- Written by Ethan Abbott
Toxicology Literature of Note
This letter to the editor describes an experience with a false positive phencyclidine (PCP) screen caused by metronidazole. Although we do not have PCP screens on our UDS at SBH, it is important to recall that the UDS is a screen with many false positives and negatives. The UDS also cannot be utilized to confirm intoxication with a substance, rather it can show a potential exposure. Always look at the clinical scenario, and when in doubt call Tox!
An interesting look at the use of GI decontamination (activated charcoal) and antidotes in the ED and if there is a difference in regards to the race and ethnicity of the patient. There are multiple studies in the ED literature on racial disparities, but this is the first to look at the toxicology field in particular.
This study looks at the use of IM haloperidol, midazolam, ziprasidone and olanzapine in agitated delirium. We are all very familiar with this entity and the paper actually uses a smaller dose of midazolam than we usually do. Although we do not have ziprasidone and olanzapine on formulary, you may encounter these drugs as you rotate through or move to other EDs.
Toxicology in the News
Contamination of ethanol with methanol and other toxic alcohols occurs sporadically, and has been seen to occur in Cambodia, Kenya and India. These outbreaks can overrun an already strained hospital system in these countries. Although not the same, Canada recently recalled bottles of Gin that were not properly diluted. This lead to the alcohol content being twice what was claimed on the bottle. Thankfully, no reported illness or fatalities have been discovered related to this error.
CBD and “medical marijuana” are some hot topics in medicine and toxicology, with new regulations and studies coming out on the possible benefits of this therapy. Unfortunately in Utah, over 50 people became ill after being exposure to a “CBD oil”, which actually contained 0%CBD! It was purchased from head shops illustrating that, just as with supplements, the FDA does not regulate what is actually in the product being sold.
Although we do not often come into contact with snakes in the concrete jungle that is NYC, it is worth knowing that just because you chop off it’s head, does not mean you can’t be envenomated!
FYI, Jacobi is our snake bite center. – Still call Tox though . . .
Toxicology Toxin of the Month
This month I wanted to direct everyone to go The Tox & The Hound, and take a look at the amazing piece on bupropion (“Illbutrin”) by Dr. Dan Rusyniak. . . co-host of the podcast “The Dantastic Mr. Tox & Howard” with someone else you might know . . .
Just a little taste . . .
So why do I hate this drug? But before I go there, a brief digression. It is important that everyone reading this understands that I am writing from an odd perch. My perspective is skewed, as if I borrowed someone else’s glasses. As a medical toxicologist, I only see the problems drugs cause. No one is calling up the poison center and telling the specialist “hey, guess what, I’m taking Xyban™ and I haven’t smoked in 7 months!” When you work at Midas™, all mufflers are broken. Ok, back to why I don’t like this drug. First, let’s look at its structure (it is a tox blog, of course there are structures) . . .