Archive for September 2014

Must-listen podcast: anti-NMDA receptor encephalitis

September 29, 2014, 11:34 am


As part of its “Best Case Ever” series, the Emergency Medicine Cases podcast has a superb discussion by Dr. David Carr of anti-NMDA receptor encephalitis, a relatively new but important diagnosis that is generally under-recognized and often missed. To listen to it, click here.

The reason this diagnosis is of interest to toxicologists is that during the early …

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Tox on the web: narcotic noodles, intranasal narcan, and much more!

September 29, 2014, 12:11 am

The Antidote: A long piece in the  The New Yorker by Ian Frazier describes the epidemic of overdoses from both prescription opiate analgesics and heroin, how that epidemic affects the New York City borough of Staten Island, and the potential role of intranasal naloxone in reducing the number of deaths. A little superficial regarding the origins of the epidemic and …

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Review: cobalt toxicity and artificial metal hips

September 25, 2014, 1:28 pm



Systemic toxicity related to metal hip prostheses. Bradberry SM et al. Clin Toxicol 2014;52:837-847.


As TPR has reported before, cobalt poisoning can cause hypothyroidism, cardiomyopathy, and neurotoxicity. Neurological manifestations include:

  • optic nerve damage and retinopathy with reduced visual acuity
  • bilateral nerve deafness and tinnitus
  • polyneuropathy (sensory and motor)
  • cognitive impairment and memory loss

A number of papers and …

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Avoid couchlock! Four things to know about cannabis pharmacology

September 18, 2014, 11:23 am


With medical marijuana now legal in 23 states and the District of Columbia — and recreational weed available in Colorado and Washington State — knowing the pharmacokinetics of THC has never been more important, both for consumers and the physicians who must counsel and treat them. Recently, the New York Times’ Pulitzer Prize-winning columnist Maureen Dowd got into trouble …

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Tox on the Web: sarin, lithium, strychnine, and much more!

September 18, 2014, 12:36 am


Toxicologist as Man on Couch with Laptop: This video shows a short presentation by Larissa Laskowski a first year fellow at the NYC Poison Control Center, describing the work of Eliot Higgins and the Brown Moses blog. Higgins — an unemployed finance worker several years ago with no knowledge about weapons of warfare — started blogging about the …

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Case Report: Synthetic Cannabinoid K2 and Myocardial Infarction

September 16, 2014, 7:29 pm


K2—Not the Spice of Life; Synthetic Cannabinoids and ST Elevation Myocardial Infarction: A Case Report. McKeever RG et al. J Med Toxicol 2014 Aug 26 [Epub ahead of print]


Use of synthetic cannabinoids has been associated with a broad range of adverse effects, including tachycardia, hypertension, seizures, psychosis, renal injury, and cyclic vomiting.

This article describes 16-year-old male who …

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Conservative treatment for asymptomatic body packers?

September 10, 2014, 5:32 pm

Body packer

Body packer


Asymptomatic body packers should be treated conservatively. Glovinski PV et al. Dan Med J 2013 Nov;60:A4723


Kudos to the authors for putting their general conclusion in the title. Unfortunately, there’ s less here than meets the eye.

This is a retrospective review of 57 patients suspected of body packing, seen at Hvidovre Hospital in Denmark. However, …

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Do pediatric patients require endoscopy after ingesting a laundry pod?

September 8, 2014, 5:16 pm


Laundry Detergent Pod Ingestions: Is There a Need for Endoscopy? Smith E et al. J Med Toxicol 2014 Sep;10(3):286-91


The authors never answer their title question definitively, but you wouldn’t expect that they’d be able to on the basis of this small case series and the limited data published to date.

Ingestion of laundry detergent pod (LDP) ingredients can …

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Tox Tunes #88: Junco Partner (Professor Longhair)

September 7, 2014, 10:54 pm


Professor Longhair (Henry “Roy” Byrd, 1918-1980) combined classic New Orleans rhythm and blues piano with Afro-Cuban funk to produce music that was exciting and utterly original. Many years ago, I was working in a research lab in New York City, living in a West Village studio that rented for $78 a month. (Yes, it was that long ago.) I …

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