Question of the Day – Wednesday June 3, 2020
In a recent cohort study, carbon monoxide poisoning appeared to be associated with an increased risk of this complication in the first 90 days after poisoning? Cho et al. performed a cohort study in carbon monoxide poisoned patients and found an increased risk of…
Question of the Day – Tuesday June 2, 2020
Seizures and sympathomimetic effects are well-described after bupropion toxicity. This effect, however, is more controversial. In a recent retrospective analysis of single agent bupropion exposures, 13 patients (5.9%) were diagnosed with serotonin toxicity. (Murray B et al. Single Agent Bupropion exposures: Clinical characteristics and…
Question of the Day – Monday June 1, 2020
Which drug was removed from the market after only 6 months in 1986, only to return in 1989 with new warnings and a lower maximum recommended dose? Bupropion’s original recommended dose was 400-600 mg/day, but a high incidence of seizure at this dose lead…
Question of the Day – Friday May 29, 2020
How often are suspected cyclopeptide-containing mushroom exposures reported to poison centers confirmed by a mycologist? A retrospective review of NPDS data from 2008-2018 included 148 cases. Only 25 cases had mycologist identification of mushrooms, of which 20 were confirmed to contain cyclopeptides with 2…
Question of the Day – Thursday May 28, 2020
When is the onset of hemolysis after brown recluse spider envenomation? A retrospective review of patients seen by a medical toxicology consult service identified 97 patients with brown recluse spider envenomation over 8 years. Approximately 40% developed hemolysis with a median time to onset…
Question of the Day – Wednesday May 27, 2020
How often are other substances identified in patients with gamma hydroxybutyrate contributing to death? A retrospective analysis of the National Coronial Information System in Australia identified 74 patients in which gamma hydroxybutyrate contributed to death over a 20-year period. There were 64 patients with…
Question of the Day – Tuesday May 26, 2020
What is the proposed target and mechanism of action of high dose diazepam in chloroquine toxicity? The peripheral type benzodiazepine receptor (TSPO- Translator Protein) has been suggested as a target for the observed cardioprotective effect of high dose diazepam in chloroquine toxicity. Diazepam has…
Question of the Day – Monday May 25, 2020
A patient with a history of chronic cocaine use expires after injecting an unknown substance. He initially presented seizure, wide complex tachycardia, hypertension, hyperthermia and tachycardia. What type of blood tube, drawn at the time of death would best facilitate diagnosing acute cocaine intoxication as…
Question of the Day – Friday May 22, 2020
What is the onset of fomepizole for the treatment of disulfiram-ethanol reaction? A retrospective case series of 10 patients admitted to an ICU with acute disulfiram-ethanol reaction used a single dose of fomepizole 7.5 mg/kg IV. All patients had rapid symptom improvement and vasopressors…
Question of the Day – Thursday May 21, 2020
What is the antidote for patient with toxicity secondary to piperidylthiambutene? Naloxone. Piperidylthiambutene is a recently identified synthetic opioid. It is structurally different than fentanyl or other synthetic opioids. Limited data suggests that it has potency at the mu-opioid receptor similar to morphine. (https://www.npsdiscovery.org/wp-content/uploads/2019/09/Piperidylthiambutene_091819_NMSLabs_Report.pdf…