic hypotension. Its vasoconstrictive properties can lead to hypertension and reflex bradycardia. We characterized midodrine exposures reported to United States poison centers from 2000 to 2023.</p><p><strong>Methods: </strong>We performed a retrospective analysis of single-substance midodrine exposures reported to the National Poison Data System^®. Descriptive statistics were used to characterize temporal trends, demographics, exposure reasons, level of healthcare, and medical outcomes. National estimates of retail outpatient midodrine prescriptions during 2002-2023 were obtained from IQVIA Total Patient Tracker.</p><p><strong>Results: </strong>The number of patients dispensed midodrine from retail pharmacies increased 695%, from 55,300 in 2002 to 439,659 in 2023. There were 1,935 midodrine exposures reported to the National Poison Data System^® from 1 January 2000 to 31 December 2023. Exposures increased 714%, from 21 calls in 2000 to 171 calls in 2023. The most common features reported were hypertension in 277 (14.3%) and bradycardia in 197 (10.2%). Therapeutic errors accounted for most cases in most age groups except adolescents aged 13-19 years, in which suspected suicide was the most commonly reported reason (50.2%). Most exposures were managed at home. Among 866 patients who sought medical care, 437 (50.5%) were treated/evaluated and released, but 115 (13.3%) were admitted to a critical care unit.</p><p><strong>Discussion: </strong>Midodrine exposures increased over time, particularly among individuals aged 20-59 years and 60 years and older, with a concomitant increase in retail midodrine dispensing. Although most exposures were managed at home, severe adverse effects have been reported, especially among patients with suspected suicidal ingestions compared to those with therapeutic errors. The National Poison Data System^® is limited by its passive surveillance design, and not all exposures are reported.</p><p><strong>Conclusions: </strong>Better understanding of midodrine exposures and associated outcomes can inform poison center triage and medical management. Improved surveillance and clinician awareness may reduce morbidity and mortality associated with midodrine toxicity.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985255","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 \"effectiveness and tolerability of methylthioninium chloride (methylene blue) for the treatment of methemoglobinemia: twenty-four years of experience at a single poison center\".","authors":"Elize Visser, Danique Schmitz, Daan J Touw, Bart G J Dekkers","doi":"10.1080/15563650.2025.2546557","DOIUrl":"https://doi.org/10.1080/15563650.2025.2546557","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986151","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":"Radiological features of paraquat-induced pulmonary fibrosis.","authors":"Mingxing Wang, Jie Jiao, Jie Liu, Jianhui Zhao, Baoqiang Gong","doi":"10.1080/15563650.2025.2542471","DOIUrl":"https://doi.org/10.1080/15563650.2025.2542471","url":null,"abstract":"<p><strong>Introduction: </strong>Paraquat poisoning remains of toxicological concern as it may cause multiple organ failure after substantial ingestion, and in those less severely poisoned, pulmonary fibrosis.</p><p><strong>Case summary: </strong>We describe a patient who developed paraquat-induced pulmonary fibrosis and iatrogenic atelectasis due to a right subclavian vein catheterization.</p><p><strong>Images: </strong>The chest radiograph obtained on hospital day 3 demonstrates a right tension hemothorax. A repeat chest radiograph obtained on hospital day 4 demonstrates a large right pneumothorax. A chest radiograph obtained on hospital day 11 demonstrates resolution of the pneumothorax with development of patchy infiltrates in the left lung and right upper lobe with relative sparing of the right lower lobe. Subsequent computed tomography scans of the lung demonstrate severe disease in the aerated left lung with near resolution in the lower portions of the right lung.</p><p><strong>Conclusion: </strong>Our patient developed the typical clinical and radiological features of paraquat-induced pulmonary fibrosis, more marked in the left lung compared to the non-aerated right lung.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-4"},"PeriodicalIF":3.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985756","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":"Real-world experience of veno-arterial extracorporeal membrane oxygenation in severe aluminium phosphide poisoning.","authors":"Arvind Kumar, Jai Prakash, Kirti Berwal, Gaurav Arya, Varun Narwal, Ekal Arora, Anoop Kumar, Nisha Yadav, Dhruva Chaudhry, Aman Dhankar, Sonalika Arora, Anand Kumar Yadav, Jagjeet Singh, Aman Ahuja, Pawan Kumar Singh","doi":"10.1080/15563650.2025.2544948","DOIUrl":"https://doi.org/10.1080/15563650.2025.2544948","url":null,"abstract":"<p><strong>Introduction: </strong>Mitochondrial toxicity caused by phosphine released from aluminium phosphide in the presence of moisture leads to haemodynamic collapse, and the mortality from aluminium phosphide ingestion is high. In anecdotal studies, veno-arterial extracorporeal membrane oxygenation appears to reduce mortality.</p><p><strong>Methods: </strong>A retrospective, single-centre study was conducted of patients with aluminium phosphide poisoning managed between 2019 and 2023. Clinical data were retrieved and analysed. Additionally, outcomes of patients who declined hospital admission were traced and reviewed.</p><p><strong>Results: </strong>Of the 182 patients admitted with aluminium phosphide poisoning, 78 (42.9%) underwent veno-arterial extracorporeal-membrane-oxygenation, with a mean age of 34.4 ± 11.7 years. At presentation, 60 patients (76.9%) exhibited multiple organ dysfunction, and 74 (94.9%) showed electrocardiographic abnormalities. Veno-arterial extracorporeal membrane oxygenation was initiated in the emergency department for 68 patients (87.2%) and during cardiopulmonary resuscitation in eight patients (10.3%). Concurrent kidney replacement therapy was administered to 53 patients (67.9%). The median time from emergency department arrival to veno-arterial extracorporeal membrane oxygenation initiation was 1 h (IQR: 0.5-2.0 h), with a significant (<i>P</i> = 0.02) delay observed among survivors. The median duration of extracorporeal membrane oxygenation support was 48.0 h (IQR: 36.0-68.0 h), and the median intensive care unit stay was 6 days (IQR: 4-9 days). The overall survival with veno-arterial extracorporeal membrane oxygenation was 67.9% (<i>n</i> = 53), while 25 patients (32.1%) died despite this support. Among the 17 traceable patients who declined admission, the mortality was 100%. Complications related to extracorporeal membrane oxygenation occurred in 63 patients (80.8%), with 15 (19.2%) experiencing severe adverse events.</p><p><strong>Discussion: </strong>Our study has some limitations. It was a single-centre retrospective study, which limits the generalizability of the findings, and our data are prone to selection bias.</p><p><strong>Conclusion: </strong>A retrospective study of 78 patients with aluminium phosphide poisoning who underwent veno-arterial extracorporeal membrane oxygenation was conducted in a single centre, and the overall survival was 67.9%. Veno-arterial extracorporeal membrane oxygenation offers temporary circulatory support during reversible myocardial depression with a high risk of complications. Further prospective, multicentre studies are warranted to refine indications, evaluate cost-effectiveness and assess long-term outcomes in aluminium phosphide poisoning.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":3.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985795","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":"Chemical epiglottitis causing airway compromise after benzalkonium chloride ingestion.","authors":"Akiko Izumikawa, Yuji Okazaki, Akifumi Kariya, Fumiya Inoue, Kentaro Egusa, Waso Fujinaka","doi":"10.1080/15563650.2025.2536315","DOIUrl":"https://doi.org/10.1080/15563650.2025.2536315","url":null,"abstract":"<p><strong>Introduction: </strong>Benzalkonium chloride, a quaternary ammonium compound with disinfectant properties, produces caustic effects at concentrations of 0.1% or higher. However, the relationship between the characteristics of the ingested substance and clinical severity, including airway compromise, is not always straightforward.</p><p><strong>Case summary: </strong>A 77-year-old man presented with odynophagia and drooling after accidentally ingesting only 1 mL of 10% benzalkonium chloride and 1% isopropyl methyl phenol (Neotraban Green^®). Given the risk of airway compromise, emergency endotracheal intubation was performed. Despite the high concentration, no oral, esophageal, or gastric injury was observed.</p><p><strong>Images: </strong>Flexible laryngoscopy revealed marked epiglottic and arytenoid swelling, leading to a diagnosis of chemical epiglottitis.</p><p><strong>Conclusion: </strong>Even minimal ingestion of high-concentration benzalkonium chloride can cause life-threatening upper airway injury. Clinicians should maintain a high index of suspicion for airway compromise in cases of caustic ingestion based not only on ingested volume but also on clinical signs.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857378","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":"Magnesium sulfate and/or calcium channel blockers as co-adjuvant treatments to standard therapy for acute organophosphate insecticide poisoning: a systematic review and meta-analysis.","authors":"Omar De Santi, Marcelo Orellana, Cecilia Di Niro, Vanina Greco","doi":"10.1080/15563650.2025.2526116","DOIUrl":"https://doi.org/10.1080/15563650.2025.2526116","url":null,"abstract":"<p><strong>Introduction: </strong>Organophosphate insecticide poisoning remains a significant public health issue in low- and middle-income countries. Standard treatment involves atropine and pralidoxime or obidoxime, however adjunctive therapies like magnesium sulfate and calcium channel blockers may offer additional benefits. This review aims to evaluate the efficacy and safety of magnesium sulfate and/or calcium channel blockers as adjunctive treatments for organophosphate insecticide poisoning.</p><p><strong>Methods: </strong>We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identifying randomized controlled trials that compared the use of magnesium sulfate or calcium channel blockers with standard treatment in hospitalized patients with organophosphate insecticide poisoning. Data were extracted regarding mortality, atropine requirements, hospital length of stay, and mechanical ventilation needs.</p><p><strong>Results: </strong>No trials were identified for calcium channel blockers. Eight randomized controlled trials (total <i>n</i> = 549) across diverse settings evaluated magnesium sulfate as adjunctive therapy. The risk ratio for mortality (seven studies, total <i>n</i> = 469) comparing magnesium sulfate versus standard therapy was 0.37 (95% CI: 0.22-0.64). Magnesium sulfate also significantly reduced daily atropine requirements (mean difference = -23.27; 95% CI: -36.57 to -9.97). No significant differences were found for hospital length of stay or mechanical ventilation. Three studies monitored safety, with only one reporting transient hypotension at higher magnesium infusion rates.</p><p><strong>Discussion: </strong>While the results suggest that magnesium sulfate may be a promising adjunct in the treatment of organophosphate insecticide poisoning, with potential benefits in reducing mortality and atropine dosage, the evidence is based on small studies with limited sample sizes. We were unable to find evidence to support the use of calcium channel blockers.</p><p><strong>Conclusions: </strong>Intravenous magnesium sulfate may reduce mortality and atropine requirements in acute organophosphate insecticide poisoning, with a favorable safety profile. These findings should be interpreted with caution, and larger, well-designed randomized controlled trials are needed to determine the role of magnesium sulfate in organophosphate insecticide poisoning.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-11"},"PeriodicalIF":3.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824797","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":"Methotrexate-induced epidermal necrosis.","authors":"Christopher Kennedy, John A Thompson","doi":"10.1080/15563650.2025.2532616","DOIUrl":"https://doi.org/10.1080/15563650.2025.2532616","url":null,"abstract":"<p><strong>Introduction: </strong>Methotrexate-induced epidermal necrosis is a rare, potentially fatal mucocutaneous reaction that clinically mimics Stevens-Johnson syndrome/toxic epidermal necrolysis. Early clinical manifestations include leukopenia, thrombocytopenia, mucositis and skin erosions. Risk factors for methotrexate-induced epidermal necrosis include age greater than 60 years, chronic kidney disease, and high initial dose of methotrexate (>10 mg/weekly) without folic acid supplementation.</p><p><strong>Case summary: </strong>A 63-year-old female with a history of psoriasis started taking oral methotrexate 10 mg weekly without folic acid supplementation and developed a desquamating rash covering more than 70% of her body. Her rash developed within two weeks of starting methotrexate. She received treatment with calcium folinate and made a full recovery.</p><p><strong>Images: </strong>Clinical images obtained on hospital day two show diffuse skin erosions and necrosis.</p><p><strong>Conclusion: </strong>Methotrexate-induced epidermal necrosis is an uncommon, potentially fatal, adverse reaction to methotrexate. Early diagnosis of methotrexate-induced epidermal necrosis can prompt early intervention with calcium folinate and hopefully mitigate potentially fatal outcomes associated with methotrexate toxicity.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144824798","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":"Crotalidae polyvalent immune Fab (ovine) dosing in <i>Agkistrodon contortrix</i> envenomation: a single-center retrospective cohort study.","authors":"Kevin Baumgartner, Frank Dicker, Kim-Long Nguyen, Christianne Jafari, Emilie Lothet, Ellen Salmo, Taylor Kaser, Sarah Berg, David B Liss, Rachel M Ancona, Michael E Mullins","doi":"10.1080/15563650.2025.2530591","DOIUrl":"https://doi.org/10.1080/15563650.2025.2530591","url":null,"abstract":"<p><strong>Introduction: </strong>Crotalidae polyvalent immune Fab (ovine) is indicated for the treatment of <i>Agkistrodon contortrix</i> (copperhead) envenomation. Medical toxicologists have used lower Crotalidae polyvalent immune Fab (ovine) antivenom doses than those recommended in the prescribing information for the treatment of copperhead envenomation.</p><p><strong>Methods: </strong>We conducted a single-center retrospective chart review of patients with copperhead envenomation seen by our medical toxicology consult service between January 2001 and June 2023. Patients with dry bites, envenomation by other snakes, no antivenom treatment, treatment with non-Fab antivenom, or inaccessible data were excluded. Trained investigators abstracted data on antivenom dosing, demographics, examination findings, laboratory results, processes of care, and opioid administration from the medical record. The primary aim was to describe antivenom dosing. The secondary aim was to assess the relationship between initial antivenom dose (less than four vials versus four or more vials) and clinical outcomes.</p><p><strong>Results: </strong>We included 143 patients. The median (IQR) initial and total antivenom doses were four vials (two-four vials) and four vials (four-six vials), respectively. Antivenom redosing occurred in 41 cases (29%). Lower initial doses of antivenom were not associated with increases in the Snakebite Severity Score, extent of soft tissue injury, total opioid dose, length of stay, or occurrence of redosing.</p><p><strong>Discussion: </strong>Patients seen by our consult service frequently received lower doses of antivenom than those recommended in the prescribing information, without association with poor in-hospital clinical outcomes. These results are consistent with previous observational studies and, if confirmed by prospective research, may support a change in antivenom dosing strategies for copperhead envenomation that could result in substantial cost savings.</p><p><strong>Conclusion: </strong>Our consult service frequently used lower doses of antivenom for copperhead envenomation than recommended in the prescribing information. This practice did not appear to be associated with frequent antivenom redosing, progression of soft tissue injury, higher opioid doses, or increased length of stay.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796623","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":"Clinical characteristics of patients in the emergency department involved in the recreational use of etomidate and its analogues confirmed by liquid chromatography-tandem mass spectrometry.","authors":"Te-I Weng, Chi-Tzu Chung, Hsien-Yi Chen, Lengsu W Chin, Ju-Yu Chen, Guan-Yuan Chen, Cheng-Chung Fang","doi":"10.1080/15563650.2025.2527855","DOIUrl":"https://doi.org/10.1080/15563650.2025.2527855","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796622","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":"Severe systemic inflammatory response and acute kidney injury induced by Kambô intoxication.","authors":"Erick Daniel Alvarez-Boizo, Diana Ugalde-Soto, Jesús Pinedo-Vázquez, Gabriel Zavala-Rodríguez, Manuel Alejandro Marroquin-Barrera, Gibran Felipe Azamar-Morales, Zeltzin Olivia Guerrero-Mancinas, Erik Cimé-Aké","doi":"10.1080/15563650.2025.2541705","DOIUrl":"https://doi.org/10.1080/15563650.2025.2541705","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791718","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}