Toxicology – JournalFeed

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In this small, retrospective review of 22 patients with antimuscarinic delirium who received antidotal therapy with transdermal +/- oral rivastigmine, there were no major adverse effects observed, and symptom resolution generally occurred within a matter of hours.

Source
Greene SC. Rivastigmine Use in the Treatment of Antimuscarinic Delirium. J Med Toxicol. 2023 Jul;19(3):284-287. doi: 10.1007/s13181-023-00947-1. Epub 2023 May 19.

Feb 3 2023

Alcoholic Hepatitis – Spoon-Feed Version

GI, Toxicology

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Patients with alcohol-associated hepatitis have a high rate of complications and short-term mortality of 20-50%. Prompt recognition and treatment, including initiation of treatment for alcohol use disorder, is important to improve patient outcomes.

Source
Alcohol-Associated Hepatitis. NEJM. 2022 Dec 29; 387 (26): 2436-2448.

Feb 2 2023

Inebriation Estimation – Can You Guess Blood Alcohol Levels?

Toxicology

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ED clinicians are often inaccurate in their estimations of patients’ blood alcohol content (BAC). Overestimation is common, especially in patients arriving by ambulance compared to walk-ins.

Source
Clinician assessment of blood alcohol levels among emergency department patients. Am J Emerg Med. 2023 Jan;63:110-112. doi: 10.1016/j.ajem.2022.10.045. Epub 2022 Oct 31.

Jan 30 2023

Xylazine (aka Tranq) – What You Need to Know

Toxicology

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Xylazine is a non-opioid emerging drug of abuse that can cause significant respiratory and CNS depression in overdose as well as necrotic skin ulcerations. It does not respond to naloxone.

Source
Warning About Xylazine, a Veterinary Sedative Found in Illicit Drugs. JAMA. 2022 Dec 20;328(23):2296. doi: 10.1001/jama.2022.20045.

Oct 19 2022

AMS, Hyperthermia, Hyperreflexia? How to Nail This Clinical Diagnosis

Pharmacy/Pharmacology, Toxicology

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Here are the clinical clues to keep you from missing serotonin syndrome (SS) and pearls to treat it once you make the diagnosis.

Sep 30 2022

Is It Just Me or Are We Seeing More Cannabis Hyperemesis?

GI, Toxicology

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Legalization of cannabis in Ontario was not associated with an increase in ED visits for cannabis hyperemesis syndrome (CHS); however, after legislation passed allowing commercialization of cannabis, there was a large increase in visits for CHS.

Source
Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada. JAMA Netw Open. 2022 Sep 16. Doi:10.1001/jamanetworkopen.2022.31937

Jan 4 2022

Deaths from OTC Cough and Cold Medicine

Pediatrics, Toxicology

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Cough and cold medications (CCM) have off-label usage as sedatives and, unfortunately, for child mistreatment. Pediatric populations, especially those < 2 years of age, are most susceptible to CCM related deaths.

Nov 19 2021

Time = Brain in Carbon Monoxide Poisoning

Environmental, Toxicology

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Patients treated with hyperbaric oxygen therapy within 6 hours of carbon monoxide exposure had better 6-month neurocognitive outcomes than patients who received treatment within 6-24 hours. Poor outcomes increased as time-to-treatment increased.

Jun 1 2021

AHA Statement on Opioid-Associated OHCA

Cardiology, EMS, Pharmacy/Pharmacology, Toxicology

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The AHA has released a quite comprehensive statement surrounding opioid-associated cardiac arrest. This is an expansive manuscript ranging from epidemiology to pre-hospital treatment, to post-resuscitation care and prevention methods.

Apr 23 2021

Can You Diagnose GHB Intoxication Clinically?

Toxicology

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Emergency physicians were not accurate in clinically diagnosing gamma-hydroxybutyrate (GHB) intoxication. A rapid test is needed.