Do not get a serum acetaminophen level less than 4 hours after an acute ingestion

February 9, 2017, 2:50 pm

APAP★★★★☆

Can a serum acetaminophen concentration obtained less than 4 hours post-ingestion determine which patients do not require treatment with acetylcysteine? Yarema MC et al. Clin Toxicol 2017 Feb;55:102-108.

Abstract

For decades the decision whether or not to treat acute acetaminophen [APAP] toxicity with N-acetylcysteine (NAC) has been guided by a serum APAP level drawn 4 or more hours after …

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Amnesia and hippocampal ischemia in 4 opiate abusers: a case series

February 1, 2017, 12:26 am

Hippocampus (wikipedia.org)

Hippocampus (wikipedia.org)

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Complete, bilateral hippocampal ischemia: a case series. Small JE et al. Neruocase 2016 Oct;22:411-415.

Abstract

Last week, we reviewed an MMWR investigation into a cluster of 14 cases of acute anterograde amnesia with MRI evidence of bilateral hippocampal ischemia identified in Massachusetts during the years 2012-2016. This constellation of features is distinctly unusual — especially when symmetric and …

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Anterograde amnesia and bilateral hippocampus ischemia: is it caused by substance abuse?

January 26, 2017, 11:51 pm

Bilateral hippocampal ischemia on MRI [Source: MMWR]

Diffusion weighted MRI findings in patient with unusual amnestic syndrome — Massachusetts, 2012
[Source: MMWR]

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Cluster of an Unusual Amnestic Syndrome — Massachusetts, 2012-2016. Barash JA et al. MMWR Morb Mortal Wkly Rep 2017;66:76-79

Full Text

Late in 2015 a Boston neurologist reported a cluster of 4 cases of anterograde amnesia associated with MRI evidence of bilateral hippocampal ischemia. After …

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Is commercial kratom being spiked with a naturally occurring potent opioid

January 24, 2017, 2:15 pm

 

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Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine. Lydecker AG et al. J Med Toxicol 2016;12:341-349.

Abstract

This well done paper provides — among other things — a helpful short review kratom, a psychoactive product  derived from the Mitragyna speciosa plant.

M speciosa contains more than 40 distinct alkaloids. The primary alkaloid — mitragynine — is an …

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TPR Podcast Episode #13: Naloxone in the Age of Carfentanil

January 18, 2017, 10:33 pm

In this “Lucky 13” episode of the TPR podcast, Steven and Leon discuss naloxone, and address the following issues: 1) Does the concept of a “heroin overdose patient” have meaning anymore in this age of U-47700, fentanyl, and carfentanil? 2) Given the adulteration of both heroin and counterfeit prescription medications with extremely potent synthetic opioids, do we have to reconsider our entire approach to opioid overdose patients? 3) Can past medical literature guide us in our management of these patients?(Hint: the answer is no.) 4) What medical toxicology paper do Steve and Leon — in an unusual state of agreement — feel was the best to appear in 2016? For the Show Notes and links to articles discussed in the Podcast, click "Read more" below.
Podcast Episode
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The 7th Annual Alexander Awards: The Best Tox Reading of 2016

January 1, 2017, 4:59 pm

 Alexander Gettler

Alexander Gettler

When TPR began giving out the annual Alexander Awards for best long-form writing in the field of toxicology, the eligibility criteria included the requirement that “entries must be fully and freely accessible” on the web. After 2016 — a remarkably truth-impaired year scarred by fake news and unchallenged mendacity — supporting aggressive, unbiased, fearless journalism appears to us …

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Severe respiratory depression after snorting U-47700

December 29, 2016, 8:54 pm

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Two cases of intoxication with new synthetic opioid, U-47700. Domanski K et al. Clin Toxicol 2017 Jan;55:46-50.

Abstract

U-47700 was first synthesized by Upjohn in the 1970s — hence the “U”. The company was seeking to develop an analgesic as effective as morphine but not addictive. Work on this compound was abandoned when the addictive properties of the drug became …

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Lipid therapy in oral poisoning: a not-so-systematic review

December 27, 2016, 4:12 pm

intralipid-161x300★★☆☆☆

No support for lipid rescue in oral poisoning: A systematic review and analysis of 160 published cases. Forsberg M et al. Hum Exp Toxicol 2016 Nov 24 [Epub ahead of print]

Abstract

The authors’ goal was “to present a systematic review and case analysis of practically all published reports on humans treated with lipid rescue for LAST [local anesthetic systemic …

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Synthetic cannabinoid AMB-FUBINACA responsible for July 2016 “zombie” episode

December 18, 2016, 6:37 pm

ak-47-24-karat-gold★★★★☆

“Zombie” Outbreak Caused by the Synthetic Cannabinoid AMB-FUBINACA in New York, Adams AJ et al. N Engl J Med 2016 Dec 14 [Epub ahead of print]

Abstract 

On July 12, 2016, the New York Times reported that in the course of one day, in the Bushwick and Bedford-Stuyvesant areas of Brooklyn, 33 people had been transported to hospitals after apparently …

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