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Dr. Howard Greller, MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound) joins the show. A FANTASTIC episode complete with toxic sleuthing of fatal poisoning cases and answering questions from reddit.com/r/askdrugs.

Music from Pixabay

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

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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 here 

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In this episode Ryan and Toxo dissect the fascinating underbelly of illegal cosmetic procedures and breakdown the toxicities that arise from them.

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 contouring (pumping parties)
• Synthol muscles
• Capsule face cosmetics

Toxicity

• Infection
• Self explanatory

Filler embolism

• Review 1, Review 2, Review 3
• Filler lodges in pulmonary vasculature->clotting, bleeding, inflammation
• 95% occur within 72 hours
• Primarily respiratory symptoms (cough/hypoxemia)
• Chest x ray ground glass opacity
• Treat with supportive care (oxygen all the way through ECMO) +/- steroids
• Filler Blindness
• CRAO from body filler
• No effective treatment (exception, can use hyaluronidase if filler is hyaluronic acid)

Granuloma

• Inflammatory nodules from prolonged filler exposure
• May occur months to year after injection
• Illegal cosmetic= frequently lipogranuloma due to oil being present in many illegal cosmetic
• Granulomatous hypercalcemia
• Excess calcitriol production from ganuloma causes hyperCA
• Can be extremely delayed (up to 28 years)
• Recurrence up to 45%
• Treat with standard therapies (fluid, bisphosphonate) + steroids and/or ketoconazole to turn down granuloma CYP27B1 calcitriol production

Case from the show

• Some details changed for educational purposes

Music in this episode from pixabay.com

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Send in your guesses to [email protected]

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In this episode of toxicologist vs internet guest Dr. Andrew Farkas, MD joins the show. This a great episode that covers everything from the drugs you would need in the apocalypse to what to worry about if your cats are dying. Complete with toxic sleuthing of fatal poisoning cases and answering questions from reddit.com/r/askdrugs.

• 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 post

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In this episode Ryan and Toxo take a closer look at ketamine induced irreversible bladder damage.

History

• Discovery of Ketamine
• Melamine outbreaks

Clinical Effects

• Index cases
• Survey of Ketamine use prior to symptoms

Mechanism/Treatment

• Mechanism/Treatment systematic review
• Rat models

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What substance could cause these symptoms? Send your guesses to [email protected] to participate in episode 10!

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In this episode of toxicologist vs the internet Ryan Is joined by special guest Dr. Justin Corcoran, MD an emergency medicine physician and medical toxicologist. They take turns answering questions from reddit.com/r/askdrugs (the internet, really, really needs a toxicologist) and challenge each others toxic sleuthing by presenting cases of poisoning and allowing the other to determine the toxin responsible.

"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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Ryan and Toxo dive in to Delta 8 THC, a new (maybe?) legal drug sweeping the U.S.

• Comprehensive article on Delta-8 THC, its growing popularity, and concerns: https://www.nytimes.com/2021/02/27/health/marijuana-hemp-delta-8-thc.html

1. Systematic Review:
2. Summarizes findings from a single key study on Delta-8 THC. https://pubmed.ncbi.nlm.nih.gov/29385080/
3. Original Study (may not be accessible):
4. Investigates Delta-8 THC effects in humans.
5. https://www.karger.com/Article/Abstract/136375

• HPLC-MS/MS Strategies:
• Analytical methods for testing Delta-8 THC.
• https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaa184/6018445?redirectedFrom=fulltext

• Mechanism of Action:
• Study exploring how Delta-8 THC binds to cannabinoid receptors.
• https://pubmed.ncbi.nlm.nih.gov/27398024/

If you’re interested in learning more or exploring the impact of Delta-8 THC, these resources provide a great starting point. Thank you for listening!

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