A show about poisoning from those who treat poisoning. Join your hosts, Clinical Toxicologist Ryan (@EMPoisonPharmD) and Robo-Toxicologist Toxo (@LabPoison) as they discuss the history, science, and medical management of the infinite poisons the world has to offer! Episodes, med videos, games and more at thepoisonlab.com
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Send in Your Questions For "Ask a Toxicologist"
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Have a burning question you have always wanted to ask a toxicologist? What are tips for managing an anticholinergic overdose? What is the deadliest poison? Why are they called lead pencils if there is no lead?! Send your questions in to toxtalk1@gmail.com to take part in a future episode! (If you would like to be anonymous simply state it in the em…
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Episode #31- Open and Shut (Mystery case 31) with Guests Dr. Dan McCabe and Dr. Crissy Lawson
1:42:35
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In this episode Ryan is joined by two expert guests to help read listener guesses for the cause of this poisoning murder and shed light on the toxin involved in the case, which puzzled medicolegal investigators. Ryan is joined by Dr. Dan McCabe, MD (emergency medicine physician, medical toxicologist, medical director of Iowa poison center) and Dr. …
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The Poison Lab - Stump The Toxicologist Reel 2023
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In this bonus episode Ryan highlights some of the great episodes done in 2023 and compiles ALL of the stump the toxicologist segments from 2023 into one easy to consume episode. Test your toxicology differential skills with more than six poisoning cases. Check out the actual episodes for more information in the show notes on each of the poisonings.…
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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
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Where is Episode #31 and Bonus Episodes- Ryan Joins "The Larry Meiller Radio Show" and The "EMS2020" Podcast
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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
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Episode #30- Bromazolam, Etonitazene, and Carfentanil Walk into a Bar – Trends in Novel Illicit Drugs with Dr. Alex Krotulski
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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 …
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Episode #29- Inefficient Heat (Mystery Case 29) & Toxicologists vs The internet with Dr. Ann Arens
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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…
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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
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Episode #28- A very NACCT Holiday- High Yield Abstract Review 2023 North American Congress of Clinical Toxicology
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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 …
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Episode #26-APAPalooza. A North American Congress of Clinical Toxicology 2023 Acetaminophen Research Highlight
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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…
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Episode #25-AHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity Guidelines with Co-Author Dr. Eric Lavonas MD
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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…
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High Yield Highlight- 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning
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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…
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Episode #24- The Poison Lab Does Psilocybin- A Deep Dive with Psilocybin Research Pharmacist Dr. Paul Hutson
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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…
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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
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Episode #23- Acetaminophen Poisoning Management: US & Canada Consensus Statement with Co-Author Dr. Richard Dart, MD, PhD
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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…
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High Yield Highlight-Consensus Statement on Management of Acetaminophen Poisoning in the US and Canada
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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…
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Episode #22- Toxicologists vs the Internet (#9) With Guest Dr Frank Paloucek PharmD DABAT FAACT
1:28:32
1:28:32
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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…
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Episode# 21- The Undead Patient: The Complexity of Brain Death Determination in Drug Overdose
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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…
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Episode #20- Toxicologists vs the Internet (#8) With Guest Dr Adam Blumenberg MD
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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…
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High yield highlight- Managing a Bupropion overdose
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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…
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Episode #19- A Prescription for Heartache (& Seizures) (Bupropion)
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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…
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Mini Episode: Bridging the Gap- Bupropion's not your average wide QRS with Dr. Travis Olives
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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…
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Mini Episode: Who Seizes in Bupropion Overdose with Dr Ari Filip MD
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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…
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2022 North American Congress of Clinical Toxicology (NACCT) High Yield Abstract Review
1:27:46
1:27:46
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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…
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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
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Episode #17- Toxicologists vs the Internet (#7) With Guest Dr Emily Kiernan DO
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1:25:40
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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…
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Episode #16- Phenibut. The emerging drug you don’t know about (yet)
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1:04:56
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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…
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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
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Episode #15- Toxicologists vs the Internet (#6) With Guest Dr Joshua Trebach MD
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1:16:02
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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
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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
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Case Teaser Episode 14- Fast and Fatalurious
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Send in your guesses to toxtalk1@gmail.comBy Ryan Feldman
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Episode #13- Toxicologists vs the Internet (#5) With Guest Dr Howard Greller MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound)
1:21:49
1:21:49
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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
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Where is Episode 13 ? Bonus Episodes AND Next Episode Guest Dr. Howard Greller MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound),
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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
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Episode #12- Lethal Buttock Injection (And Other Toxicities of Illegal Cosmetic Body Fillers)
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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…
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Case Teaser Episode 12- CHALLENGING case of hypercalcemia
1:21
1:21
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Send in your guesses to toxtalk1@gmail.comBy Ryan Feldman
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Episode #11- Toxicologists vs the Internet (#4) With Guest Dr Andrew Farkas MD
1:03:05
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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
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Episode #10- You Left Your Bladder in The K-Hole?
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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
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Case Teaser Episode 10: How to lose a bladder in 10 months
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1:33
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What substance could cause these symptoms? Send your guesses to Toxtalk1@gmail.com to participate in episode 10!By Ryan Feldman
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Episode #9- Toxicologists vs the Internet (#3) With Guest Dr Justin Corcoran MD
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"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…
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Mini Episode: Setting The Record Straight on Delta 8 (THC)
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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…
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Episode #8- More Bitter than Sweet (Mad Honey and Grayanotoxin)
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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/…
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Episode #7- Toxicologists vs the Internet (#2) With Guest Dr Jillian Theobald MD, PHD
1:15:37
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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 …
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Mini Episode: Managing Crashing Hydroxychloroquine/Chloroquine OD
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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 …
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Episode #6- Barking Up the Wrong Tree (Cinohonism, Quinine & Quinidine)
1:06:57
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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 …
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Episode #5- Toxicologists vs The Internet (#1) With Guest Dr. Matthew Stanton PharmD, DABAT
1:07:32
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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…
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Mini episode: Early After Depolarizations and Experimental Mechanisms of Torsades
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Great review of potential torsades mechanisms based off experimental data- https://www.sciencedirect.com/science/article/pii/S1880427611800050By Ryan Feldman
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Mini Episode: The Saga of the Cardiac Action Potential
15:27
15:27
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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…
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Episode #4- The Rise of Lethal Loperamide
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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 …
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Episode #3- Toddler Time Bombs (Poison Center Triage)
1:07:24
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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…
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Episode #2- The Other Problem With Bullets (Lead and Lead Poisoning from Bullets)
1:10:40
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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…
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