Welcome back to The Tox Lab! We are kicking off 2026 by exploring drugs that disrupt metabolism and the consequences that can follow.

In this episode, we focus on compounds that alter glucose metabolism and the interplay between toxicology and biochemistry. We discuss a fatal case of metformin toxicity and the analytical and interpretive challenges involved in recognising this diagnosis.

We then turn to amphetamine-like weight loss drugs, examining the risks they pose to individuals with diabetes and the evidence linking methamphetamine use to an increased risk of fatal diabetic ketoacidosis. Finally, we explore a case involving SGLT2 inhibitor therapy and unexpected positive urine ethanol results, highlighting the importance of pre-analytical factors and careful interpretation in toxicology.

Join us as we unpack how drugs can interfere with metabolic pathways, why these effects matter clinically, and what toxicologists need to consider when metabolism goes wrong.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/pii/S037907382500324X

https://onlinelibrary.wiley.com/doi/10.1155/2015/917869

https://journals.sagepub.com/doi/10.1177/00258024211020936?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

https://www.nejm.org/doi/full/10.1056/NEJMc2313463

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re closing out the year with a festive twist as we explore the link between marzipan, bitter almonds, and cyanide.

We take a closer look at the chemistry linking cyanide to almonds and discuss a case of intentional bitter almond ingestion. We then turn to National Poisons Information Service data to examine patterns of cyanide exposure, clinical outcomes, and the antidotes used in management.

To round off the episode, we dip into the archives with a historical case report describing thallium poisoning linked to contaminated marzipan, reminding us that even festive treats can carry hidden toxicological risks.

Join us for a seasonal deep dive into poisons, cases, and chemistry as we wrap up the year on a sweet but slightly sinister note.

Hope you enjoy!

We're taking a little break over the festive season but will be back with a brand new episode on the 5th January!

Links to the papers we discussed:

https://onlinelibrary.wiley.com/doi/10.1002/ccr3.8418

https://www.tandfonline.com/doi/full/10.1080/15563650.2022.2080074

https://www.tandfonline.com/doi/abs/10.3109/15563659409017979

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at serotonin and its intriguing role in both depression and epilepsy.

We review recent data examining the seizure risk associated with different classes of antidepressants and what this means for clinical decision making. We then explore a case report in which sertraline, an SSRI, appeared to have an anti-seizure effect, challenging some long-held assumptions. Finally, we discuss emerging evidence on the potential use of serotonergic therapies in epilepsy management and even in reducing the risk of SUDEP.

Join us as we unravel the complex relationship between serotonin, antidepressants, and seizure disorders, and what this evolving evidence could mean for patient care.

Hope you enjoy!

Links to the papers we discussed:

https://www.sciencedirect.com/science/article/pii/S0165032725005853?via%3Dihub

https://www.seizure-journal.com/article/S1059-1311(20)30145-X/fulltext

https://pmc.ncbi.nlm.nih.gov/articles/PMC8478129/

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we are examining the growing evidence around cannabis and cardiovascular risk.

We start with a recent systematic review and meta-analysis that explores whether cannabis use is linked to higher rates of cardiovascular disease. We break down the strength of the data and discuss what the current evidence can and cannot tell us.

We then move onto research investigating how THC and its metabolites affect cardiac myocyte structure and function. These findings offer a possible mechanistic explanation for cardiac dysregulation and may help connect population-level associations with cellular effects.

Join us as we unpack the toxicology, the uncertainties, and what this emerging research means for clinicians, researchers, and anyone interested in the evolving science of cannabis and heart health.

Hope you enjoy!

Links to the papers we discussed:

https://heart.bmj.com/content/111/22/1047.long

https://www.ahajournals.org/doi/10.1161/JAHA.123.030178

https://pmc.ncbi.nlm.nih.gov/articles/PMC8835806/pdf/ijms-23-01401.pdf

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re diving into the emerging world of “space oil”, the anesthetic drug etomidate, which has begun appearing in the recreational drug supply across parts of Asia and beyond.

We explore several cases involving etomidate vaping, where repeated exposure led to adrenal insufficiency due to its potent inhibition of 11β-hydroxylase. We also discuss a fatal ingestion case, highlighting just how dangerous this drug can become when used outside controlled medical settings.

Etomidate’s presence isn’t limited to Asia: it has recently been detected alongside fentanyl in Philadelphia and identified in a handful of UK seizures, raising important questions about its evolving role in the illicit drug market. With emerging analogues starting to surface, the landscape may become even more complex.

Join us as we unpack the pharmacology, the clinical consequences, and why etomidate is now a substance toxicologists are watching closely.

Hope you enjoy!

Links to the papers we discussed:

https://www.hkmj.org/system/files/hkmj2412244.pdf

https://link.springer.com/article/10.1007/s12024-024-00813-8

https://hip.phila.gov/document/4686/PDPH-HAN-429U-Etomidate-08.12.2024-1.pdf/

https://www.gov.uk/government/publications/acmd-review-of-the-evidence-on-the-use-and-harms-of-etomidate

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re taking a closer look at organophosphates, a diverse group of compounds used everywhere from agriculture to chemical warfare.

We walk through two real-world poisoning cases: an accidental exposure from a head lice treatment and an intentional ingestion of phorate, illustrating just how wide the spectrum of organophosphate toxicity can be. Along the way, we break down their mechanism of action, why their effects can be so severe, and the key treatment approaches clinicians depend on.

We also revisit the Salisbury poisonings, exploring the devastating impact of organophosphate nerve agents and the wider implications for public health and emergency response.

Join us as we unpack the chemistry, the clinical realities, and the far-reaching consequences of these powerful compounds.

Hope you enjoy!

Links to the papers we discussed:

https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf096/8300174?redirectedFrom=fulltext

https://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1581362/full

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re exploring a series of fascinating and unusual poisoning cases, each with its own toxic twist.

From hair straightening treatments and bearded fireworms to midodrine, isotocyanozene, and sodium azide, we discuss the mechanisms, clinical presentations, and toxicological challenges behind each case.

Join us as we unpack what these cases reveal about the diverse and sometimes surprising ways that chemicals and compounds can cause harm.

Hope you enjoy!

Links to the papers we discussed:

https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2577706?src=

https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2541702

https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2546073

https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2528995

https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2528990

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re turning our attention inward to errors in toxicology.

From calibration and maintenance mistakes to reporting issues and even instances of fraud, we unpack how things can go wrong in the analytical process and what that means for the credibility of our field.

We explore the real-world consequences of these errors and most importantly, what we can learn from them to strengthen toxicology as a discipline.

Join us for a candid look at accuracy, accountability, and the human side of science.

Hope you enjoy!

Link to the paper we discussed:

https://www.sciencedirect.com/science/article/pii/S2589871X25000580

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re discussing brorphine — a novel synthetic opioid that briefly appeared on the drug market around 2020.

We explore its emergence and pharmacology, including data on its activity at the µ-opioid receptor. We also discuss one of the few documented case studies describing an individual presenting for detoxification following brorphine use. Finally, we review recent research examining its in vitro and in vivo metabolites, highlighting how these findings may offer new ways to detect this short-lived substance.

Although brorphine is now under international control, could other “orphine” analogues step into the spotlight, potentially replacing nitazenes as the next wave of synthetic opioids?

Join us as we unpack the chemistry, the risks, and what the story of brorphine reveals about the constantly shifting landscape of synthetic opioids.

Hope you enjoy!

Links to the papers we discussed:

https://academic.oup.com/jat/article-abstract/44/9/937/5879253?login=false

https://www.sciencedirect.com/science/article/abs/pii/S0379073821003091?via%3Dihub

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]

This week on The Tox Lab, we’re celebrating our 50th episode — and one whole year of toxicology talk! 🎉

Join us as we look back on some of our most memorable moments from the past year, revisit a few topics with new updates, and share what’s next for The Tox Lab.

Whether you’ve been here since episode one or you’re just joining us, thank you for being part of our growing community of toxicologists, scientists, and curious listeners. Here’s to another year of exploring the science behind the substances!

Hope you enjoy!

Link to ketamine paper we mentioned:

https://journals.sagepub.com/doi/10.1177/02698811251373058

Disclaimer: All opinions are our own.

Find us on instagram: @the_tox_lab

Email us here: [email protected]