Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Presence and quantity of ingredients in sports supplements purportedly containing the orchid <i>Eria jarensis</i>.","authors":"Pieter A Cohen, Radek Abarca, Alia Sovereign, Mikayla Joyce Gonzaga, Roy Gerona","doi":"10.1080/15563650.2025.2515242","DOIUrl":"https://doi.org/10.1080/15563650.2025.2515242","url":null,"abstract":"<p><strong>Introduction: </strong>The orchid <i>Eria jarensis</i>, purported to be a major source of <i>N,N</i>-dimethylphenethylamine, is promoted as a novel botanical ingredient in sport supplements.</p><p><strong>Objective: </strong>To determine the presence and quantity of ingredients found in <i>Eria jarensis</i> sports supplements.</p><p><strong>Methods: </strong>Supplements were purchased online in the United States, and each product was analyzed using liquid chromatography-quadrupole time-of-flight mass spectrometry.</p><p><strong>Results: </strong>None of the 12 <i>Eria jarensis</i> supplements analyzed were accurately labeled. The products contained inaccurately labeled quantities of caffeine, theobromine, hordenine, yohimbine, <i>N,N</i>-dimethylphenethylamine, and synephrine. Products that listed caffeine on the label contained quantities ranging from 0.1 to 665 mg/serving size. Nine of 12 products either listed an ingredient on the label that was not detected in the product or contained a stimulant not listed on the label. Four of 12 products contained an undeclared stimulant. In addition, two of these products contained the United States Food and Drug Administration-prohibited stimulant 1,4-dimethylamylamine.</p><p><strong>Discussion: </strong>The United States Food and Drug Administration does not evaluate the safety or quality of supplements prior to market introduction, and our findings reflect the consequences of this regulatory framework.</p><p><strong>Conclusion: </strong>Sports supplements labeled as containing <i>Eria jarensis</i> that we tested were inaccurately labeled and contained high quantities of caffeine and undeclared stimulants.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661731","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 broken mercury thermometer in the orbital cavity.","authors":"Meng Li, Hui Zhu, Hu Liu, Hao Sun","doi":"10.1080/15563650.2025.2528991","DOIUrl":"https://doi.org/10.1080/15563650.2025.2528991","url":null,"abstract":"<p><strong>Introduction: </strong>Elemental mercury exposure is an important public health concern. Direct soft tissue exposure to mercury is rare and can lead to local inflammatory reactions and complications if not promptly addressed.</p><p><strong>Case summary: </strong>We report a 4-year-old boy with a foreign body intrusion to the left periorbital region after he fell onto a glass mercury thermometer. The thermometer head, containing elemental mercury, was embedded beneath the lower eyelid skin. Initial symptoms were minimal, but two months later, the patient developed swelling and a palpable mass. Fibrous tissue, glass, and leaked elemental mercury were surgically removed to minimize complications caused by mercury dissemination, such as granuloma or sterile abscess formation.</p><p><strong>Images: </strong>The mass moved with eye movements. Skull radiographs revealed a linear distribution of mercury around the orbit. Surgery was performed to remove the mercury. Histopathology showed lymphocytic infiltration around mercury droplets, indicating localized inflammation. At three-month follow-up, there were no residual abnormalities.</p><p><strong>Conclusion: </strong>This patient highlights the importance of recognition and surgical management in periorbital mercury exposure. Precise removal may prevent complications.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629301","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":"Derivation and internal validation of a clinical diagnostic score for acute Chinese medicine poisoning involving aconite.","authors":"Rex Pui Kin Lam, Ka Kit Chua, Ping Yui Ku, Shuk Ching Ting, Tsz Kit Chow, Chi Keung Chan, Man Li Tse, Eric Ho Yin Lau, Timothy Hudson Rainer","doi":"10.1080/15563650.2025.2512818","DOIUrl":"10.1080/15563650.2025.2512818","url":null,"abstract":"<p><strong>Introduction: </strong><i>Aconitum</i> spp. alkaloids, used in traditional Chinese medicine, are potent cardiotoxins and neurotoxins. Timely diagnosis of aconite poisoning remains challenging due to the long laboratory turnaround time. We aimed to derive and internally validate a diagnostic score for rapid recognition of acute Chinese medicine poisoning involving aconite using clinical parameters.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study on consecutive patients with laboratory-confirmed Chinese medicine poisoning reported to the Hong Kong Poison Control Centre between 1 July 2008 and 30 June 2021. The reference standard was the diagnosis of acute aconite poisoning by a clinical toxicologist and laboratory detection of aconitine or related alkaloids in the patients' urine, serum, or gastric lavage specimens. Univariate analyses, followed by multivariable logistic regression, were performed to identify independent predictors of laboratory-confirmed aconite poisoning. A scoring system was developed based on the regression coefficients of the independent predictors and internally validated using bootstrapping.</p><p><strong>Results: </strong>We identified 542 eligible episodes, of which 179 involved aconite and 363 involved other herbs. The median patient age of the included episodes was 55 years (range 4-98 years). A clinical diagnostic score was developed based on the six independent predictors: hypotension (systolic blood pressure <90 mmHg in adults or < age-appropriate ranges in children, 3 points), herbal decoction or wine formulation (2 points), facial or oral numbness (2 points), ventricular tachycardia (1 point), limb numbness (1 point), and premature atrial or ventricular contractions (1 point). The score ranges from 0 to 10, with a higher score indicating a higher likelihood of aconite poisoning. At the cutoff point of ≥3, the sensitivity and negative predictive value of the score were 0.98 and 0.99, respectively. A higher specificity (0.92) and positive predictive value (0.84) could be achieved with a cutoff point at ≥4. The area under the receiver operating characteristic curve was 0.965 (95% CI: 0.950-0.980) during derivation and 0.965 (95% bias-corrected and accelerated CI: 0.947-0.977) during internal validation.</p><p><strong>Discussion: </strong>The newly derived Clinical Aconite Poisoning Score is simple to use, but its real-time discriminatory performance in diverse populations with Chinese medicine poisoning in real-world settings and its impacts on clinical management are unknown.</p><p><strong>Conclusions: </strong>In the context of Chinese medicine poisoning, the Clinical Aconite Poisoning Score might be useful in early recognition of aconite poisoning before laboratory confirmation. Future prospective studies are warranted to externally validate its real-time discriminatory performance in real-world settings before clinical adoption.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"476-487"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319174","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":"Anaphylactoid reactions to acetylcysteine treatment in wild mushroom poisoning patients in Yunnan, China.","authors":"Ting-Yu Lei, Liu-Fang Chuan, Xi-Qian Xing, Fen-Shuang Zheng, Shuang-Lan Xu, Wen-Ji He, Xu-Bing Chen, Zhen Zhang","doi":"10.1080/15563650.2025.2509723","DOIUrl":"10.1080/15563650.2025.2509723","url":null,"abstract":"<p><strong>Introduction: </strong>The Affiliated Hospital of Yunnan University, serving as the Poisoning Treatment Center of Yunnan Province, receives nearly all patients with wild mushroom poisoning requiring emergency treatment. We anecdotally observed a higher incidence of anaphylactoid reactions in patients admitted to our hospital for wild mushroom poisoning who received acetylcysteine.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted from January 1, 2023, to August 31, 2024. The study included patients who received intravenous acetylcysteine. Patients were divided into two groups: the exposure group comprised patients with wild mushroom poisoning, while the comparison group included patients receiving acetylcysteine for other indications. The primary outcome measure was the occurrence of anaphylactoid reactions. Subgroup analyses were performed for sex, age, weight, dose, history of allergies, total bilirubin concentration, alanine aminotransferase activity, aspartate aminotransferase activity, gamma-glutamyl transferase activity, alkaline phosphatase activity, prothrombin time, and the fastest rate of acetylcysteine infusion.</p><p><strong>Results: </strong>One-hundred and ten patients were included: 20 with wild mushroom poisoning and 90 without. Patients with wild mushroom poisoning exhibited a significantly higher risk of anaphylactoid reactions (OR: 5.43; 95% CI: 1.63-18.13). Symptoms of anaphylactoid reactions were typically mild. Additionally, female gender (OR: 3.49; 95% CI: 1.02-11.95) and history of allergies (OR: 3.82; 95% CI: 1.11-13.20) were identified as independent risk factors. A predictive model combining these factors showed good performance (area under the receiver operating characteristic curve 0.88; 95% CI: 0.81-0.95).</p><p><strong>Discussion: </strong>A possible reason for this phenomenon is the presence of various trace mineral elements in wild mushrooms, which exhibit higher bioavailability when mushrooms are not cooked fully. Accumulated mineral elements in wild mushroom poisoning patients bind with acetylcysteine, forming substances that cause anaphylactoid reactions.</p><p><strong>Conclusions: </strong>Patients with wild mushroom poisoning appear to be at an increased risk of anaphylactoid reactions during intravenous acetylcysteine administration compared to those who did not consume wild mushrooms.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"458-465"},"PeriodicalIF":3.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218542","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":"Study of micro-signals: proposed analysis methodology based on data from the Lille Poison Control and Toxicovigilance Center.","authors":"Tracy Lurant, Anne Garat, Emma Nemesien, Patrick Nisse, Ramy Azzouz, Djamel Zitouni","doi":"10.1080/15563650.2025.2512822","DOIUrl":"10.1080/15563650.2025.2512822","url":null,"abstract":"<p><strong>Introduction: </strong>This project aimed to enhance the Lille Poison Control and Toxicovigilance Center health surveillance and proactive response to intoxication-related issues by integrating a micro-signal analysis methodology.</p><p><strong>Methods: </strong>We developed a methodology employing Poisson distribution and historical limits to identify unusual signals marked by significant variations, often obscured by case age, continuous information flow (due to the 24/7 operational nature of the service), or team rotations. A severity score was created to prioritize micro-signals based on case seriousness to facilitate rapid and appropriate interventions. Additionally, a dashboard was developed to visualize detected micro-signals as a heat map, improving accessibility and decision-making for poison center professionals.</p><p><strong>Results: </strong>Testing the methodology with historical Lille Poison Control and Toxicovigilance Center data demonstrated its viability and the medical relevance of the severity score calculations. It highlighted the effect of national measures on the use of an anxiolytic that had not been detected by the teams at the time. In addition, when the values returned by the severity score are interpreted by class of substance, rather than individually, similar orders of magnitude are observed (e.g., mushrooms, anxiolytics in our case study).</p><p><strong>Discussion: </strong>Our approach shows potential for improving patient care and responsiveness in toxicovigilance, particularly within the French Lille Poison Control and Toxicovigilance Center network. One limitation of the current dashboard is that it only carries out analysis by product. Future enhancements include the integration of a thesaurus which will also allow analysis by class.</p><p><strong>Conclusion: </strong>This study integrated a micro-signal analysis method into a health surveillance system to detect hidden trends in poison center data, improving emergency response and substance management.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"495-506"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278060","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":"Characterizing pharmacobezoar formation: a descriptive analysis from VigiBase.","authors":"Massimo Carollo, Nicoletta Luxi, Salvatore Crisafulli","doi":"10.1080/15563650.2025.2508428","DOIUrl":"10.1080/15563650.2025.2508428","url":null,"abstract":"<p><strong>Introduction: </strong>Pharmacobezoars are concretions of drugs that can persist within the gastrointestinal tract and can lead to mechanical obstruction and pharmacological toxicity. We aimed to provide a descriptive analysis of reported cases of pharmacobezoar in VigiBase, the World Health Organization global database of adverse event reports for medicines and vaccines.</p><p><strong>Methods: </strong>We conducted a descriptive analysis of all de-duplicated individual case safety reports related to pharmacobezoars recorded in VigiBase, from its inception in 1968 to March 2, 2025. In a subgroup analysis, we selected reports containing at least one Preferred Term related to drug overdose, misuse, or suicidal behavior to identify potential cases of acute intoxication.</p><p><strong>Results: </strong>A total of 632 individual case safety reports related to pharmacobezoars were analyzed. These primarily involved male patients (<i>n</i> = 318; 50.3%), with a median age of 60.0 years (IQR 43.0-71.0 years). Overall, 432 reports (68.4%) described serious adverse drug reactions. The most frequently involved drugs were carbidopa/levodopa (<i>n</i> = 148; 23.4%), quetiapine (<i>n</i> = 63; 10.0%), sucralfate (<i>n</i> = 46; 7.3%), nifedipine (<i>n</i> = 41; 6.5%), and acetylsalicylic acid (<i>n</i> = 40; 6.3%). The subgroup analysis included 158 reports related to acute intoxications, mostly involving female patients (<i>n</i> = 103; 65.2%), with a median age of 43.0 years (IQR 24.0-54.0 years). Almost all were serious (<i>n</i> = 156; 98.7%), with quetiapine, venlafaxine, ibuprofen, acetylsalicylic acid, paracetamol, and lorazepam most frequently reported.</p><p><strong>Discussion: </strong>The findings highlight the clinical severity and heterogeneous presentation of pharmacobezoars. Carbidopa/levodopa was frequently reported, possibly reflecting underlying conditions such as Parkinson disease with delayed gastric motility. The high prevalence of psychotropics underscores the need for targeted prevention in at-risk populations, particularly those with psychiatric comorbidities.</p><p><strong>Conclusions: </strong>While pharmacobezoars are rare, their association with serious and potentially fatal outcomes warrants increased clinical awareness. Early recognition and appropriate management may be particularly important in cases involving high-risk drugs.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"447-457"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176427","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":"Outcomes of benzonatate exposures reported to a single United States poison center: a 20-year review.","authors":"Corey D Cicci, Jillian Theobald, Matthew Stanton, Ryan Feldman","doi":"10.1080/15563650.2025.2512817","DOIUrl":"10.1080/15563650.2025.2512817","url":null,"abstract":"<p><strong>Background: </strong>Benzonatate is an antitussive with sodium channel blocking properties that may cause seizures, dysrhythmias, and death in overdose. Limited data describe the medical outcomes of benzonatate exposures, and no standard treatment guidelines exist for managing benzonatate toxicity. We characterized clinical outcomes and management of benzonatate exposures over a 20-year period at the Wisconsin Poison Center.</p><p><strong>Methods: </strong>This retrospective case review examined all benzonatate exposures reported to a single regional poison center from January 1, 2000 through December 31, 2019. Exposures were excluded if the medical record was incomplete. The primary outcome was the rate of serious adverse effects, defined as seizure, electrocardiogram changes, coma or central nervous system depression, or death. Potential life-saving treatments (antiepileptics, antidysrhythmics, vasopressors, sodium bicarbonate, or intravenous lipid therapy) were also assessed.</p><p><strong>Results: </strong>A total of 313 calls were received with 48 exposures excluded, leaving 265 exposures included for analysis. Most exposures were female (162/265; 61%) with a median age of 19 years (IQR: 4-39 years). Sixteen exposures were adverse reactions only. Of intentional exposures (106/265; 40%), 23 (22%) experienced at least one serious adverse effect and 40 (38%) were hospitalized. Of unintentional exposures (143/265, 54%), one (0.7%) experienced a serious adverse effect and three (2%) were hospitalized. Regarding 77 unintentional pediatric exposures, none experienced a serious adverse effect, with two (2/77; 3%) hospitalized. Two deaths (0.8%) occurred during the study period; both were intentional exposures.</p><p><strong>Discussion: </strong>While severe outcomes are possible after intentional exposures, unintentional exposures rarely exhibited serious toxicities. No therapeutic interventions beyond supportive care were consistently employed.</p><p><strong>Conclusions: </strong>Intentional exposures to benzonatate more commonly warranted significant therapeutic interventions and caused a higher incidence of serious toxicity. Unintentional exposures did not result in clinically significant adverse effects. Although benzonatate can result in serious toxicity, adults with unintentional exposures may be candidates for home management.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"488-494"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288134","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":"Intrauterine exposure to nitrous oxide and neurological sequelae in an infant.","authors":"Katharina von Fabeck, Corinne Schmitt, Nicolas Simon","doi":"10.1080/15563650.2025.2509725","DOIUrl":"10.1080/15563650.2025.2509725","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"522-523"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176432","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":"Exogenous [Pyr¹]apelin-13 prevents bupivacaine-induced cardiotoxicity via the apelin (APJ) receptor.","authors":"Chaoxing Chen, Shishi Zhao, Zhengjie Chen, Yuting He, Jiali Chen, Liangyu Zheng, Yun Xia, Thomas J Papadimos, Kejian Shi, Hongfei Chen, Le Liu, Xuzhong Xu, Zhousheng Jin, Quanguang Wang","doi":"10.1080/15563650.2025.2510528","DOIUrl":"10.1080/15563650.2025.2510528","url":null,"abstract":"<p><strong>Background: </strong>Abnormal energy metabolism is an important mechanism in the development of bupivacaine-induced cardiotoxicity. Apelin, a peptide derived from adipocytes, plays a pivotal role in both energy metabolism and the regulation of the cardiovascular system, thereby potentially linking it to bupivacaine-induced cardiotoxicity.</p><p><strong>Methods: </strong>Our study employed both an <i>ex vivo</i> Sprague-Dawley neonatal rat cardiomyocyte-based bupivacaine toxicity model and an <i>in vivo</i> bupivacaine-induced adult male Sprague-Dawley rat asystole model. Beating frequency ratio, survival rate and oxygen consumption rate were assessed, and changes in mitochondrial ultrastructure were examined. The expression of adenosine monophosphate-activated protein kinase, acetyl coenzyme-A carboxylase, and peroxisome proliferator-activated receptor-gamma coactivator-1α were quantified.</p><p><strong>Results: </strong>Exogenous [Pyr¹]apelin-13 22 μmol/L improved bupivacaine-induced 90 μmol/L inhibition of the cardiomyocyte beating frequency ratio (mean difference 0.48; 95% CI: 0.35-0.62; <i>P <0</i>.001; <i>n</i> = 5) after a 20 min exposure. [Pyr¹]apelin-13 also preserved mitochondrial ultrastructure, modulated oxygen consumption rate, and these protective effects were nullified by apelin receptor short hairpin ribonucleic acid. Exogenous [Pyr¹]apelin-13 0.15 mg/kg improved the survival rate in adult male rats with bupivacaine-induced 30 mg/kg asystole (12/12 [100%] versus 6/12 [50%]; <i>P</i> = 0.014), while the presence of the specific apelin receptor antagonist Phe13-Ala, at an equivalent dose abolished this benefit (3/12 [25%]). Additionally, apelin treatment was associated with upregulation of metabolic proteins, including adenosine monophosphate-activated protein kinase, acetyl coenzyme-A carboxylase, and peroxisome proliferator-activated receptor-gamma coactivator-1α in the heart tissue over a 60 min period.</p><p><strong>Discussion: </strong>Despite apelin being identified initially as the sole apelin receptor ligand, evidence shows distinct effects between apelin and apelin receptor knockout models, as well as Phe13-Ala and adenovirus-mediated apelin receptor interventions. We confirmed that the cardioprotective effects of apelin depend on apelin receptor interaction.</p><p><strong>Conclusions: </strong>Exogenous [Pyr¹]apelin-13 reversed bupivacaine-induced cardiotoxicity in adult male Sprague-Dawley rats and neonatal cardiomyocytes via modulation of mitochondrial structure and function, mediated through the apelin receptor.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"507-517"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218543","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":"Laryngeal edema after ingestion of an ornamental plant (<i>Alocasia odora</i>): serial clinical images in an elderly patient.","authors":"Yusuke Miyazaki, Hiroki Takeda, Tetsuya Takahashi","doi":"10.1080/15563650.2025.2507762","DOIUrl":"10.1080/15563650.2025.2507762","url":null,"abstract":"<p><strong>Introduction: </strong><i>Alocasia odora</i> contains calcium oxalate crystals that can cause severe mucosal irritation and airway edema. Ingestion may lead to critical airway compromise.</p><p><strong>Case summary: </strong>A 91-year-old woman developed oropharyngeal pain and swelling after biting into a boiled root of <i>Alocasia odora</i>, mistaking it for edible taro. She experienced lip and tongue swelling and was transported to the emergency department. Fiberoptic laryngoscopy showed marked bilateral arytenoid edema. She received intramuscular epinephrine, intravenous chlorphenamine maleate, famotidine, and methylprednisolone. Her symptoms gradually improved, and she was discharged on hospital day 5 without complications.</p><p><strong>Images: </strong>Serial laryngoscopic images demonstrated the resolution of localized airway edema over 10 days.</p><p><strong>Conclusions: </strong>This case visually documents the time course of laryngeal edema due to calcium oxalate exposure and highlights the importance of early airway assessment following toxic plant ingestion.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"518-520"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251810","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}