Showing papers in "Clinical Toxicology in 2021"
TL;DR: Evidence from COVID-19 treatment suggests QT/QTc prolongation is of concern, particularly when used in combination with azithromycin, although disagreement exists across studies.
Abstract: While chloroquine, a derivative of quinine, has been used as an antimalarial for 70 years, hydroxychloroquine is now used to treat conditions such as rheumatoid arthritis and systemic lupus erythem...
60 citations
TL;DR: To the editor,Since December 2019, a pandemic outbreak of emerging coronavirus disease (COVID-19) due to SARS-CoV-2 is spreading, resulting in exponentially increasing numbers of infected individua...
Abstract: To the editor,Since December 2019, a pandemic outbreak of emerging coronavirus disease (COVID-19) due to SARS-CoV-2 is spreading, resulting in exponentially increasing numbers of infected individua...
36 citations
TL;DR: The toxicological syndrome induced by sargassum seaweed exposure is close to the toxidrome associated with acute H2S exposure in the range of 0–10 ppm, suggests this study, which suggests that patients living in massive stranding areas may be exposed to H 2S > 5’ppm for 50 days per year.
Abstract: Since 2011, there have been ongoing massive unexplained increases of sargassum seaweed strandings along the coastlines of Caribbean countries. The objective of our study was to describe the clinica...
25 citations
TL;DR: In this paper, a bill to legalize cannabis was introduced to the Canadian Parliament and presented to the public, and on October 17, 2018, Canada legalized recreational cannabis use in the country.
Abstract: On April 13, 2017, a bill to legalize cannabis was introduced to the Canadian Parliament and presented to the public. On October 17, 2018, Canada legalized recreational cannabis use. We assessed in...
24 citations
TL;DR: In this paper, the authors assess the impact of the COVID-19 pandemic on French Poison Control Centre (PCC) call characteristics, and report cases of xenobiotic exposures from 1 March to 30 April in 2018, 2019, a...
Abstract: The aim was to assess the impact of the COVID-19 pandemic on French Poison Control Centre (PCC) call characteristics.Reported cases of xenobiotic exposures from 1 March to 30 April in 2018, 2019, a...
21 citations
TL;DR: Physostigmine was superior to lorazepam in controlling antimuscarinic delirium and agitation after bolus dosing, and control ofDelirium after a 4-h infusion.
Abstract: Toxicity from antimuscarinic agents precipitates a constellation of signs and symptoms; two of the most significant are agitation and delirium. Benzodiazepines are commonly used for treatment; phys...
20 citations
TL;DR: Both dialyzability and clinical data do not support a clinical benefit from ECTRs for CCB poisoning, and the EXTRIP workgroup recommends against using extracorporeal methods to enhance the elimination of amlodipine, diltiazem, and verapamil in patients with severe poisoning.
Abstract: Calcium channel blockers (CCBs) are commonly used to treat conditions such as arterial hypertension and supraventricular dysrhythmias Poisoning from these drugs can lead to severe morbidity and mo
19 citations
TL;DR: The contemporary mortality rate of patients with presumed cyclopeptide-mushroom poisoning is only 8.8%.
Abstract: This study was designed to determine the fatality rate of suspected cyclopeptide-containing mushroom ingestions reported to the National Poison Data System (NPDS). Although silibinin reportedly imp...
19 citations
TL;DR: While fatal SS is rare, frequently observed features include hyperthermia, seizures, and high CK activities, and Cyproheptadine use appears infrequent for these patients.
Abstract: Serotonin syndrome (SS) is a drug-induced potentially life-threatening clinical condition. There is a paucity of data on the risk factors, clinical course, and complications associated with fatal S...
18 citations
TL;DR: The observed concentrations of SCs vary widely and often have overlapping ranges for fatal and non-fatal cases, therefore, a referenced compilation of concentration ranges would be useful.
Abstract: Introduction: Synthetic cannabinoids (SCs) are the largest and most diverse group of new psychoactive substances. Their influence on organism is unpredictable and often lead to intoxications, inclu...
18 citations
TL;DR: This analysis is the first to link the geospatial dynamics of social media and public health interventions to poison center calls about exposure to household cleaners to lead to different dynamics in PCC calls.
Abstract: Calls to poison control about exposure to household cleaners have increased during the COVID-19 pandemic. This dynamic may reflect increased exposure from public health efforts as well as health mi...
TL;DR: Dear Editor, Alcohol-based hand sanitizers (ABHS) are increasingly being used during the Coronavirus Disease 2019 (COVID-19) pandemic.
Abstract: Dear Editor, Alcohol-based hand sanitizers (ABHS) are increasingly being used during the Coronavirus Disease 2019 (COVID-19) pandemic. The first U.S. case was identified in late January 2020. ABHS ...
TL;DR: The use of counterfeit products is a public health concern, as it constitutes a high risk for consumer health, mainly caused by the uncontrolled use of steroids, stimulants, sexual enhancers, and other medicaments, without medical indication or supervision.
Abstract: The illegal market of counterfeit and falsified medicines and supplements containing unlabeled pharmaceuticals is expanding worldwide. They are usually referred to by the term “performance and imag...
TL;DR: In this article, the presence and quantity of experimental stimulants in sports supplements containing deterenol have been found to be associated with serious adverse events including cardiac arrest, including cardiac failure.
Abstract: Weight loss and sports supplements containing deterenol have been associated with serious adverse events including cardiac arrest.To determine the presence and quantity of experimental stimulants i...
TL;DR: A review of the current diagnostic criteria, utilizing case reports of fatalities to evaluate how many meet the various diagnostic criteria and propose practical solutions to resolve controversies in diagnosis is provided in this article.
Abstract: Introduction Serotonin syndrome (toxicity) describes adverse drug effects from toxic amounts of intra-synaptic central nervous system serotonin. A wide range of drugs have been implicated to cause serotonin toxicity, not all justifiably. The plausible agents all have a final common pathway resulting in a substantial increase in central nervous system serotonergic neurotransmission. Serotonin toxicity is characterized by neuromuscular excitation, mental status changes, and autonomic dysregulation. Signs and symptoms represent a spectrum of toxicity (mild to life-threatening) related to increasing serotonin concentrations. As there is no consensus on the threshold for "toxicity" or diagnostic criteria, the true incidence of serotonin toxicity is unknown. The incidence in overdose is easier to quantify and is reasonably common in serotonergic antidepressant overdoses. In a large case series of overdoses, moderate serotonin toxicity occurred in 14% of poisonings with a selective serotonin reuptake inhibitor. While half those ingesting a monoamine oxidase inhibitor in combination with a serotonergic agent in overdose exhibit at least moderately severe serotonin toxicity. In contrast, the incidence of serotonin toxicity in those on therapeutic serotonergic agents appears to be very low. Objectives To provide a narrative review of the current diagnostic criteria, utilizing case reports of fatalities to evaluate how many meet the various diagnostic criteria and propose practical solutions to resolve controversies in diagnosis. Methods A review of serotonin toxicity diagnostic criteria in the English literature was completed by searching Embase and PubMed from January 1990 to July 2021 for the keywords "serotonin syndrome/toxicity" paired with "diagnostic criteria" or "diagnosis." Also, fatal cases of serotonin toxicity identified from a recent systematic review were independently examined to determine what diagnostic criteria were met and whether serotonin toxicity or another cause was most likely. Review of diagnosis criteria Serotonin toxicity is a clinical diagnosis, four diagnostic criteria (Sternbach, Serotonin Syndrome Scale, Radomski, and Hunter) have been proposed. However, the Serotonin Syndrome Scale has not been validated in patients with serotonin toxicity and only utilized in those on a serotonergic agent. The remaining three criteria are utilized more widely but have undergone little refinement or validation. Review of fatal cases Shortfalls with diagnostic criteria can be illustrated by examining case fatalities. Of 55 fatal cases reviewed, 12 (22%) were unlikely to be serotonin toxicity. Sternbach and Radomski criteria were met by 25 (45%), 20 (36%) had insufficient data reported and 10 (18%) met an exclusion criterion. Few had sufficient information reported to determine whether Hunter Criteria were met, with only 13 (24%) documented as meeting the criteria, the remaining 42 (76%) had insufficient data. Resolving shortfalls in current diagnostic criteria As serotonin toxicity is a clinical diagnosis, issues arise when basing the diagnosis on symptom criteria alone, without considering whether the drug/s ingested increase central nervous system serotonin or whether there is an alternative diagnosis. This has resulted in case reports and government warnings for drugs that cannot plausibly cause significant serotonin toxicity (e.g., ondansetron and antipsychotics). We propose when assessing for a serotonin toxidrome, both the causative agent(s) and clinical scenario is considered to determine the likelihood of serotonin toxicity. Then the clinical features assessed, those with a moderate to high prior probability (e.g., serotonergic drug-drug interaction, overdose, recent initiation or increase in dose of serotonergic agent/s) could be diagnosed based on the Hunter criteria. However, those with a low probability (e.g., stable therapeutic doses of a serotonergic agent) require more specific and stringent criteria. Finally, we propose a minimum dataset for case reports/series of serotonin toxicity. Conclusions More complete and accurate reporting of serotonin toxicity cases is required in the future, to avoid further misleading associations that are physiologically implausible.
TL;DR: Where there is clinical suspicion of death due to synthetic cathinones, postmortem blood concentrations >1 μg/mL (in person without developed tolerance) can be cautiously considered as lethal concentrations, however the exact ranges cannot be established.
Abstract: Synthetic cathinones are the second most frequently seized group of new psychoactive substances. They are sold as replacements for controlled stimulants such as amphetamine, cocaine and MDMA. Synth...
TL;DR: In this article, the authors found no evidence of benefit for TPE in D-AKI in snakebite-associated TMA, and defined snakebite associated TMA as anemia with schistocytosis and either thrombocytopenia or > 25% drop in platelet count.
Abstract: Background Snakebite-associated thrombotic microangiopathy (TMA) occurs in a subset of patients with venom-induced consumption coagulopathy (VICC) following snakebite. Acute kidney injury (AKI) is the commonest end-organ manifestation of TMA. The epidemiology, diagnostic features, outcomes, and effectiveness of interventions including therapeutic plasma-exchange (TPE), in snakebite-associated TMA are poorly understood. Methods We reviewed all patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project (2004-2018 inclusive), a prospective cohort study, from 202 participating Australian hospitals across the country. TMA was defined as anemia with schistocytosis. Results 2069 patients with suspected snakebite were enrolled, with 1158 (56.0%) systemically envenomed, of which 842 (72.7%) developed VICC, from which 104 (12.4%) developed TMA. Of those systemically envenomed, TMA occurred in 26% (13/50) taipan, 17% (60/351) brown, and 8% (16/197) tiger snakebites. Thrombocytopenia was present in 90% (94/104) of TMA cases, and a further eight (8%) had a > 25% decrease in platelets from the presentation. Patients with TMA were significantly older than non-TMA patients with VICC (53 [35-61] versus 41 [24-55] years, median [IQR], p 90-day follow-up for 25 D-AKI cases (130 person-years) showed no end-stage kidney disease but 52% (13/25) had ≥ stage 3 chronic kidney disease (CKD). Conclusion Our findings support a definition of snakebite-associated TMA as anemia with schistocytosis and either thrombocytopenia or >25% drop in platelet count. AKI occurring with snakebite-associated TMA varied in severity, with most achieving DFS, but with a risk of long-term CKD in half. We found no evidence of benefit for TPE in D-AKI.
TL;DR: A dramatic rise in tianeptine toxicity, particularly in patients experiencing withdrawal symptoms, beginning in May 2019 is observed, and health care practitioners should be increasingly aware of this xenobiotic as usage may be on the rise.
Abstract: Background: Tianeptine is an antidepressant structurally similar to tricyclic antidepressants which is approved abroad but is currently a drug of abuse in the United States since at least 2000 In
TL;DR: Sodium nitrite is an oxidizing agent capable of producing methemoglobinemia as mentioned in this paper, and large quantities of sodium nitrite can be purchased online, and recent literature has identified several cases where it has been used to produce methemoglobin.
Abstract: Sodium nitrite is an oxidizing agent capable of producing profound methemoglobinemia. Large quantities of sodium nitrite can be purchased online, and recent literature has identified several cases ...
TL;DR: Antivipmyn Tri TM as currently used did not show any benefit in recovery from coagulopathy and was found to be similar for age, sex-ratio, proportion of bleedings, necrosis, and severity.
Abstract: Introduction: In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guia...
TL;DR: In this article, the authors investigate characteristics and trends of methamphetamine exposures reported to United States poison control centers and analyze data from the National Poison Data System (NPDS) from January 1, 2011 to February 7, 2012.
Abstract: To investigate characteristics and trends of methamphetamine exposures reported to United States (US) poison control centers. Data from the National Poison Data System were analyzed. From January 1...
University of Barcelona1, Guy's and St Thomas' NHS Foundation Trust2, King's College London3, European Monitoring Centre for Drugs and Drug Addiction4, Mater Misericordiae University Hospital5, Our Lady of Lourdes Hospital6, Oslo University Hospital7, University of Oslo8, Paris Diderot University9, Gdańsk Medical University10, University of Bern11, University of Basel12, Technische Universität München13, Mater Dei Hospital14
TL;DR: In this article, the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different pattens and sex groups.
Abstract: To analyse the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different patt...
TL;DR: Peripheral nerve involvement is not uncommon after recovery from a cholinergic crisis in chlorpyrifos self-poisoning and debilitating in some patients, and Detection of subclinical injury on NCS may provide an early window to prevent severe symptomatic neuropathy.
Abstract: Despite organophosphate pesticide is the most prevalent cause of acute poisoning in low- and middle-income countries, data on organophosphate induced delayed neuropathy (OPIDN) are limited. We aime...
TL;DR: It is speculated that severe renal failure requiring hemodialysis is not a typical finding of P. mucrosquamatus envenomation, and patients with finger as the bite site and bullae or blister formation should be carefully examined for wound necrosis, secondary infection, and subsequent surgery.
Abstract: Protobothrops mucrosquamatus bite induces wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and acute renal failure. The severity of the hematological derangements and associated fact...
TL;DR: There was no link between regular kratom use and electrocardiographic abnormalities with an estimated average daily intake of 434.28 mg of mitragynine, and there were no differences in the odds of having prolonged QTc intervals between kratom users and controls.
Abstract: Little is known about the cardiotoxic effects of kratom (Mitragyna speciosa Korth.), a medicinal plant. This analytical cross-sectional study investigated the prevalence of electrocardiogram (ECG) ...
TL;DR: Hospital patients treated with two naloxone dosing regimens were found to be more likely to have opioid withdrawal symptoms but also morelikely to meet reversal criteria versus LDN patients, and HDN patients were more likely of having OW but also of meeting reversal criteria.
Abstract: When managing opioid overdose (OD) patients, the optimal naloxone regimen should rapidly reverse respiratory depression while avoiding opioid withdrawal. Published naloxone administration guideline...
TL;DR: In recent years, the Noble false widow spider Steatoda nobilis (Thorell, 1875) has expanded its range globally and may represent a potential threat to native ecosystems and public health as discussed by the authors.
Abstract: In recent years, the Noble false widow spider Steatoda nobilis (Thorell, 1875) has expanded its range globally and may represent a potential threat to native ecosystems and public health. Increasin...
TL;DR: It is found that AKI is uncommon in Hypnale spp.
Abstract: Acute kidney injury (AKI) is the most serious clinical manifestation of the Sri Lankan hump-nosed pit viper (Hypnale spp.) bites. Thrombotic microangiopathy (TMA) is increasingly recognized in asso...
TL;DR: In this paper, the authors discuss how novel psychoactive substances (NPS), specifically novel synthetic opioids, continue to fuel death rates in the United States' (US) opioid epidemic, posing an ongoing public health threat.
Abstract: To the Editor,Novel psychoactive substances (NPS), specifically novel synthetic opioids, continue to fuel death rates in the United States’ (US) opioid epidemic, posing an ongoing public health thr
TL;DR: According to the latest medical evidence, Methadone and buprenorphine-naloxone (Suboxone®) are effective treatments for opioid use disorder (OUD) as discussed by the authors.
Abstract: According to the latest medical evidence, Methadone and buprenorphine-naloxone (Suboxone®) are effective treatments for opioid use disorder (OUD). While the evidence basis for the use of these medi...