Pop quiz: cardiac arrhythmia from an herbal medicine

November 20, 2014, 11:35 pm


Life-threatening cardiovascular toxicity following ingestion of Chinese herbal medicine. Martinez A et al. Emerg Med Australas 2014 Oct;26:512-13.


This case report describes a 46-year-old Chinese woman in Melbourne who presented with peri-oral and facial paresthesias, gastronintestinal disturbance (nausea, vomiting, diarrhea,  abdominal pain,) tachycardia and hypotension. She also had decreased level of consciousness and ventricular tachycardia. Symptoms started 30 minutes …

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What’s better for amatoxin poisoning: silibinin or leprechaun luck?

November 17, 2014, 9:22 pm

Amanita phalloides

Amanita phalloides


Survival Following Investigational Treatment of Amanita Mushroom Poisoning: Thistle or Shamrock? Gores KM et al. Chest 2014 Oct 1 [Epub ahead of print]


Amatoxins are potent RNA inhibitors, shutting down protein synthesis and producing hepatonecrosis and, occasionally, renal injury.

There is not generally accepted treatment for amatoxin-induced hepatotoxicity aside from supportive care, early multi dose activated charcoal, …

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Crayola toxicology: life-threatening causes of bluish vomiting

November 14, 2014, 12:08 am


 Bluish vomiting: a rare clinical presentation of poisoning. Higny J et al. Acta Clin Belg 2014;69:299-301.


This case report describes a 65-year-old man who ingested an unknown substance and subsequently present with pharyngitis and mucositis, nausea, diarrhea, abdominal pain, and blue-green vomitus. The remainder of the physical exam and basic laboratory results were unremarkable.

The authors use the case …

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Snorting bupropion

November 12, 2014, 10:47 pm


An 11-year review of bupropion insufflation exposures in adults reported to the California Poison Control System. Lewis JC et al. Clin Toxicol 2014 Nov;52:969-972.


The abuse of bupropion by pulverizing and snorting the medication has been described at least as far back as 2002. Bupropion inhibits re-uptake of dopamine and norepinephrine, but apparently has little or no effect …

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Methoxphenidine: a designer dissociative drug

November 11, 2014, 10:14 pm


Acute toxicity associated with the recreational use of the novel dissociative psychoactive substance methoxphenidine. Hofer KE et al. Clin Toxicol 2014 Oct 28 [Epub ahead of print]


Methoxphenidine  (MXP) is a dissociative drug with actions apparently similar to those of phencyclidine (PCP), ketamine, and methoxetamine (MXE). It is often sold as a “research chemical” and labelled as “Not for …

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Ban the Words: should the phrase “should be considered” be banished from the toxicology literature?

November 10, 2014, 12:23 pm

Interventions such as gastric lavage and whole bowel irrigation are labor intensive and associated with significant adverse effects. In addition, they have never been proven to improve clinical outcomes. Are we now at a point where we can stop discussing them, easing them into a dignified retirement along with ipecac-induced emesis? Many texts and review articles suggest that these interventions …

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Saturday with SMACC: Weingart on sepsis in New York City

November 8, 2014, 8:16 pm

In this brilliant talk from smaccGOLD last March in Australia, Scott Weingart talks about lessons from the STOP Sepsis Collaborative project in New York City based on their experience with 15,000 severe sepsis patients.

In brief, the Collaborative achieved a 22% reduction of in-patient mortality in these patients by relatively simple measures that did not involve early goal-directed therapy or …

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Sun Tzu and the Art of Focusing in Medical Toxicology

November 7, 2014, 6:28 pm

PocketSunTzuThe philosophy expressed in Sun Tzu’s classic The Art of War has been applied to everything from military strategy to business management. But what does it have to teach practitioners of emergency medicine and medical toxicology? In my current column for Emergency Medicine News I discuss a very important lesson from the book that will completely change the way you …

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There is no real evidence on treating calcium channel blocker overdose

November 6, 2014, 8:06 pm


Treatment of calcium channel blocker poisoning: A systematic review. St-Onge M et al. Clin Toxicol 2014 Nov;52:926-944.


This systematic review is massive, thorough, intimidating, and all but unreadable.

As a prelude to establishing a clinical guideline for treatment of calcium channel blocker (CCB) overdose, the 14 Canadian authors systematically searched and evaluated relevant literature. They initially identified 15,577(!) citations, …

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