Clinical Toxicology

INTRODUCTION: In July 2020, an outbreak of methanol-contaminated hand sanitizers in the United States prompted our regional poison center to implement a more conservative triage guideline for hand sanitizer exposures. All pediatric hand sanitizer ingestions of more than a "taste" were referred to a healthcare facility for assessment. We then evaluated the effect of this change on identifying patients with methanol poisoning. METHODS: This was a single-center, retrospective review of pediatric (<19 years) hand sanitizer ingestions reported to our poison center from May 1, 2020 through January 28, 2022...

INTRODUCTION: Drug-induced liver injury can be challenging to diagnose, as it can develop following the use of many prescription and nonprescription medications, herbals, and dietary supplements. Food products may not be routinely considered as a potential cause of hepatotoxicity. We describe the clinical features of two cases of acute liver injury following consumption of a smoothie product. CASE PRESENTATIONS: Two patients independently presented to the hospital with epigastric pain and acute liver injury...

INTRODUCTION: Controversy exists with regard to risk of secondary exposure of health care workers caring for patients who have ingested an organophosphate insecticide. We aim to report clinical effects of staff members caring for an organophosphate poisoned patient. INCIDENT: A 76-year-old male presented to the Emergency Department exhibiting a cholinergic toxidrome requiring atropine, intubation and mechanical ventilation. METHODS: We undertook a retrospective chart review of any Emergency Department presentations for medical assessment in relation to the incident and conducted telephone interviews of any healthcare workers who did not present but were deemed to be closely involved with patient care...

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BACKGROUND: Pressure bandage immobilisation has remained the recommended first aid treatment for more than 40 years in Australia. However, whilst it is used in most people bitten by a snake, it is often applied poorly, and patients have been envenomed despite good pressure bandage immobilisation. We report two patients who suffered harm from this procedure. CASE REPORTS: Two men, a 35-year-old and a 44-year-old, were bitten by snakes. Both had a prompt application of pressure bandage immobilisation, and both reported significant pain requiring opioid analgesia whilst being transferred from remote Australia to Cairns Hospital, Queensland...

BACKGROUND: Occupational exposure to hazardous substances is a major public health problem. In the workplace, eye exposures are common and can be a major cause of morbidity and disability. This commentary discusses the role of poison information centres in providing valuable information on the circumstances and causes of these incidents. OCCUPATIONAL HEALTH SURVEILLANCE: As many eye exposures are easily preventable, there is a need to establish better safety practices in the workplace...

BACKGROUND: Despite conflicting data, intravenous lipid emulsion has emerged as a potential antidote. The "lipid sink" theory suggests that following intravenous administration of lipid, lipophilic drugs are sequestered in the vascular compartment, thereby reducing their tissue concentrations. This study sought to determine if survival is associated with the intoxicant's degree of lipophilicity. METHODS: We reviewed all cases in the Toxicology Investigators Consortium's lipid sub-registry between May 2012 through December 2018...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

INTRODUCTION: An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication. METHODS: In this prospective cohort study, we collected data on all pediatric patients (<18 years) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium...

CONTEXT: Despite a rapidly growing number of older cocaine users, the link between cocaine use and suicide attempt in older adults has not been examined. We examined associations between co-used other substances and (1) suspected suicide attempts versus other intentional misuse, and (2) major medical outcomes (major effect or death) of suspected suicide attempts and other intentional misuse. METHODS: We used the 2015-2021 United States National Poison Data System ( N  = 5,191 cases age 50 and older)...

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INTRODUCTION: Serum sickness is a poorly reported delayed adverse reaction following snake antivenom therapy. We aimed to assess the frequency of serum sickness associated with administering Indian polyvalent antivenom in Sri Lanka. METHODS: We recruited patients from the Anuradhapura snakebite cohort who were admitted to a rural tertiary care hospital in Sri Lanka over one year period. Patients were interviewed over the phone 21 to 28 days post-envenoming to collect data on clinical effects: fever/chills, arthralgia/myalgia, rash, malaise, headache, abdominal pain, and nausea/vomiting...

INTRODUCTION: Community programs to teach nonmedical laypeople how to recognize an opioid overdose and effectively resuscitate the victim using naloxone have proliferated recently as a significant component of harm-reduction efforts. Although many such programs target laypeople like first responders or friends and family members of people who use drugs, there are currently no programs that specifically target addiction counselors, despite their work with a client population at high risk of an opioid overdose...

INTRODUCTION: Management of patients with salicylate toxicity frequently requires urine alkalinization to enhance excretion of salicylate. One strategy for determining when to stop urine alkalinization is to wait for two consecutive serum salicylate concentrations to be less than 300 mg/L (2.17 mmol/L) and declining. When alkalinization of the urine ceases, a rebound in serum salicylate concentration can occur from tissue redistribution or delayed gastrointestinal absorption...

CONTEXT: Lacrimators are used by individuals for personal defense and by police for crowd control during periods of civil unrest. Increased public awareness about their use has raised concerns about their application and safety. OBJECTIVE: To characterize patterns of lacrimator exposures in the United States, we describe temporal trends of calls to poison centers by demographics, substances, medical outcomes, exposure sites, and scenarios. METHODS: A retrospective data analysis was performed for all single-substance lacrimator exposures in the United States reported to the National Poison Data System between 2000 and 2021...

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OBJECTIVE: To highlight the similarity between madd fruit seeds and enteral drug concealment ("body packing") on computed tomography when evaluated by Hounsfield Units. CASE REPORT: A 13-year-old girl from Senegal presented to the Emergency Department with severe abdominal pain. Examination showed right lower quadrant tenderness with rebound. Computed tomography scan of the abdomen and pelvis revealed smooth, well circumscribed, multiple intraluminal foreign bodies measuring up to 2 cm in size with Hounsfield Units measuring up to 200...

INTRODUCTION: Most carbon monoxide poisoning is preventable. Tracking of longitudinal trends in carbon monoxide-related mortality is needed to guide public health efforts. This study sought to describe mortality in the United States from carbon monoxide poisoning, examine the epidemiology of unintentional ("accidental") and intentional exposures, and identify trends in both. METHODS: The Centers for Disease Control and Prevention's Wonder databases were utilized to extract online data from National Center for Health Statistics files containing mortality data in the United States from 2015-2021...

THE GOIÂNIA INCIDENT: In September 1987, two men in Goiânia, Brazil, discovered an abandoned international standard capsule containing less than 100 g of cesium-137 chloride. The material was unguarded, and the warning systems were inadequate and inscrutable. The men took the capsule and sold it for scrap, and within days the city would be contaminated with highly radioactive material. Within weeks, 112,000 individuals would be screened for radioactive contamination, 249 would be exposed to radioactive materials, 46 would receive medical treatment for radioactive contamination, and four would die from acute radiation sickness...