Archive for the ‘Best of TPR’ Category

Must-watch: video showing murder of Kim Jong Nam

February 22, 2017, 1:25 pm

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Extraordinary security footage from Kuala Lumpur International Airport in Malaysia showing details surrounding the February 13 killing by poison of Kim Jong Nam, the half-brother of North Korea leader Kim Jong Un. The video was posted by Fuji Television and the Wall Street Journal, and can be seen by clicking here.

The video makes it possible to establish …

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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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