Archive for the ‘Best of TPR’ Category

Treating “heroin” overdose: the past is no guide

November 22, 2016, 12:06 am


Do heroin overdose patients require observation after receiving naloxone? Tillman MW et al. Clin Toxicol 2016 Nov 16:1-7 [Epub ahead of print]


The stated goal of this study was to search the medical literature in an attempt to answer 3 main questions:

  1. “What are the medical risks to a heroin user who refuses ambulance transfer after naloxone?
  2. “If

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Absolute must-read: LA Times on the myth of OxyContin’s 12-hour analgesic effect

May 7, 2016, 9:15 pm


Quick: how long does a dose of Oxycontin provide pain relief?

Most clinicians would probably say 12 hours, since the drug was extensively marketed as a twice-daily opioid analgesic and the manufacturer — Purdue Pharma — cited this originally unique convenience factor as justifying its high cost, which could exceed $630 a bottle.

In an explosive and masterfully written i…

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Severe bupropion overdose and ECMO: two great saves

February 12, 2016, 12:29 am




Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrance Oxygenation. Heise CW et al. J Med Toxicol 2016 Feb 8 [Epub Ahead of Print]


This awesome, exciting paper from Banner University Medical Center in Phoenix describes two teenagers with severe bupropion overdose who survived refractory cardiac arrest after veno-arterial extracorporeal membrane oxygenation

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W-18, a synthetic opiate 100 times more potent than fentanyl

February 4, 2016, 2:01 pm



Last August, Canadian police seized 110 illegal fentanyl pills at a home in Alberta province. Yesterday, Global News reported that some of the pills have tested positive for an extremely potent opioid called W-18.

This is certainly a disturbing development, since W-18 is a μ-receptor agonist 100 times more potent than fentanyl. According to B.C. Centre for Disease

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Must-read: review of single-dose activated charcoal

November 17, 2015, 12:25 am


Activated charcoal for acute overdose: a reappraisal. Juurlink D. Br J Clin Pharmacol 2015 Sep 26 [Epub ahead of print]


The British Journal of Clinical Pharmacology seems to be publishing a series of articles on basic management of the poisoned patient. Several weeks ago we reviewed (and highly recommended) Marco Sivilotti’s excellent discussion of flumazenil, naloxone and the

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Use of flumazenil and naloxone in poisoned patients

November 2, 2015, 11:08 pm


Flumazenil, naloxone and the ‘coma cocktail’ Sivilotti MLA Br J Clin Pharmacol 2015 Aug 7 [Epub ahead of print]


This very smart paper reviews factors affecting the clinical use of two antidotes that reliably reverse  coma caused by two major classes of poisons: flumazenil for benzodiazepines, and naloxone for opiates.

Both these antidotes are specific, rapid-acting, short-lived, and titratable. …

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The first 100 “Tox Tunes”

August 30, 2015, 9:15 pm

On January 3, 2010, TPR launched “Tox Tunes,” a series of clips of songs about drug, toxins, and poisons starting with Keith Richards’ version of Reverent Gary Davis’s “Cocaine Blues.” Last week, we featured our one-hundredth tune, Amy Winehouse’s classic — and tragically ironic — song “Rehab.” To celebrate the 100-tunes milestone, we are listing all …

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Early metabolic acidosis and coma in massive acetaminophen overdose

August 7, 2015, 1:33 pm


Coma and Severe Acidosis: Remember to Consider Acetaminophen. Villano JH et al. J Med Toxicol 2015 July 8 [Epub ahead of print]


This paper, from UC-San Diego, contains an excellent case discussion that makes numerous important points about a patient who presents with decreased mental status and high-anion-gap metabolic acidosis.

The patient was a 28-year-old male who was …

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ED sedation with droperidol is relatively safe and effective

May 19, 2015, 7:57 pm


The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Calver L et al. Ann Emerg Med 2015 Apr 11 [Epub ahead of print]


Before the Food and Drug Administration issued a black box warning in 2001 regarding the relationship between droperidol and risk of QTc prolongation, the drug had been used for …

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