The Poison Lab

In this exciting live episode from the 2024 North American Congress of Clinical Toxicology (NACCT) in Denver, Ryan dives into 12 of the most impactful research abstracts presented at the conference directly with the authors themselves. Covering a wide range of toxicology topics—from the NACSTOP2 trial on acetaminophen overdose, ECG intervals, cannabis toxicity in young children, and more—each guest breaks down their study’s findings and clinical relevance. If you missed the conference or want a deeper understanding of the year's most important toxicology research, this episode is for you. Check the show notes for links to the published abstracts, the full list of studies discussed, and time stamps for where you can find those studies.

Link to published abstract manuscript

Abstracts

07:48-Abstract #1. The NACSTOP2 trial: a multi-center randomized controlled trial investigating the early cessation of n-acetylcysteine in acetaminophen overdose

• Guest- Dr. Anslem Wong, MD, PhD

21:33- Abstract #36. ECG intervals: does one size really fit all?

• Guest- Dr. Caitlin Roake, MD, PhD

25:41- Abstract #85. Do abnormal electrocardiographic intervals predict death in poisoned patients older than 65 years?

• Guest- Dr. Michael Chary, MD

30:06- Abstract #61. Minimum tetrahydrocannabinol dose that produces severe symptoms in children <6 years old with cannabis edible ingestions

• Guest- Dr. Keahi Horowitz, MD

36:25- Abstract #114. Frequency and severity of cannabis toxicity before and after legislative change to increase cannabis edible package size

• Guest- Dr. Robert Hendrickson, MD

38:24- Abstract #101. Quantification of acetaminophen line-crossers in the setting o f overdose with delayed gastric absorption

• Guest- Dr. Jamie Sterr, PharmD

41:41- Abstract #175. Cause for pause: bradycardia induced by transdermal rivastigmine in anticholinergic delirium

• Guest- Dr. Santiago Batista Minaya, MD

46:21- Abstract #199. Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) Syndrome with poor neurological outcome in the setting of suspected opioid use

• Guest- Jack Yang and Dr. Avery Michienzi, DO

49:49- 191. Severity scores for caustic injury: Zargar they even used?

• Guest- Dr. Amar Chakrabortya, MD

53:!2- Abstract #9. Disparity in immune-mediated reactions to Crotalidae polyvalent immune fab (ovine) and Crotalidae immune F(ab’)2 [equine] in alpha-gal endemic regions and alpha-gal sensitized adults

• Guest- Dr. Ari Filip, MD

59:10- Abstract # 26. Acute propranolol overdose and dose thresholds of severe toxicity

• Guest- Dr. Katherine Isoardi, MBBS

1:06:05- 28. Risk of serotonin toxicity following acute lamotrigine overdose

• Guest- Dr. Angela Chiew, MBBS, PhD (Introduction at 1:00:00)

1:12:36- Interview with AACT President Elect

• Guest- Dr. Jillian Theobald, MD, PhD

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In this episode the poison lab hosts scientific discourse . Three listeners (Dr. Michael Mullins, Dr. Donna Seger, and Dr. Leon Gussow) write in their critiques surrounding specific recommendations and language used with the AHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity guidelines. Lead author of the guidelines Dr. Eric Lavonas then responds to and addresses their points with counterpoints or appraisals. Tune in and draw your own conclusions!

• Link to guidelines
• Link to high yield review

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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 [email protected] to take part in a future episode! (If you would like to be anonymous simply state it in the email)

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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. Crissy Lawson PharmD (emergency medicine pharmacist).

• SPOLIER ALERT
• Mystery case from the show
• Review Paper from Dr's Lawson, McCabe, and Feldman (PMID: 38613376)
• Toxo's show note references

1. TV special about Mary Yoder colchicine murder
2. Colchicine potential arrhythmic effects
3. Go fund me for Dr. Betty Bowman

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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.

• Frank Paloucek Episode
• Adam Blumenberg Episode

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Do you think you know the cause of these symptoms? Send your guesses to [email protected] to take part in the next episode 

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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 homepage
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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 places around the Center for Forensic Science Research and Education quarterly report on Novel Psychoactive Substances found in patients and drug products.

The episode starts with a discussion of the novel benzodiazepines market, highlighting bromazolam and how long it may remain in the market. Then they discuss the opioids highlighting where we are seeing carfentanil, what is happening with Para Fluorofentanyl, and other super potent opioids emergening (such as N -pyrrolidino etonitazene). After a quick discussion of synthetic cathinone's and PCP/ketamine derivatives they jump to synthetic cannabinoids, examining the history of brodifacoum contamination and how regulation has led to market changes.

1. Resources
2. https://www.cfsre.org/
3. Quarterly report discussed on this episode
4. More on Dr. Krotulski
5. Poster from Dr. Kortulksi on naming conventions for NPS
6. Time stamps to jump to any portion of the episode you want to revisit
7. Introduction-5:00-32:50

• 06:30-25:16- Discussion CSFRE mission, history of NPS reports, and other available reports
• 25:14- "Miscellaneous drugs: Furanyl UF17, medetomidine"
• 28:15- Difference between GC/MS and LCqTOF

1. Novel Benzodiazepines- 32:50
2. Novel Opioids-43:00
3. Stimulants and hallucinogens- 1:01:43
4. Synthetic cannabinoids- 1:07:40
5. Novel psychedelics markets, hemp products, phenibut, tianeptine, and kratom-1:25:12

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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 case.

• Case report for mystery case
• Review paper cited by Dr. Arens
• Interview with DNP user by Chubby Emu
• Case 1
• Some also contain CALCIUM NITRATE and can cause methemoglobinemia
• Case 2
• Case 3

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The GOTTA PICCEM Poisonous Mushroom Game!

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Do you think you know the cause of these symptoms? Send your guesses to [email protected] to take part in episode 29

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The GOTTA PICCEM Poisonous Mushroom Game!

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