Question Of The Day

What renal toxin has been identified in “Birthwort,” or “Dutchman’s Pipe”?   Aristolochic Acid Gökmen MR, Cosyns JP, Arlt VM, Stiborová M, Phillips DH, Schmeiser HH, Simmonds MS, Cook HT, Vanherweghem JL, Nortier JL, Lord GM. The epidemiology, diagnosis, and management of aristolochic acid nephropathy:…

A lack of negative feedback on which enzyme can result in the accumulation of 5-oxoproline in the setting of APAP depletion of glutathione stores?   gamma glutamylcysteine synthestase Armenian, Patil, et al. “5-Oxoprolinemia Causing Elevated Anion Gap Metabolic Acidosis in the Setting of Acetaminophen Use.”…

Hard metal lung disease occurs after exposure to particles of hard metal alloys. Which of the metals are more commonly associated with hard metal lung disease?   Tungsten carbide and cobalt. Mizutani RF et al. Hard metal lung disease: A Case Series. J Bras Pneumol…

List four classes of drugs associated with drug-induced aseptic meningitis   NSAIDs (ibuprofen most commonly reported), antibiotics, immunosuppressives-immunomodulatory and antiepileptics. Moris G et al. The Challenge of Drug Induced Aseptic Meningitis Revisited. JAMA Intern Med 2014; 174(9). doi:10.1001/jamainternmed.2014.2918

This biomarker is being studied to assess ethanol consumption?   Blood phosphatidyl ethanol (PEth) is only formed in the presence of ethanol and has a half-life in blood of 4-6 days. It is being studied as a potential biomarker to examine alcohol use in the…

What is the metabolic fate of trioxane?   In acidic environments, trioxane depolymerizes to formaldehyde which is then rapidly oxidized by aldehyde dehydrogenase to formic acid. Theobald JL et al. Trioxane ingestion in a child. Wilderness & Environmental Medicine 2020; 31(3):350-353. https://doi.org/10.1016/j.wem.2020.05.002

A patient who works in a lumber mill that processes wood from western red cedar and cypress trees presents with worsening shortness of breath and chest tightness for the last few weeks. Which agent is the most likely cause of the patient’s symptoms?   Plicatic…

What is this compound and what is its toxicity?   2,5-hexanedione. Peripheral neuropathy specifically axonopathy (“dying back”). Structure: https://en.wikipedia.org/wiki/Hexane-2%2C5-dione

What is the name of the monoclonal antibody approved for use against inhaled anthrax poisoning?   Raxibacumab is a recombinant human monoclonal antibody developed against inhalational anthrax. It works by preventing binding of the protective antigen component of the anthrax toxin to its receptors in…

A 47 year old male presents to the Emergency Department with altered mental status. Initial labs reveal: VBG: 6.91/17/50; BMP: 140/7.1/105/<5/20/1.0; gluc 130; ALT 42; AST 56; Ammonia 327. What is the likely culprit?   Methanol. Hyperammonemia has been associated with methanol and ethylene glycol…