Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episodeBy Ryan Feldman

A quick update to share some other shows Ryan has been on in the last few weeks! Check the show notes for links to each episode! Ryan on "The Larry Meiller Show" discussing delta cannabanoids Link to stream Link to download Ryan on EMS2020 talking prehospital overdose Link to episode Show homepageBy Christopher Pfingsten, Spencer OLIVER

In this episode Ryan interviews Dr. Alex Krotulski PhD from the Center for Forensic Science Research and Education. Together take a look at trends in novel opioids, benzodiazepines, stimulants, hallucinogens, synthetic cannabinoids, and "hemp products" that are showing up in your patients, drug products, and fatal overdoses. The conversation takes …

Dr. Ann Arens, MD an emergency medicine physician and medical toxicologist with Oschner Medical center in New Orleans, LA joins the show to educate us on some HOT toxins, solve toxic cases, and opine on the philosophical and existential reasons drugs even exist. Tune in for a fantastic discussion with Dr. Arens and to hear the answer to our mystery…

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 18By Ryan Feldman

In this episode Ryan is joined by a guest panel (Dr. Grant Comstock MD, Dr. Joshua Trebach MD, Dr. Emily Kiernan DO, and Dr Frank Paloucek PharmD, DABAT) to review nine of the most interesting or clinically impactful research abstracts that were presented at the 2023 North American Congress of Clinical Toxicology (NACCT) in Montreal Canada. If you …

In this episode, Ryan dives into cutting-edge research on the treatment of acetaminophen (APAP) overdose, featuring interviews with authors of several key abstracts from the North American Congress of Clinical Toxicology (NACCT) in Montreal Canada (Abstracts and posters available in the show notes). We get first looks insights into research evaluat…

In this episode, Ryan sits down with Dr. Eric Lavonas MD, a seasoned EM resuscitation guideline writer, emergency medicine physician, medical toxicologist, and lead author of the latest update to the American Heart Association's guidelines for the management of cardiac arrest and life-threatening toxicity due to poisoning. They have an in-depth dis…

In this episode Ryan does a high yield "just the facts" break down of the recently released "2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovasc…

In this enlightening episode, Ryan engages in a deep conversation with Dr. Paul Hutson, PharmD, a renowned researcher in the field of psilocybin and director of the Transdisciplinary Center for Research in Psychoactive Substances at the University of Wisconsin Madison. Dr. Hutson shares his extensive knowledge and insights into the promising role o…

New Art and New Tox Trinkets. If you want to share your tox joy in the real world, find some trinkets here: https://www.etsy.com/shop/thepoisonlabBy Ryan Feldman

Mini episode- High-yield over view of Management of Acetaminophen Poisoning in the US and Canada Consensus Statement In this Ryan sits down with Dr. Richard Dart MD, PhD. He is the lead author of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, A…

This episode is a a high yield "just the facts" break down of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informe…

Dr. Frank Paloucek, PharmD, DABAT (@itsalltox) joins the show. He was one of the very first emergency medicine pharmacists and one of the original board-certified clinical toxicologists (DABAT). He is now a proudly retired professor emeritus at The Univeristy of Illinois at Chicago. In his tenure there he spent nearly 20 years as the program direct…

In this episode Ryan explores the concept of brain death and the implications of drug overdoses causing false positive diagnosis of brain death. He is joined by an author of the ACMT Position statement on brain death in overdose (Dr. Andrew Stolbach MD) as well as authors of two case reports (neuro critical care physician Dr. Ranier Reyes and emerg…

Dr. Adam Blumenberg, MD (@ABlumenbergMD) Join's the show. He is an emergency medicine physician, medical toxicologist, and Assistant Professor at Columbia University Medical Center in New York City. He hosts his own toxicology youtube series (www.ToxicHistory.com) and has developed multiple free medical education software programs in toxicology (ww…

Ready for a high-octane dose of knowledge? 🔥🧠 Ryan's got you covered with this electrifying mini-episode on managing a bupropion overdose! 💊💥 Beware - there are plenty of pitfalls you'll want to avoid. Check out the full episode and other mini-episodes for even more tips and tricks! 🎧👀 Bupropion is the #1 antidepressant cause of major (life threate…

What do bath salts, face eating zombies, and antidepressants have in common? In this episode Ryan has a number of guests (Dr Filip, Dr Olives, Dr Reyes) join to discuss a unique heart breaking poisoning that is now the number one cause of major life threatening effects in antidepressant overdose in the United States. Check out the mini episodes for…

Rohr 2004- Gap junction blockade can cause a wide QRS Vink 2004 Connexin 43 is the most important protein for connexon formation and cardiac signal transmission Callier 2012- Bupropion does not block sodium channels, and does exhibit similar effects on the cardiac action potential as known gap junction Burnham 2014 Bupropion has an IC50 for connexi…

TL;DR Your patient can seize 8-24 hours in, usually they have neurologic symptoms and tachycardia before hand Tachycardia may be masked by coingestions and symptoms may be very delayed Do not discharge a patient without discussing observation time with a toxicologist or poison center Do not dismiss tachycardia and anxiety as situational in a buprop…

All published abstracts can be found here Abstracts Category 1: Amlodipine Vasoplegia Abstract 1: Vasodilation in patients with calcium channel blocker poisoning treated with high dose insulin: a comparison of amlodipine versus non-dihydropyridines Study of HDI on propranolol poisoned pigs Study of Minnesota HDI protocol Abstract 2: Amlodipine anxi…

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 18By Ryan Feldman

Recent Healthcare poisoning in the news Nurse reportedly feeding children insulin (all information is uncomfirmed) and killing 7 neonates (not all insulin related) Anesthesiologist charged with murder for 2000 mcg fentanyl doses given during care in ICU Diethylene glycol and Ethylene glycol outbreak in Gambia Not talked about in the show but physic…

More on St Anthony's fire CDC MWR Study documenting increased poison center exposures (Dr. Graves & Dr. Liebelt) Phenibut case series from Dr. McCabe All published cases of phenibut withdrawal, reported baclofen regimens, clinical outcomes, multimodal therapies THEORETICAL UNTESTED Phenibut withdrawal treatment schema (Not tested, not intended as t…

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 16By Ryan Feldman

Case report Ryan Feldman wrote about himself Stump the Tox cases Case #1 Case #2 case series from Dr Jillian Theobald Case #3 Case #4 Ask drugs Fanconi syndrome in expired tetracyclineBy Ryan Feldman

Digoxin kinetics Amiodarone overdose Post market safety review Review of published exposures and severe outcomes from US poison center Case from the showBy Ryan Feldman

Send in your guesses to toxtalk1@gmail.comBy Ryan Feldman

Music from Pixabay Additional information on toxins from fatal poisoning cases Toxin 1 Toxin 2 Toxin 3 Toxin 4 Popper article referenced by Dr. GrellerBy Howard Greller

No episode today. Head here for the live radio show! Join us next show for Dr. Howard Greller of Sirius XM Doctor Radio, Dantastic Mr Tox & Howard, and Tox & Hound Find the article about the poison lab hereBy Ryan Feldman

Music in this episode from pixabay.com Intro Case report of hemolysis after sodium deoxycholate injection History Epidemiology ASPS stats Florida Unlicensed Activity Unit Cost of surgeon fee for buttock implant 2018 Recent new stories Botox and Bubbles grifter Quick bio on cases mentioned in show Common injection practices Feminizing body contourin…

Send in your guesses to toxtalk1@gmail.comBy Ryan Feldman

Research from Dr Farkas Additional information on toxins from Fatal poisoning cases Toxin 1 Toxin 2 Toxin 3 Toxin 4 "Toxicologist vs the internet" segment Cocaethylene review Benzodiazepine urine drug screening - Blog postBy Ryan Feldman

History Discovery of Ketamine Melamine outbreaks Clinical Effects Index cases Survey of Ketamine use prior to symptoms Mechanism/Treatment Mechanism/Treatment systematic review Rat modelsBy Ryan Feldman

What substance could cause these symptoms? Send your guesses to Toxtalk1@gmail.com to participate in episode 10!By Ryan Feldman

"Toxicologist vs the internet" segment Everythingisosm.com (Blog post) Biased Mu Receptor ligands Oliceridine mouse studies Opioid hearing loss (Blog post) Opioid hearing loss review Tox pupils (Blog post) Why tramadol is awful (Blog post) Additional information on toxins from Fatal poisoning cases Toxin 1 Toxin 2 Toxin 3 Toxin 4…

New york times article on delta 8 THC https://www.nytimes.com/2021/02/27/health/marijuana-hemp-delta-8-thc.html Studies of delta 8 THC in man Systematic review that summarizes single study https://pubmed.ncbi.nlm.nih.gov/29385080/ Actual study (may not be accessible) https://www.karger.com/Article/Abstract/136375 HPLCS-MS-MS delta 8 testing strateg…

Case from the show https://pubmed.ncbi.nlm.nih.gov/22163140/ Mithradates https://www.wemjournal.org/article/S1080-6032(11)00043-3/pdf Case series on mad honey effects https://pubmed.ncbi.nlm.nih.gov/20575670/ Blog post on sodium channel openers https://emcrit.org/toxhound/ff-plant-sodium-channel-openers/…

Things from the show! Ketamine for depression, patient experience blog https://humanparts.medium.com/30-years-of-depression-gone-3dffafabc7cf?fbclid=IwAR1gh08Kn3uSczlKbvMH54yjkWILzyA_6O3Y82q4hVqcAr3shozxwegCnmg Fasoracetam https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770454/#CR14 Kava Hepatic injury- https://pubmed.ncbi.nlm.nih.gov/15114493/ Anti …

Quick review Toxic dose Chloroquine >5g severe toxicity is expected (toxicity may develop below this) HCQ less well defind Clinical effects Seizures (sodium channel blockade) Arrhythmia (sodium channel blockade) Hypotension (Alpha blockade) Hypokalemia Management Activated Charcoal if awake and alert and no risk of emesis Early invasive supportive …

Historical perspective on use of cinchona bark powder for malaria https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973170/ Evolutionarily pressure of malaria on beta thalassemia (sickle sell) traits https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499995/ Cinchonism Classic toxicities causes by ingestion of quinoline derivatives found in the bark of the …

Article authored by Ryan and Matt regarding potential toxicity of vitamin e acetate in THC vape cartridges https://pubmed.ncbi.nlm.nih.gov/32451600/ https://pubmed.ncbi.nlm.nih.gov/33528766/ News article about the man arrested 1 floor below our Host where co-author of above paper is quouted. for selling vape cartridges https://www.jsonline.com/stor…

Great review of potential torsades mechanisms based off experimental data- https://www.sciencedirect.com/science/article/pii/S1880427611800050By Ryan Feldman

Action potential Sodium/Potassium ATPase pumps create more positively charged ions outside the cell than inside the cell, this creates a relative negative charge in the cell Phase 4- Resting (~ -90 mv) Phase 0- Sodium enters the cell (+10 mv) Phase 1- Potassium efflux from cell as now there is no negative charge holding it in (0 mv) Phase 2- Calciu…

Buying as much loperamide as you possibly can Loperamide history 1969- Synthesized (1) 1976 FDA Approved as schedule V (2) Jaffe trial of "abuse potential"- https://pubmed.ncbi.nlm.nih.gov/7438696/ 1982- Descheduled (3) 2010-Annually Increasing in # of poison center calls, cases of arrhythmia and hospitalization (4,5,6) 2016- Submission to DEA for …

Case report from beginning of show https://pediatrics.aappublications.org/content/130/6/e1700 "One Pill Can Kill Resources" http://missouripoisoncenter.org/wp-content/uploads/2015/02/2011-One-Pill-Can-Kill.pdf https://pubmed.ncbi.nlm.nih.gov/16419734/ https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Poison-P…

Excellent review of sources, clinical effects, and management Calello DP, Henretig FM. Lead. In: Goldfrank's Toxicologic Emergencies, 10th ed, Hoffman RS, Howland MA, Lewin NA, et al (Eds), McGraw Hill Education, New York 2015. p.1219. Toxic substances database for lead https://www.atsdr.cdc.gov/toxprofiles/tp.asp?id=96&tid=22 Clinical Case from to…

Concepts in this episode testing our tests Sensitivity: Rate of Positive test in those who have the disease Specificity: Rate of negative test in those without the disease Positive predictive value: True positive/ True Positive + False Positive Negative predictive value: True negative/True negative + False negative (PK) Bioavailablity = Amount of d…

Ryan and Toxo talk about the the history of a commonly used disinfectant. They break down the many ways it can cause harm if not used appropriately, including creating chemical weapons and turning you... Key points Bleach mixed with various chemicals can make many toxic substances Bleach + acid= chlorine gas Bartholette original Cl2 + H2O ⇄ HCl + H…

Ryan and Toxo introduce their roles while explaining the current state of toxicology and what exactly a poison is. Information about medical and clinical toxicology can be found at American Academy of Clinical Toxicology (AACT)- clintox.org American College of Medical Toxicology (ACMT)- acmt.netBy Ryan Feldman