Archive for the ‘Medical’ Category

Must-read post: Why dialyze patients with chronic, asymptomatic hyperlithemia?

September 19, 2016, 9:39 pm


About a month ago I discussed a new state-of-the-art review of lithium poisoning, which I rated “four skulls” and called a near must-read. Now comes a superb post entitled “Why dialyze patients with chronic, asymptomatic hyperlithemia” from Josh Farkas from and It is essential reading for all clinicians who deal with lithium poisoned patients.

Dr. Farkas …

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Must-read: ayahuasca in America

September 9, 2016, 1:02 am

Ecuadorian ayahuasca shaman (Ammit Jack/

Ecuadorian ayahuasca shaman (Ammit Jack/

In the current (Sept 12) issue of The New Yorker. Ariel Levy writes about the drug-fueled South American shamanistic ritual ayahuasca (or yagé,) and how its plants and practices are being imported to “hip” American areas such as Brooklyn and Silicon Valley. As TPR has explained before:

Pharmacologically, ayahuasca is quite interesting. It is

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Case series: 8 patients exposed to phony alprazolam (Xanax) containing fentanyl and/or etizolam

August 24, 2016, 11:50 pm


Adverse Effects From Counterfeit Alprazolam Tablets. Arens AM et al. Ann Emerg Med 2016 Aug 8 [Epub ahead of print]


In March of this year,there were 9 deaths reported in Pinellas County, Florida (the Tampa/St. Petersburg area) associated with fake alprazolam (Xanax) tablets containing fentanyl. Earlier, similar counterfeit pills had been seen around San Francisco and in Monroe County …

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State-of-the-art review of lithium poisoning: almost a must-read

August 19, 2016, 9:50 pm


Lithium Poisoning: State of the Art.  Baird-Gunning J et al. J Intensive Care Med 2016 Aug 11 [Epub ahead of print]


This is a very good paper, the best comprehensive review I can remember reading on lithium. It is up to date, with 78 references as recent as 2015. A major reason I liked it so much is that …

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Elephant-tranquilizer (carfentanil)-tainted heroin showing up in Ohio

August 10, 2016, 2:55 pm


Human Health Hazards of Veterinary Medications: Information for Emergency Departments. Lust EB et al. J Emerg Med 2011 Feb;40:198-207


Yesterday, Canadian police announced that, earlier in the summer, they had seized one kilogram of carfentanil contained in a package labelled “Printer Parts” shipped from China and addressed to a man in Calgary.

Carfentanil is frequently, and accurately, referred to …

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Seven cases of laboratory-confirmed exposures to the synthetic cannabinoid MDMB-CHMICA

August 8, 2016, 6:53 pm


Clinical toxicity following analytically confirmed use of the synthetic cannabinoid receptor agonist MDMB-CHMICA. A report from the Identification Of Novel psychoActive substances (IONA) study. Hill SL et al. Clin Toxicol 2016 Sep;54:638-643.


MDMB-CHMICA is a synthetic cannabinoid receptor agonist (SCRA) with strong affinity for the CB1 receptor. It has to date not been banned in may localities, …

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Counterfeit Norco containing fentanyl and the synthetic opioid U-47700

July 28, 2016, 6:30 pm


Fentanyl and a Novel Synthetic Opioid U-47700 Masquerading as Street “Norco” in Central California: A Case Report. Armenian P et al. Ann Emerg Med 2016 [Epub ahead of print]

Full Text

In a recent “Toxicology Rounds” column for Emergency Medicine News, I pointed out that designer opioids such as U-47700 are being identified in street drug specimens and overdose …

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All bleeding stops — but does idarucizumab (Praxbind) make it stop faster?

July 27, 2016, 2:56 pm


Persistent life-threatening hemorrhage after administration of idarucizumab. Alhashem HM et al. Am J Emerg Med 2016 June 30 [Epub ahead of print]


Dabigatran (Pradaxa) is a direct thrombin inhibitor approved for stroke and embolism prophylaxis in patients with non-valve-related atrial fibrillation. When it was first released in 2008, a major disincentive to widespread use was the lack of a …

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A normal (or negative) anion gap does NOT rule out salicylate toxicity

July 23, 2016, 4:40 pm


Salicylate toxicity in the absence of anion gap metabolic acidosis. Bauer S, Darracq MA. Am J Emerg Med  2016 Jul;34(7):1328.e1-3


Moderate-to-severe salicylate toxicity typically presents with a combined metabolic acidosis and respiratory alkalosis. Often, the arterial blood gas shows a pH quite near the normal 7.4, but with decreased pCO2 and decreased bicarbonate.

However, occasional case reports have …

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