How to interpret urine drug tests for marijuana: a review

November 19, 2016, 5:45 pm

Linda Parton/

Linda Parton/


Interpretation of Workplace Tests for Cannabinoids. Kulig K. J Med Toxicol 2016 Sep 29 [Epub ahead of print]


The interpretation of workplace urine drug tests for marijuana often becomes a point of contention in workman’s compensation cases or proceedings moving towards firing an employee. In may experience, the court or arbitrator not infrequently gets the science of …

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Missing loperamide (Imodium) abuse can be a fatal mistake

November 15, 2016, 5:45 pm


Epidemiologic Trends in Loperamide Abuse and Misuse. Vakkalanka JP et al. Ann Emerg Med 2016 Nov 4 [Epub ahead of print]


This paper reviews loperamide exposures reported to the National Poison Data System  over the 6-year period from 2010 through 2015. Because of the well-recognized limitations involved in retrospective analysis of poison center data, there is not much clinically …

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Does exposure to marijuana cause myocardial infarction?

November 12, 2016, 2:38 pm


Prolonged cardiac arrest complicating a massive ST-segment elevation myocardial infarction associated with marijuana consumption. Orsini J et al. J Community Hosp Intern Med Perspect 2016 Sept 7;6(4):31695

Full Text

The medical literature contains scattered, rare case reports and series describing myocardial infarction, acute coronary syndrome, and cardiac arrest associated with exposure to cannabis. (Extreme emphasis on the word “associated.”) This …

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Exposure to edible marijuana products causes lethargy, especially in children

November 4, 2016, 12:05 am

Li'l Ratskull Designs/

Li’l Ratskull Designs/


Characterization of edible marijuana product exposures reported to United States poison centers. Cao D et al. Clin Toxic 2016 Nov;54:840-846.


As mentioned here a number of times in the past, I find papers that abstract and collate data from computerized poison center registries frustrating and infuriating. They are invariably beset by multiple intractable limitations: incomplete and …

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Alcoholic ketoacidosis: case report and review

October 12, 2016, 3:45 pm


A Patient with Alcoholic Ketoacidosis and Profound Lactemia. Gerrity RS et al. J Emerg Med 2016 Oct;51:447-449.


This is a very good short case-based review of alcoholic ketoacidosis (AKA), and well-worth the 5 – 10 minutes reading time.

Some key points:

  • Development of AKA requires increased (binge) alcohol intake along with starvation (decreased food and water intake.)
  • The characteristic

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TPR Podcast Episode #12: 25 years of weird and wacky toxicology papers

September 26, 2016, 9:54 am

The Poison Review started as a hard-copy newsletter and accompanying tape cassette in the summer of 1992, when George H.W. Bush was President. In this episode of the TPR podcast, Tim Ericsson, Steve Aks and I look back at some the the weirdest and wackiest toxicology articles we've reviewed in the last quarter-century. Topics will include an air stewardess with puzzling diarrhea, the toxicology of ingesting contents of a lava lamp, and a scientific look into whether or no Beano prevents flatulence. Enjoy!
Podcast Episode

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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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