Must-read article: America’s Misguided War on Childhood Lead Exposures

March 23, 2018, 12:58 am

Photo: shutterstock/jamie hooper

Very soon, the Centers for Disease Control and Prevention “reference level” for blood lead concentration will be lowered from 5 μg/dL to 3.5 μg/dL. As Charles Schmidt  explains in his superb well-researched article “America’s Misguided War on Childhood Lead Exposures” just published by Undark Magazine, there are several crucially important things to realize about this …

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A diagnosis you can’t afford to miss

March 2, 2018, 1:14 pm

★★★★☆

Antibody-Mediated Encephalitis. Dalmau J, Graus F. N Engl J Med 2018 Mar 1;378:840-851.

Reference

TPR has posted before about anti-NMDA receptor encephalitis, a must-know, can’t-miss, humbling diagnosis that is distressingly easy to overlook. Although it is not a toxicologic condition, all toxicologists and emergency physicians should be thoroughly familiar with its presentation and clinical course. Let me explain why.…

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Flubromazolam: a potent designer benzodiazepine

February 27, 2018, 10:20 pm

Flubromazolam

★★★☆☆

Flubromazolam — A new life-threatening designer benzodiazepine. Lukasik-Glebocka M et al. Clin Toxicol 2016;54:66-68.

Abstract

Last month, the Peoria (IL) Journal-Star reported that local police had seized samples of two rarely seen designer sedatives: flubromazolam (alleged street name “liquid Xanax“) and etizolam.

This paper from Poland presents a case report of flubromazolam exposure. A 27-year-old male …

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Can we improve prognostic indications in acetaminophen-induced hepatic failure?

February 9, 2018, 4:13 pm

★★½☆☆

Hypoglycemia and lactic acidosis outperform King’s College criteria for predicting death or transplant in acetaminophen toxic patients. Levine M et al. Clin Toxicol 2018 Jan 5 [Epub ahead of print]

Abstract

The standard tool used in evaluating acetaminophen-poisoned patients for possible orthotopic liver transplantation (OLT) is the King’s College Criteria (KCC).

The KCC identify 2 groups of patients who …

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Can smoking marijuana cause meningitis?

February 2, 2018, 2:30 pm

Cryptococcus neoformans (wikipedia.org)

★★½☆☆

Cryptococcal meningitis in a daily cannabis smoker without evidence of immunodeficiency. Shapiro BB et al. BMJ Case Rep 2018 Jan 26 [Epub ahead of print]

Abstract

Can smoking marijuana cause meningitis?

The question is not unreasonable. A wide range of pathogenic fungi — including Aspergillus and various Cryptococcus species — have been isolated from dispensary-grade medical marijuana …

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Anterograde amnesia and hippocampal lesions: is fentanyl the culprit?

January 31, 2018, 1:23 pm

Hippocampus (wikipedia.org)

★★★☆☆

An Unusual Amnesic Syndrome Associated With Combined Fentanyl and Cocaine Use. Duru LB et al. Ann Intern Med 30 Jan 2018 [Epub ahead of print]

Reference

Last year we reviewed an MMWR report describing 14 cases of anterograde amnesia associated with substance abuse and bilateral ischemia of the hippocampi, as well as an additional paper giving somewhat more …

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Comprehensive up-to-date review of toxic alcohol poisoning

January 30, 2018, 1:05 am

★★★½☆

Toxic Alcohols. Kraut JA, Mullins ME. N Engl J Med 2018 Jan 18;378:270-280.

Reference

This is a good general review and update of clinical issues regarding the major toxic alcohols: methanol, ethylene glycol, isopropanol, diethylene glycol, and propylene glycol.

The article is chockablock with information, and would I think be somewhat difficult to follow if one was not already familiar …

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Tox Tunes #114: Mr. Pharmacist (The Fall)

January 28, 2018, 10:28 pm

Although The Fall had been making music since the late 1970s and is considered one of the most durable and long-lasting groups to emerge from the British post-punk scene, they had really never been on my radar. When the group’s vocalist and founder Mark E. Smith died this week, his obituary in the New York Times noted:

At various points

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Tox Tunes #113: Legend of a Mind (Moody Blues)

January 15, 2018, 12:28 am

“Legend of a Mind” is about Timothy Leary, the one-time Harvard professor of psychology and 1960s LSD-mountebank Timothy Leary, whom Richard Nixon once called the “most dangerous man in America.”

Timothy Leary’s Dead
No, no, he’s outside looking in
He’ll fly his astral plane
Takes you trips around the bay
Brings you back the same day
Timothy Leary, Timothy

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