Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Role of peripheral blood smear in identifying thrombotic microangiopathy in snakebites with venom-induced consumption coagulopathy.","authors":"Maglin Monica Lisa Joseph Tomy, Aboobacker Mohamed Rafi, Siju V Abraham, Ramesh Bhaskaran, Susheela J Innah","doi":"10.1080/15563650.2025.2528992","DOIUrl":"https://doi.org/10.1080/15563650.2025.2528992","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombotic microangiopathy is a clinical syndrome that may occur following snake envenomation, and is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and microvascular thrombotic occlusion, often leading to acute kidney injury. This study investigates the role of peripheral blood smear analysis in predicting thrombotic microangiopathy in snakebite patients with coagulopathy at a South Indian tertiary care center.</p><p><strong>Methods: </strong>This prospective observational study was conducted over a 20-month period. Patients with snakebite-induced coagulopathy were enrolled, and those with a history of transfusion, bleeding disorders, hemolytic anemia, or anticoagulant use were excluded. Clinical assessments and laboratory investigations, including full blood count, peripheral blood smear, kidney function tests, and lactate dehydrogenase activity, were performed at 48 h, 72 h, and 96 h post-bite.</p><p><strong>Results: </strong>Out of 58 patients, 9% developed thrombotic microangiopathy, with all cases showing fragmented red blood cells (schistocytes) on blood smear. Thrombocytopenia occurred in 43% of patients, and 36% developed acute kidney injury, with 16 requiring hemodialysis. Patients with schistocytes had longer hospital stays with a median of 30 days (IQR: 28-48 days) compared to those without schistocytes who had a median hospital stay of 7 days (IQR: 5-10 days) (<i>P</i> = 0.001). The mortality rate was 3%.</p><p><strong>Discussion: </strong>The presence of schistocytes in peripheral blood smear was strongly associated with acute kidney injury and prolonged hospitalization. Schistocytes may serve as an early indicator of thrombotic microangiopathy in snakebite patients, facilitating timely intervention. The use of a peripheral blood smear is a simple, cost-effective diagnostic tool in resource-limited settings to aid in the prediction of thrombotic microangiopathy and guide treatment, especially for optimal referral to specialized centers.</p><p><strong>Conclusions: </strong>Peripheral blood smear analysis can be a valuable predictor of thrombotic microangiopathy in snakebite patients, with a potential role in improving outcomes in resource-constrained settings that need further evaluation.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-10"},"PeriodicalIF":3.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777662","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 the reproducibility and validity of the use of the causality assessment method for poisonings designed and applied by the French poison control centres.","authors":"Sandra Sinno-Tellier, Dorian Délepine, Dominique Vodovar, Coralie Bragança, Marie Sponga, Emmanuel Puskarczyk, Ingrid Blanc-Brisset, Fanny Pelissier, Ismaïl Ahmed, Jacques Manel, Juliette Bloch, Alexis Descatha","doi":"10.1080/15563650.2025.2515239","DOIUrl":"10.1080/15563650.2025.2515239","url":null,"abstract":"<p><strong>Introduction: </strong>French poison control centres have developed and use a standardised causality assessment method based on a decision tree for poisoning cases involving a wide range of xenobiotics, which includes five ascending levels (I0-I4) and six determinants. This study was designed to evaluate inter-rater reliability and the validity of using this method.</p><p><strong>Methods: </strong>A reference group of toxicologists identified five categories of cases - based on the route of exposure with two circumstances for the oral route - recorded in the French National Database of Poisonings. The reference group assessed by consensus the level of causality of each randomly selected case as the reference level. Toxicologists from poison centres, not belonging to the reference group, were selected as raters. Inter-rater reliability was assessed using weighted Light's kappa. The results of raters were compared against the reference to test the validity of the method. A subgroup analysis of inter-rater reliability was also performed according to rater experience, case category, and causality determinant.</p><p><strong>Results: </strong>Nineteen raters reviewed the 86 cases selected by the reference group. Kappa was equal to 0.55 (moderate agreement). Sensitivity was 0.90 and specificity was 0.62 when comparing I0 versus I1-I4 classes. The agreement between raters increased with experience except for the most experienced group. Ocular route of exposure had the highest kappa (0.70) among the five case categories. Kappa for the causality determinants varied from 0.31 (exposure) to 0.54 (bibliographical references).</p><p><strong>Discussion: </strong>The causality assessment of poisonings was carried out on real-life cases. Our results are close to those of studies on causality methods in pharmacovigilance and nutrivigilance, despite a wider scope of application.</p><p><strong>Conclusion: </strong>Causality assessment method employed by French poison control centres is useful, although coding of some determinants should be improved. Further refinement of the causality assessment method will also further enhance its utility.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"570-578"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629302","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":"Adverse reactions of liquorice consumed in the diet: a 10-year retrospective study of poison centres in France.","authors":"Weniko Caré, Guillaume Grenet, Corinne Schmitt, Luc De Haro, Jérôme Langrand, Gaël Le Roux, Dominique Vodovar","doi":"10.1080/15563650.2025.2514643","DOIUrl":"10.1080/15563650.2025.2514643","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to describe the symptoms, patient demographics, and trends over time of adverse effects related to liquorice consumed in the diet reported to French poison centres.</p><p><strong>Methods: </strong>We performed a retrospective study of data from French poison centres of cases of adverse effects of liquorice consumed in the diet, with a high causality score, between 2012 and 2021 (10 years).</p><p><strong>Results: </strong>Sixty-four cases were included. The annual number of cases ranged from three to nine, with no significant variation over the study period. Liquorice-induced reactions were very rare (0.008% of all cases with symptoms reported to French poison centres). The products consumed were non-alcoholic beverages (non-alcoholic pastis, liquorice-based Antésite^®, and liquorice syrup), alcoholic beverages of the pastis type (10.9%), confectionery containing liquorice (12.5%), confectionery made with liquorice extract only (9.4%), herbal teas (12.5%) and food supplements (4.7%). Consumption was commonly chronic (67.2%) and non-compliant (70.3%). Chronic users presented with symptoms suggestive of pseudohyperaldosteronism, the severity of which seemed to correlate with the amount of glycyrrhizin ingested. Severity was high in 43.8% of cases. When the outcome was known (56.3%), it was favourable in almost all cases (94.4%), often after inpatient care, particularly in an intensive care unit. One patient had sequelae due to a stroke, and one fatality was reported. Severe cases were observed with all types of products, except liquorice syrup and food supplements, and more frequently with beverages (pastis with or without alcohol, and Antésite^®).</p><p><strong>Discussion: </strong>Due to significant variability in response to glycyrrhizin, some patients presented signs and symptoms suggestive of pseudohyperaldosteronism such as hypokalaemia, salt and water retention, and hypertension despite consuming the product as directed.</p><p><strong>Conclusions: </strong>Liquorice-induced effects were rarely reported to French poison centres, but their severity was high. Most patients were adults with chronic and non-compliant consumption, especially of soft drinks, with a clinical presentation suggestive of pseudohyperaldosteronism.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"579-587"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677198","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":"10.1080/15563650.2025.2543627","DOIUrl":"10.1080/15563650.2025.2543627","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"607"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839772","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 effects, outcomes, and disposition of unintentional pediatric mushroom exposures reported to United States poison centers from 2009 through 2023.","authors":"Anna Zmuda, Rita Farah, Conner McDonald, Avery Michienzi","doi":"10.1080/15563650.2025.2519325","DOIUrl":"10.1080/15563650.2025.2519325","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric exposures to mushrooms can cause distress to parents and healthcare workers due to fear that ingestion could be toxic or fatal. This study aims to characterize the clinical effects, outcomes and disposition of unintentional pediatric mushroom exposures reported to poison centers in the United States over the past 15 years.</p><p><strong>Methods: </strong>This is a retrospective study of the National Poison Data System^® from 2009 to 2023, which analyzes unintentional single-substance mushroom exposures in patients aged 5 years or younger. The primary outcomes were the rate of clinical effects, medical outcomes, and disposition. The secondary outcome was medical outcomes amongst patients who received activated charcoal.</p><p><strong>Results: </strong>There were 50,323 exposures, but no symptoms (89.4%) were reported in the majority of children, and most were managed at home (80.1%). Minor effects were reported in 5.0% of exposures, moderate effects in 0.6% of exposures, and major effects in 0.03% of exposures. Two patients received transplants. In the group of patients who received activated charcoal (7.2%), 7.0% had minor effects, 0.6% reported moderate effects, and 0.05% reported major effects. The type of mushroom was reported as unknown in 92.1% of cases.</p><p><strong>Discussion: </strong>This study shows that clinically significant symptoms and outcomes are rare from unintentional exposures to mushrooms in children aged 5 years or younger, even without mushroom identification. Of 50,323 exposures, major outcomes were reported only in 17. Symptoms were not reported in the majority of children regardless of activated charcoal administration.</p><p><strong>Conclusion: </strong>In the absence of symptoms, it may be safe to manage children with unintentional mushroom exposures at home, even without mushroom identification, due to the low risk for adverse outcomes.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"588-592"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546837","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":"Droperidol is associated with reduced length of stay in the treatment of cannabinoid hyperemesis syndrome.","authors":"Geoffrey S Kelly, Gavin Meeks, Bradley McCoul, Vidhi K Doshi, Tim P Moran","doi":"10.1080/15563650.2025.2516128","DOIUrl":"10.1080/15563650.2025.2516128","url":null,"abstract":"<p><strong>Introduction: </strong>Droperidol is a butyrophenone-class drug with potent antiemetic properties that may be useful for treating the acute symptoms of cannabinoid hyperemesis syndrome. We evaluated the effectiveness of droperidol in emergency department patients with cannabinoid hyperemesis syndrome.</p><p><strong>Methods: </strong>This was a retrospective study of encounters that occurred between March 1, 2024 and August 31, 2024 at two tertiary academic emergency departments in Atlanta, Georgia. We identified cases of cannabinoid hyperemesis syndrome via diagnosis codes and manual review of relevant non-specific diagnoses codes. We stratified patients by use of droperidol in the emergency department. The primary outcome was length of stay and secondary outcomes were total medication use, use of opioids, disposition, and key safety outcomes (medication adverse events, dysrhythmias).</p><p><strong>Results: </strong>There were 211 encounters among 158 unique patients included in the study. Droperidol was used in 77 (36.5%) of encounters at a median dose of 1.25 mg. The length of stay was significantly reduced in the droperidol group (409 min versus 641 min). After adjustments, droperidol use was associated with a reduced length of stay (mean ratio 0.76; 95% CI: 0.62 0.94; <i>P</i> = 0.01), decreased total medication administration (OR 0.34; 95% CI: 0.20-0.58; <i>P <</i>0.001) and decreased usage of opioids (OR 0.16; 95% CI: 0.07-0.39; <i>P <</i>0.001). Discharge dispositions were non-significant (OR 1.19; 95% CI: 0.57-2.48; <i>P</i> = 0.64). There were two mild adverse drug reactions in the droperidol group.</p><p><strong>Discussion: </strong>Several drug classes with plausible mechanisms are used to treat the symptoms of cannabinoid hyperemesis syndrome. Droperidol use was associated with several favorable outcomes including decreased length of stay, total medication use, and opioid use.</p><p><strong>Conclusions: </strong>We believe that droperidol may be considered as a first line treatment in patients with cannabinoid hyperemesis syndrome. Future studies should identify optimal dosing regimens using a randomized controlled trial design.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"550-555"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288133","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":"Toxicological seizures: characteristics, outcomes and recurrence.","authors":"Kristy McCulloch, Ingrid Berling, Angela L Chiew, Katherine Wood, Keith Harris, Geoffrey Isbister, Brooke Sachs, Katherine Isoardi","doi":"10.1080/15563650.2025.2512827","DOIUrl":"10.1080/15563650.2025.2512827","url":null,"abstract":"<p><strong>Introduction: </strong>Seizures are a marker of severe toxicity following overdose. Research characterising toxicological seizures is limited. We aim to study toxicological seizures, causative agents, and recurrence.</p><p><strong>Methods: </strong>This is a retrospective observational series of patients with seizure after drug overdose, presenting to three Australian clinical toxicology units between 1 January 2014 and 31 December 2022. Patients were identified from the database of each unit, and data were supplemented by the patient's medical record. Follow-up data were extracted in June 2024.</p><p><strong>Results: </strong>Over the nine-year period, there were 38,493 presentations to the three toxicology units. A seizure occurred in 284 presentations (275 patients). The median age was 29 years (IQR: 21-39 years; range: 15-86 years), and there were 150 males (55%). A previous seizure disorder was documented in 29/275 (11%) patients. In 82 (30%) presentations, more than one proconvulsant drug was taken. In 202 single proconvulsant exposures, the most common agents were tramadol (18/202, 9%), 3,4-methylenedioxymetamfetamine (15/202, 7%), and quetiapine (15/202, 7%). The highest seizure rate, considering total presentations for each agent, was for synthetic cannabinoid receptor agonists (9/43, 21%), tramadol (18/524, 3.4%), cocaine (14/516, 2.2%), and propranolol (8/427, 1.9%). A single seizure occurred in 169 (60%) cases, while status epilepticus occurred in 62 (22%). The median seizure duration was 1 min (IQR:1-3 min). The median time to the first seizure was 2.5 h (IQR: 1.0-7.1 h). Seizures occurred within 12 h for immediate-release preparations and within 24 h for slow-release preparations. Follow-up occurred in 221/275 (80%) patients. Seizure recurrence occurred in 45/221 (20%) patients. In eight patients (4%), a new diagnosis of epilepsy was established.</p><p><strong>Discussion: </strong>Both seizure recurrence and a subsequent diagnosis of epilepsy occurred more frequently than expected. A toxicological seizure may herald a propensity for future seizures and epilepsy.</p><p><strong>Conclusions: </strong>In this series, toxicological seizures were most common after tramadol, 3,4-methylenedioxymetamfetamine, quetiapine and cocaine. Seizure recurrence was common, with 4% of patients later diagnosed with epilepsy, supporting toxicological seizures being investigated, managed and followed up as rigorously as unprovoked first seizures.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":"63 8","pages":"527-533"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995129","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":"10.1080/15563650.2025.2532312","DOIUrl":"10.1080/15563650.2025.2532312","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"604"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610935","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":"10.1080/15563650.2025.2538387","DOIUrl":"10.1080/15563650.2025.2538387","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"605"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736602","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":"10.1080/15563650.2025.2529105","DOIUrl":"10.1080/15563650.2025.2529105","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"603"},"PeriodicalIF":3.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593756","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}