Clinical Toxicology最新文献

Introduction: Severe carbon monoxide may impact the circulatory system, potentially leading to myocardial injury. This study aimed to assess left ventricular function via echocardiography in patients with acute carbon monoxide poisoning who were otherwise healthy.

Methods: We conducted an observational, single-centre study involving consecutive patients hospitalized with carbon monoxide poisoning.

Results: In a study of 112 consecutive patients with acute carbon monoxide poisoning, we identified a subset of 46 patients with moderate to severe poisoning. Among them, myocardial injury (defined by a peak high-sensitivity troponin T concentration >14.0 ng/L) was observed in 17 of 46 (36.9%) patients, forming the myocardial injury group. The remaining 29 patients formed the non-myocardial injury group. The echocardiographic assessment revealed no significant difference (P = 0.06) between the mean (±SD) left ventricular ejection fraction in the myocardial injury group (59.8 ± 5.4%), compared to the mean (±SD) in the non-myocardial injury group (62.9 ± 5.5%). However, the mean (±SD) left ventricular global longitudinal strain was significantly higher (P = 0.008) in the myocardial injury group (-20.1 ± 1.8%) compared to the non-myocardial injury group (-22.1 ± 2.4%). Patients in the myocardial injury group also exhibited significantly higher (P <0.001) mean heart rates (108.9 beats/min) compared to the non-myocardial injury group (87.6 beats/min). In addition, the mean plasma lactate concentration was significantly higher (P <0.001) in the myocardial injury group (1.95 mmol/L) compared to the non-myocardial injury group (1.2 mmol/L). There were no fatalities in either group.

Discussion: Healthy patients with carbon monoxide poisoning who have myocardial injury may show minor changes in echocardiography in contrast to patients with co-morbidities.

Conclusions: In patients with moderate to severe carbon monoxide poisoning, without concurrent chronic diseases, left ventricular global longitudinal strain was significantly lower in those with myocardial injury. However, these findings are based on a small cohort, necessitating further research.

Introduction: In November 2020, Oregon passed Measures 109 and 110 altering the legal landscape for psychoactive substances by regulating psilocybin use and decriminalizing possession of Schedule I substances. This coincided with the growth of the commercial nootropic (cognitive enhancers) mushroom industry, including products such as mushroom gummies marketed for "legal highs." Despite these product claims, concerns have been raised about their safety profile. Our study aimed to assess the accuracy of labeling of these products and quantify their psychoactive contents.

Methods: Eight gummy products were procured from seven different smoke and vape shops in Portland, Oregon. Gummy samples were homogenized and analyzed using liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Products were screened for psychoactive compounds, including psilocybin, psilocin, and their analogues, as well as for purported Amanita muscaria derivatives. Quantitative analysis of identified compounds was performed using isotope dilution.

Results: Neither ibotenic acid nor muscimol, the active components of Amanita muscaria, were detected in the two products claiming to contain Amanita muscaria extracts. However, these products contained psilocin and tryptamine derivatives. One product labeled as psilocybin-free tested positive for psilocybin. Another sample claiming to be nootropic contained undisclosed Δ9-tetrahydrocannabinol. Overall, seven of the eight products contained psilocin, and six contained 4-acetoxy-N,N,dimethyltryptamine. Other detected compounds included various tryptamine congeners and kavalactones.

Discussion: Labeling was inaccurate and inconsistent in many of the products examined. Users are likely to experience psychoactive symptoms considering the concentrations of xenobiotics determined. Serotonergic effects are expected from products containing tryptamine derivatives, including those inaccurately labeled as containing Amanita muscaria extracts.

Conclusions: The labeling of psychoactive mushroom gummies we tested was overall inaccurate. Products suggesting Amanita muscaria content instead contained serotonergic tryptamines, including some which falsely claimed to be free of psilocybin.

Background: Pediatric nephrologists are rare in the United States; many children with poisoning needing extracorporeal treatments may not have timely access to care. This study compared outcomes in children receiving extracorporeal treatments for poisoning at centers with and without a pediatric nephrologist.

Methods: This was a retrospective cohort study of all patients aged ≤17 years reported to an American poison center covering three upper midwestern states during 2000-2024.

Results: We identified 72 patients: 54 received extracorporeal treatments at a hospital with pediatric nephrologists, and 18 patients aged 14-17 years (minimum weight, 35 kg) received extracorporeal treatments at hospitals staffed solely by adult nephrologists. The most common responsible poisons were toxic alcohols (10/18, 55%) and salicylates (4/18, 22%). Children receiving extracorporeal treatments from adult nephrologists more commonly (P <0.001) received intermittent hemodialysis (18/18, 100%) compared to pediatric nephrologists (31/54, 57%). Conversely, children treated by pediatric nephrologists more commonly (P <0.05) received continuous kidney replacement therapy (28/54, 52%) compared to adult nephrologists (0/18). We found no difference (P = 0.1) in mortality between the children treated by pediatric nephrologists (9/54, 17%) compared to those treated by adult nephrologists (0/18).

Discussion: Teenage children commonly received hemodialysis from adult nephrologists for poisoning and had similar outcomes to those treated by pediatric nephrologists.

Conclusions: These data suggest adult nephrologists can successfully perform extracorporeal treatments for poisoning in teenage children.

Introduction: Veno-arterial extracorporeal membrane oxygenation is frequently considered and implemented to help manage patients with cardiogenic shock from acute poisoning. However, utilization of veno-venous extracorporeal membrane oxygenation in acutely poisoned patients is largely unknown.

Method: We conducted a retrospective study analyzing the epidemiologic, clinical characteristics and survival of acutely poisoned patients placed on veno-venous extracorporeal membrane oxygenation using the Extracorporeal Life Support Organization registry. Adult cases in the United States were included after a systematic search of the registry between January 1, 2003, and November 30, 2019. Study outcomes included survival to discharge, time to cannulation, and changes in metabolic, hemodynamic, and ventilatory parameters stratified by survival.

Results: One hundred and seventeen cases were included in the analysis after excluding 216 non-poisoning-related cases. Their median age was 34 years and 69.2% were male. Opioids (45.3%) were most commonly implicated, followed by neurologic drugs (e.g., antidepressants, antiepileptics) (14.5%) and smoke inhalation (13.7%); 23 patients (19.7%) had a pre-extracorporeal membrane oxygenation cardiac arrest. The median time from admission to extracorporeal membrane oxygenation was 47 h with a median duration of extracorporeal membrane oxygenation support of 146.5 h. Survivors were cannulated significantly earlier than non-survivors (25 h versus 123 h; P = 0.02). Eighty-four patients (71.2%) survived to hospital discharge. Clinical parameters (hemodynamic, metabolic, and ventilatory) improved with veno-venous extracorporeal membrane oxygenation support, but no statistically significant difference was noted between survivors and non-survivors.

Discussion: Our study showed that veno-venous extracorporeal membrane oxygenation was infrequently utilized for poisoning-associated acute respiratory distress syndrome. Opioids were the most frequently reported exposure among the cases in which indirect lung injury may have occurred from aspiration. Although no specific clinical parameters were associated with survival, early initiation of extracorporeal membrane oxygenation may improve clinical outcomes.

Conclusions: The use of veno-venous extracorporeal membrane oxygenation for refractory respiratory failure due to poisoning was associated with a clinically significant survival benefit compared to other respiratory diagnoses requiring veno-venous extracorporeal membrane oxygenation.

Introduction: The use of weight loss supplements is increasing, often driven by online marketing. However, many of these supplements are adulterated with undeclared pharmaceutical substances, potentially posing significant health risks. We investigated the presence of sibutramine and sildenafil in weight loss supplements and assessed the associated clinical outcomes.

Materials and methods: A total of 12 weight loss supplement samples (capsules, tea, and coffee bags) were analyzed using liquid chromatography-high resolution mass spectrometry. Demographic and clinical data were collected by the Marseille Regional Pharmacovigilance Centre from 29 patients who reported using these products.

Results: All samples were found to contain sibutramine, with concentrations ranging from 7.5 mg to 15.4 mg per unit. Sildenafil was detected in all samples, with concentrations ranging from 1.7 mg to 4.8 mg per unit. Clinical data from 29 users showed significant weight loss, with an average of 7.5 kg after 37 days of use. Adverse effects included anorexia (n = 15), tachycardia (n = 13), insomnia (n = 2) and chest pain (n = 4). In some cases, more serious effects such as seizures and dependence were observed.

Discussion: Both sibutramine and sildenafil were withdrawn from the market due to cardiovascular risks. As such, the unregulated use of these products pose a serious risk to public health, particularly in individuals with underlying cardiovascular disease.

Conclusion: We detected sibutramine and sildenafil in all 12 weight loss supplements tested, which highlights the need for stricter regulation and monitoring.

Introduction: Antivenom treatment is the specific treatment for Deinagkistrodon acutus envenomation. However, safety concerns regarding the use of antivenom in this population have been reported only infrequently in the literature. We aimed to determine the incidence of anaphylactic reactions and serum sickness following antivenom administration in a cohort of patients envenomed by Deinagkistrodon acutus.

Methods: We retrospectively reviewed the medical records of patients admitted to the Hangzhou TCM Hospital between January 2018 and December 2022 with bites from Deinagkistrodon acutus. The information collected included patient demographics, clinical information, laboratory findings, details of antivenom use, use of premedications, and details of anaphylactic reactions and serum sickness.

Results: A total of 157 patients with bites from Deinagkistrodon acutus were treated with antivenom (median dose four vials) and were included in the study. All treated patients received premedications (dexamethasone and antihistamines). Adverse reactions were noted in 18 patients (11.5%). Ten of these individuals (6.4%) suffered anaphylactic reactions within the first 24 h following antivenom administration, categorized as mild (n = 5), moderate (n = 4), or severe (n = 1). Symptoms included rash, urticaria, diaphoresis, nausea, dyspnoea, wheezing, anaphylactic shock, loss of consciousness, and angioedema. Serum sickness occurred in eight patients (5.1%), manifesting primarily as urticaria or erythematous rash, fever, myalgia, arthralgia, malaise, and gastrointestinal symptoms.

Discussion: This study provided data on adverse reactions associated with antivenom administration in patients admitted with bites from Deinagkistrodon acutus admitted to a regional referral centre specializing in the management of patients with severe or complex health conditions in Zhejiang Province, China. Our results indicate a relatively low incidence of severe adverse reactions. Nevertheless, clinicians must administer appropriate snake antivenom and maintain vigilance during antivenom administration and post-treatment follow-up.

Conclusions: Antivenom therapy was efficacious in treating Deinagkistrodon acutus envenomation. Approximately one in every eight patients developed anaphylactic reactions or serum sickness, although anaphylactic shock was uncommon (0.6%).