Title:
Fungus Among Us: Updates in the Toxicology of Mushroom Poisoning
 

Description:

This symposium will examine key aspects of mushroom toxicology, including basic science, foraging mix ups, updates on novel mechanisms of toxicity, emerging clinical syndromes, evolving regulation on cultivated psychoactive mushrooms, and a focus on incorporating lessons from several recent mushroom poisoning outbreaks—including death cap cases—to highlight challenges in clinical recognition and public health response. Bringing together clinicians, toxicologists, public health experts, and mycologists, the program will explore both classic and emerging issues in the field. Overall, the goal is to connect clinical care, public health, and research to improve recognition and management of mushroom-related toxicities.

Learner Objectives: TBA

Title: Quantifying and Communicating Uncertainty: Assessing, Interpreting, and Balancing Risk in Clinical Toxicology

Description:
Clinical toxicologists are often faced with the challenge of making difficult decisions. Decisions about patient care, public health, clinical guidance, and prevention measures. Risk is an ever-present factor in the decision making process. In toxicology, we rarely know the true risk when we need to make or communicate a decision to a patient, a colleague, or the public. This symposium explores how we identify, interpret, and act on risk, particularly when evidence is limited or evolving. The sessions will examine how risk is evaluated in the literature, understood at the bedside, and communicated to patients, families, care teams, and the public. Speakers will highlight the balance between benefit and harm when considering high-resource interventions, emerging treatment strategies and antidotes, prognosis, prevention, and public health strategies. The sessions will prepare health care professionals with a practical framework to make thoughtful, patient-centered decisions in the context of uncertainty.

Learner Objectives:

• Discuss the impact of risk and uncertainty on the evaluation, treatment, and monitoring of poisoned patients, including prognostic tools and antidotal therapies.
• Analyze and debate novel strategies for evaluating and treating poisoned patients, including extracorporeal membrane oxygenation and plasma exchange (PLEX/TPE).
• Investigate the role of public health interventions, risk communication, and consensus based guidelines for preventing poisoning and promoting safe use.

Agenda:

• When Uncertainty Meets Certainty: The Acetaminophen Story
  • Reinventing the Wheel - Should We Be Using Other Prognostic Tools to Augment the Acetaminophen Nomogram?
    Summary: An overview and critical appraisal of APAPxAT, APN, Bayesian forecasting, and biomarkers to improve risk prediction in patients with acetaminophen overdose. The talk should briefly review the benefits and limitations of using prognostic tools when caring for poisoned patients.
  • Building Consensus - Development and Implementation of Consensus Based Pre-Hospital Guidelines
    Summary: Using the acetaminophen out-of-hospital triage guideline as a framework, this session will explore the process and pitfalls of developing consensus based pre-hospital guidelines for poisoned patients. The talk should describe how risk is incorporated into this development process.
  • Acetaminophen & Pregnancy - The Challenges of Communicating Nuance and Risk
    Summary: An overview and critical appraisal of the literature evaluating an association between acetaminophen and developmental issues (ASD, ADHD, etc.), including strategies for communicating risk to patients and the public.
  • Stop Right Now - Discontinuing NAC in Acetaminophen Poisoned Patients (Moderated Debate)
    Summary: A moderated debate with two speakers presenting the case for stopping n-acetylcysteine treatment at 12 hours vs. 20-21 hours.
• Risk and Resources: Managing Uncertainty in Critically Ill Patients
  • Are We a Go for ECMO? - Should Expanded Access Mean Expanded Indications?
    Summary: ECMO is becoming increasingly common in patients with drug-induced cardiac toxicity, including toxicity from bupropion, non-dihydropyridine calcium channel blockers, beta-blockers, and tricyclic antidepressants. As access to ECMO expands, it is critical that the risks and benefits are considered for other medications, including dihydropyridine calcium channel blockers and colchicine.
  • Bridging the Gap - Therapeutic Plasma Exchange for Toxin Associated Hepatotoxicity
    Summary: An overview of PLEX and the role for therapeutic plasma exchange in patients with toxin associated hepatic failure.
  • Should we Dialyze That? - Developing and Implementing Consensus Based Guidelines for Extracorporeal Therapies
    Summary: Using the Extracorporeal Treatments in Poisoning Workgroup (EXTRIP) guidelines as a framework, this session will explore the process and pitfalls of developing consensus based guidelines for extracorporeal therapies in poisoned patients. The talk should describe how risk is incorporated into this development process.
  • Going Back to College - The Role of Organ Transplantation in Poisoned Patients (Moderated Debate)
    Summary: A moderated debate with two speakers presenting on the role for organ transplant in poisoned or overdose patients.
• Perfect is the Enemy of Good: When Zero Risk Isn’t an Option
  • Pesticides, Diet Soda, and Pickled Veggies - Contextualizing Cancer Risk
    Summary: The International Agency for Research on Cancer (IARC) develops evidence-based monographs to identify causes of cancer and improve cancer prevention. This talk should include an overview of the IARC process and a critical appraisal of the benefits and limitations of the IARC methodology, classification system, and reporting mechanism.
  • Overamping - Preventing Harms of Stimulant Use
    Summary: Stimulant use disorder is a growing public health crisis and treatment access is limited. Patients with stimulant use disorder can have high rates of emergency department visits for paranoia, delusions, agitation, and other symptoms of overamping. Risk reduction interventions, including chill packs, PrEP/PEP, and safer use strategies, are a potential tool for reducing stimulant associated morbidity and mortality.
  • Defining Safe Consumption - A Critical Appraisal and Update on Safe Consumption Strategies for Patients with Substance Use Disorders
    Summary: Safe consumption strategies, including safe consumption sites or overdose prevention centers, are one potential strategy for decreased opioid and drug-related morbidity and mortality. The talk should include a discussion of safe consumption resources for patients using opioids, stimulants, and other drugs.
  • Reframing the Narrative - Medical and Non-Medical Use of Psychedelics (Moderated Debate)
    Summary: A moderated debate with two speakers presenting on medical and non-medical use of psychedelics.
  • Understanding Risk - Best Practices from an Expert Panel
    Summary: A moderated 4-5 person panel with Q&A.