Dr. Joshua Trebach, MD (@jtrebach) joins the show for some toxic sleuthing of fishy poisonings and answers questions from reddit.com/r/askdrugs.

• 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 tetracycline

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In this episode Ryan and Toxo dive into a widely available prescription poison with a frightening ability to cause rapid neurologic and cardiovascular decline, and the best part, it looks like candy!

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

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Send in your guesses to [email protected]

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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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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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