Saturday with SMACC: 17 Minutes

August 23, 2014, 1:21 pm

17 Minutes from Social Media and Critical Care on Vimeo.

It’s been 5 months since I returned from Brisbane and Australia’s Gold Coast where I attended the 2014 SMACC Gold conference — by far the most inspiring and creative medical conference I’ve ever been to. This brilliant video presentation from one of the plenary sessions is a perfect example …

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California counties sue makers of opioid analgesics

August 22, 2014, 5:34 pm

In May, two counties in California sued 5 pharmaceutical companies that make opioid analgesic medication, claiming that they waged a battle to create a “sea-change in medical and public perception” about the relative risks and benefits of these drugs by establishing a “deeply deceptive marketing campaign.” My Emergency Medicine News  column about this suit is online and can be read …

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Case series: 9 patients with acute kidney injury after smoking a synthetic cannabinoid

August 21, 2014, 11:13 pm


Acute kidney injury associated with smoking synthetic cannabinoid. Buser GL et a. Clin Toxicol 2014;52:663-673.


In the summer of 2012, two patients presented to emergency departments in western Oregon complaining of nausea, vomiting and flank pain that started shortly after smoking a synthetic cannabinoid product. Both patients had elevated serum creatinine levels and hypertension. Renal biopsy revealed acute tubular …

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Methoxetamine: a ketamine analog that is NOT bladder friendly

August 19, 2014, 11:45 pm


Methoxetamine — a novel recreational drug with potent hallucinogenic properties. Zawilska JB. Toxicol Lett 2014 Aug 13. pii: S0378-4274(14)01298-3. doi: 10.1016/j.toxlet.2014.08.011. [Epub ahead of print]


Methoxetamine (MXE) is a structural analog of ketamine, with effects that are similar but more intense and longer-lasting. Street names include:

  • MXE
  • Mexxy
  •  M-ket
  • MEX
  • Kmax
  • Special M
  • MA
  • “Legal ketamine”
  • Minx
  • Jipper
  • Roflcoptr

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On the internet, nobody knows if it’s 25C-NBOMe (“N-bomb”)

August 18, 2014, 10:22 am

25C-NBOMe (N-bomb)

25C-NBOMe (N-bomb)


25C-NBOMe: Preliminary Data on Pharmacology, Psychoactive Effects, and Toxicity of a New Potent and Dangerous Hallucinogenic Drug. Bersani FS et al. Biomed Res Int 2014;2014:734749. Epub 2014 Jul 3.

Full Text

The NBOMe drugs are phenethylamine derivatives of the 2C psychedelics. The 2 methoxybenzyl groups act to provide protection and stability, drastically increasing the potency of this drug. …

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Tox Tunes #85: Goodnight, Irene (Jerry Lee Lewis and Van Morrison)

August 17, 2014, 7:02 pm

Goodnight, Irene” was introduced by the folksinger and blues musician Lead Belly (Huddie Ledbetter, 1888-1949) and became a big hit for The Weavers in 1950. This fascinating song tells a somewhat murky story about unrequited passion and suicidal fantasies. The Weavers, however, left out the reference to opiates in Lead Belly’s original lyrics:

I love Irene
I swear …

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Iron poisoning: Tox on the Web

August 12, 2014, 11:44 am


Academic Life in Emergency Medicine has a very nice review of iron toxicity by Mary A. Wittler and David Manthey from Wake Forest University Baptist Medical Center.

Also, in a recent post at Life in the Fast Lane, Chris Nickson discusses “The Toddler with the Iron Gut” in a Q&A format.…

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Review of scorpion envenomation

August 12, 2014, 12:17 am

Asian forest scorpion

Asian forest scorpion


Scorpion Envenomation. Isbister GK, Bawaskar HS. N Engl J Med 2014 Jul 31;371:457-463.


“O! full of scorpions is my mind, dear wife!”

With over 1700 species of scorpions found all over the world, this brief review article is much too short and unfocused to provide more than a superficial overview of its topic.

The authors …

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Microcystin: the hepatotoxin that shut down Toledo’s water supply

August 8, 2014, 6:58 pm





The Toxicology of Microcystins. Dawson RM. Toxicon 1998;36:953-962.


Just when you thought it was safe to go back to the faucet . . .

While I was on vacation, the big toxicology story involved contamination of the water supply to Toledo Ohio. As a result almost half a million people in the area were warned not to

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