Archive for March 2015

3 die in Rochester NY after smoking cocaine/fentanyl combination

March 31, 2015, 11:30 pm

Several days ago, WHEC NBC news in Rochester NY reported that in the previous week at least 3 people in the area died after smoking a mixture of cocaine and fentanyl. There may have been as many as 4 additional recent deaths associated with this combination.

Late last year, there were 3 similar deaths in North Carolina.

HT: …

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ACEP Toxicology Section Antidote App (free)

March 27, 2015, 12:28 pm

Screen Shot 2015-03-27 at 11.39.48 AM

This simple but very useful app, from the Toxicology Section of the American College of Emergency Physicians, provides basic information about uses and dosing of basic antidotes used in toxicology. Version 1.1 covers approximately 50 different antidotes from A (acetylcysteine) to T (thiamine).

Of course, clinical judgment is still required when considering these treatments, and most situations requiring use of …

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Review: 23 patients with laboratory-confirmed MDPV exposure

March 24, 2015, 7:48 pm

Methylenedioxypyrovalerone (MDPV)

Methylenedioxypyrovalerone (MDPV)


Acute Methylenedioxypyrovalerone Toxicity. Fruberg BA et al. J Med Toxicol 2014 Dec 3 [Epub ahead of print]


This is an impressive paper, but for reasons the authors thoroughly discuss in their limitations sections, there is somewhat less here than meets the eye.

The authors retrospectively reviewed patients seen over a 2-year period at 10 different hospitals who …

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Non-controlled and over-the-counter drugs of abuse

March 23, 2015, 10:41 pm



Abuse of Medications That Theoretically Are Without Abuse Potential. Reeves RR et al. South Med J 2015 Mar;108:151-157.


This review of noncontrolled prescription and over-the-counter drugs that can be and have been abused for non-medical or recreational purposes is rather sketchy and anecdotal (as the authors admit,) but nevertheless contains some useful information.

Classes of drugs discussed include:…

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Tox Tunes #94: Cocaine Blues (David Bromberg)

March 22, 2015, 9:12 pm

Along comes Sally with her nose all tore
The doctor says she can’t sniff no more
He says that cocaine’s for horses, it’s not for men
He says it’s gonna kill me but he don’t say when

During the American folk music revival that started in the 1930s and continued into the 1960s and 70s, many musicians rediscovered the rich …

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Keef Kat, Boddahfinger, and other marijuana edibles — how should they be regulated

March 20, 2015, 1:04 pm

marijuana edibles


Half-Baked — The Retail Promotion of Marijuana Edibles. MacCoun RF, Mello MM. N Engl J Med 2015 Mar 12;372:989-991.

Full Text

This Perspective piece — from authors at the Stanford Schools of Law and Medicine — discusses problems raised by the increasing availability of marijuana edibles in some states. Often, these products are manufactured in forms that are enticing to …

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Sympathomimetic toxidrome: is it scorpion envenomation or methamphetamine?

March 9, 2015, 11:54 pm

Centruroides sculpturatus

Centruroides sculpturatus


Methamphetamine Ingestion Misdiagnosed as Centruroides sculpturatus Envenonmation. Strommen J, Shirazi F. Case Rep Emerg Med Epub 2015 Jan 14.

Full Text

Native to the American southwest and Mexico, Centruroides sculpturatus is the most venomous scorpion in North America. Its venom contains a variety of toxins, including α-toxins that inhibits deactivation of voltage-gated sodium channels causing excitation of both …

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Protonix (pantoprazole) can cause a false positive urine screening test for THC

March 5, 2015, 11:57 pm


13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire. Felton D et al. Pediatrics 2015 Mar 2 [Epub ahead of print]


The package insert for Protonix (pantoprazole) states:

There have been reports of false positive urine screen tests for tetrahydrocannabinol (THC) in patients receiving protein pump inhibitors.

The source of these reports have …

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Intravenous lipid emulsion in oral overdoses: what is the optimal dosing?

March 4, 2015, 11:19 pm


Confusion About Infusion: Rational Volume Limits for Intravenous lipid Emulsion during Treatment of Oral Overdoses. Fettiplace MR et al. Ann Emerg Med 28 Feb 2015 [Epub ahead of print]


As we discussed during our interview with Dr. Guy Weinberg on a recent TPR podcast, it seems intuitively obvious that the ideal dosing of lipid emulsion (LE) for treating oral …

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