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Meng H, Chen Z, Chen L, Tang W, He F, Yan X, Lin X, Se X, Xie M, Li Z, Lu L, Yu X. An outbreak of Amanita exitialis poisoning. Clin Toxicol (Phila) 2023; 61:270-275. [PMID: 36919497 DOI: 10.1080/15563650.2022.2159830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The mushroom Amanita exitialis is reported to cause acute liver injury. It is found in Southern China, and has been previously associated with a high incidence of mortality. METHODS We described a series of 10 patients with Amanita exitialis poisoning admitted to The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) in April 2022. Patient demographics, clinical features, laboratory results, therapeutic interventions, and outcome data were collected. RESULTS Among the 10 patients, 9 survived, while 1 died. Gastrointestinal symptoms were the first to appear (average latency period, 11 ± 4.2 h). Diarrhea was the most common clinical symptom (average duration, 4.4 days). Abdominal distention was an important sign, especially in severely-ill patients. Thrombocytopenia occurred on day 2 after mushroom ingestion and persisted for 3-4 days. Alanine aminotransferase and total bilirubin peaked on days 2-3. CONCLUSION Amanita exitialis poisoning is characterized by gastrointestinal symptoms and liver injury. In the patient who died, acute hepatic failure led to hepatic encephalopathy and cerebral edema. Abdominal distension accompanied by thrombocytopenia was common in critically ill patients in this outbreak.
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Affiliation(s)
- Hui Meng
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - ZhaoYin Chen
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - LanChun Chen
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - WeiXin Tang
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - Fang He
- Department of Health Management, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - XianRang Yan
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - XiaoHong Lin
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - XiaoLong Se
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - MingFei Xie
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - ZhanHan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - LiJuan Lu
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
| | - Xuetao Yu
- Department of Critical Care Medicine, The Second Affiliated Hospital of the Chinese University of Hong Kong (Shenzhen) (Longgang District People's Hospital of Shenzhen), Shenzhen, China
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Comstock G, Kaiser S, Heard K, Wang GS. Significance of temperature in antimuscarinic toxicity: a case-control study. Clin Toxicol (Phila) 2022; 60:1070-1072. [PMID: 35735006 DOI: 10.1080/15563650.2022.2088378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Antimuscarinic toxicity can result in temperature dysregulation, but the clinical significance of this is unclear. The objective of this study was to compare peak temperatures between antimuscarinic patients with and without severe clinical outcomes. METHODS This was a case-control analysis at two large, urban, academic medical centers from January 1, 2016, through December 31, 2021. We compared peak temperature (Tmax) amongst antimuscarinic patients who experienced severe outcomes with those who did not. Severe outcome was defined as seizure, ventricular dysrhythmia, hypotension, or intubation. RESULTS Fifty-six patients met inclusion criteria of which 23 developed severe outcomes: 16 seizures, 9 cases with hypotension, 5 intubations, and 2 ventricular dysrhythmias. Tmax amongst all patients ranged from 36.4-39.2 °C. There were no fatalities. There was no difference in Tmax in the emergency department or throughout hospitalization between groups, and Tmax was not predictive for the development of severe outcomes. DISCUSSION Maximum temperatures did not differ between patients with and without severe outcomes in the setting of antimuscarinic toxicity, and temperature was poorly predictive of outcomes. Our findings suggest that mild temperature dysregulation in antimuscarinic toxicity is not a key prognostic indicator for severe outcome. Further study is needed to assess implication of severe hyperthermia.
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Affiliation(s)
| | - Sasha Kaiser
- Rocky Mountain Poison and Drug Safety, Denver, CO, USA
| | - Kennon Heard
- Emergency Medicine, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
| | - George Sam Wang
- Emergency Medicine, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
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Scarfone KM, Maghsoudi N, McDonald K, Thompson H, Stefan C, Beriault DR, Werb D, Bowles JM. Emerging synthetic cannabinoids detected by a drug checking service in Toronto, Canada. Clin Toxicol (Phila) 2022; 60:979-984. [PMID: 35546568 DOI: 10.1080/15563650.2022.2069575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Toronto's Drug Checking Service (DCS) provides people who use drugs with information on the chemical composition of their substances and conducts real-time monitoring of the unregulated drug supply. Presented are first known data of three newly detected synthetic cannabinoids (SCs) in Toronto, Ontario. METHODS The present data are from samples analyzed between April and November 2020. Samples were collected at partnering harm reduction agencies in Toronto and analyzed using gas or liquid chromatography-mass spectrometry. An intake survey queried about the sample characteristics on submission, including expected drug(s). RESULTS Samples were analyzed between 1 April and 20 November 2020 (N = 19), which marks the period immediately following imposed COVID-19 border and movement restrictions in Canada. The newly detected, unexpected SCs were ACHMINACA (n = 15), AB-FUBINACA (n = 3), and 4-fluoro-MDMB-BUTINACA (n = 1). Fentanyl was expected in 74% (n = 14). Most SCs were detected in samples containing fentanyl or related analogues (n = 18; 95%), or benzodiazepine-related drugs (i.e., etizolam and flualprazolam) (n = 15; 79%). CONCLUSIONS This information can inform overdose prevention efforts and drug market monitoring of SCs in Toronto and regions served by the same drug trafficking routes. The detection of SCs during a period marked by COVID-19-related restrictions can contribute to efforts to identify global drug market trends during this time.
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Affiliation(s)
- K M Scarfone
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - N Maghsoudi
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - K McDonald
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - H Thompson
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - C Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Canada
| | - D R Beriault
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - D Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - J M Bowles
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Jang DH, Piel S, Greenwood JC, Kelly M, Mazandi VM, Ranganathan A, Lin Y, Starr J, Hallowell T, Shofer FS, Baker WB, Lafontant A, Andersen K, Ehinger JK, Kilbaugh TJ. Alterations in cerebral and cardiac mitochondrial function in a porcine model of acute carbon monoxide poisoning. Clin Toxicol (Phila) 2021; 59:801-809. [PMID: 33529085 DOI: 10.1080/15563650.2020.1870691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study is the development of a porcine model of carbon monoxide (CO) poisoning to investigate alterations in brain and heart mitochondrial function. DESIGN Two group large animal model of CO poisoning. SETTING Laboratory. SUBJECTS Ten swine were divided into two groups: Control (n = 4) and CO (n = 6). INTERVENTIONS Administration of a low dose of CO at 200 ppm to the CO group over 90 min followed by 30 min of re-oxygenation at room air. The Control group received room air for 120 min. MEASUREMENTS Non-invasive optical monitoring was used to measure cerebral blood flow and oxygenation. Cerebral microdialysis was performed to obtain semi real time measurements of cerebral metabolic status. At the end of the exposure, both fresh brain (cortical and hippocampal tissue) and heart (apical tissue) were immediately harvested to measure mitochondrial respiration and reactive oxygen species (ROS) generation and blood was collected to assess plasma cytokine concentrations. MAIN RESULTS Animals in the CO group showed significantly decreased Complex IV-linked mitochondrial respiration in hippocampal and apical heart tissue but not cortical tissue. There also was a significant increase in mitochondrial ROS generation across all measured tissue types. The CO group showed a significantly higher cerebral lactate-to-pyruvate ratio. Both IL-8 and TNFα were significantly increased in the CO group compared with the Control group obtained from plasma. While not significant there was a trend to an increase in optically measured cerebral blood flow and hemoglobin concentration in the CO group. CONCLUSIONS Low-dose CO poisoning is associated with early mitochondrial disruption prior to an observable phenotype highlighting the important role of mitochondrial function in the pathology of CO poisoning. This may represent an important intervenable pathway for therapy and intervention.
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Affiliation(s)
- David H Jang
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sarah Piel
- Resuscitation Science Center, Philadelphia, PA, USA
| | - John C Greenwood
- Department of Anesthesiology and Critical Care Medicine, Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthew Kelly
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Yuxi Lin
- Resuscitation Science Center, Philadelphia, PA, USA
| | | | | | - Frances S Shofer
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Wesley B Baker
- Department of Pediatric Neurology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Alec Lafontant
- Department of Pediatric Neurology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Kristen Andersen
- Department of Pediatric Neurology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Johannes K Ehinger
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund University, Malmo, Sweden
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Abstract
Introduction: Carbon monoxide (CO) is a colorless, odorless, and nonirritating gas. The most common exposures are from gas powered appliances such as furnaces, water heaters, stoves, and vehicles. To prevent poisoning, CO detectors with audible alarms were developed. This study aims to evaluate the effectiveness of CO detectors in reducing poisoning in Wisconsin.Methods: Records were queried from National Poison Data System for unintentional CO exposures that occurred in residences in Wisconsin during 2014-2016 (N = 703). After applying sample exclusion criteria, notes were abstracted for cases where CO detector use was mentioned (n = 408). Logistic regression analyses were used to assess the association between having a CO detector alarm and CO poisoning. Linear regression analyses were used to assess the relationship between having a CO detector alarm and poisoning severity.Results: In logistic models, odds of CO poisoning were 3.2 times higher (95% CI: 1.5, 6.9) among those who had no CO detector compared to those who had a CO detector that alarmed. In linear models, not having a CO detector was associated with a 0.34 point (95% CI: 0.17, 0.54) change in outcome severity score compared to having a CO detector that alarmed.Discussion: Individuals who were exposed to CO in the absence of a CO detector were more likely to be poisoned and to have more severe medical outcomes than those that had a CO detector that alarmed.
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Affiliation(s)
- Grace M Christensen
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, Madison, WI, USA.,CDC/CSTE Applied Epidemiology Fellowship, Madison, WI, USA
| | - Paul D Creswell
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, Madison, WI, USA.,Wisconsin Environmental Public Health Tracking (EPHT) Program, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Jon G Meiman
- Wisconsin Department of Health Services, Bureau of Environmental and Occupational Health, Madison, WI, USA
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Domanski K, Kleinschmidt KC, Greene S, Ruha AM, Bebarta VS, Onisko N, Campleman S, Brent J, Wax P. Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013-2017. Clin Toxicol (Phila) 2019; 58:178-182. [PMID: 31190571 DOI: 10.1080/15563650.2019.1627367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium's (ToxIC) North American Snakebite Registry (NASBR)Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management.Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7-12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours.Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations.Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.
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Affiliation(s)
- K Domanski
- Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - K C Kleinschmidt
- Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - S Greene
- Baylor College of Medicine, Houston, TX, USA
| | - A M Ruha
- Banner Good Samaritan Medical Center, Phoenix, AZ, USA
| | - V S Bebarta
- Emergency Medicine, Medical Toxicology, University of Colorado, Denver, CO, USA
| | - N Onisko
- Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - S Campleman
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - J Brent
- Emergency Medicine, Medical Toxicology, University of Colorado, Denver, CO, USA
| | - P Wax
- Southwestern Medical Center, University of Texas, Dallas, TX, USA
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Jang DH, Shofer FS, Weiss SL, Becker LB. Impairment of mitochondrial respiration following ex vivo cyanide exposure in peripheral blood mononuclear cells. Clin Toxicol (Phila) 2016; 54:303-7. [PMID: 26846815 DOI: 10.3109/15563650.2016.1139712] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The objective of this study is to measure mitochondrial respiration using intact cells from whole blood exposed to cyanide as a new biomarker for mitochondrial inhibition. METHODS A single nontourniqueted venous blood sample was collected from 10 healthy volunteers after informed consent. Venous lactate was measured immediately following blood collection. Half of the remaining blood sample was then incubated with 100 mM of potassium cyanide (KCN) for 5 min, and half of the sample remained unexposed. Repeat lactate measurements were performed from blood exposed and not exposed to KCN. Measurement of mitochondrial respiration: intact PBMCs were placed in a 2-mL chamber at a final concentration of 2-3 × 10(6) cells/mL. Measurements of oxygen consumption were performed at 37°C in a high-resolution oxygraph (Oxygraph-2k Oroboros Instruments, Innsbruck, Austria). Oxygen flux (in pmol O2/s/10(6) cells), which is directly proportional to oxygen consumption, was recorded continuously using DatLab software 6 (Oroboros Instruments). RESULTS There were significance differences in the relevant key parameters of mitochondrial respiration: Of the parameters measuring mitochondrial respiration, four of the six demonstrated a statistically significant mean difference between control and cyanide: for routine respiration (mean difference [control-cyanide]: 8.9 pmol O2/s/10(6) cells; 95% CI: 5.6-12.2, p < 0.0001); Proton Leak (mean difference: 0.73 pmol O2/s/10(6) cells; 95% CI: -0.33-1.79, p = 0.157); Maximal respiration (mean difference: 21.7 pmol O2/s/10(6) cells; 95% CI: 16.0-27.6, p < 0.0001); Residual oxygen consumption (mean difference 0.25 pmol O2/s/10(6) cells; 95% CI: -0.68-1.18, p = 0.557). There was a significant difference in spare respiratory capacity (SRC) and adenosine triphosphate (ATP)-linked respiration with the control samples demonstrating a higher SRC and ATP-linked respiration. Finally, there is a statistically significant difference in lactate (mean difference -0.32, 95% CI: -0.41 to -0.23, p < 0.0001), though clinically similar level, with a higher lactate concentration in the cyanide samples. CONCLUSIONS In this ex vivo model, the measurements of key parameters in mitochondrial respiration may be a more sensitive measure of cellular function when compared to lactate.
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Affiliation(s)
- David H Jang
- a Department of Emergency Medicine , Center for Mitochondrial Bioenergetics in Emergency Medicine and Critical Care (MitoEM), University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Frances S Shofer
- a Department of Emergency Medicine , Center for Mitochondrial Bioenergetics in Emergency Medicine and Critical Care (MitoEM), University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Scott L Weiss
- b Department of Anesthesia and Critical Care, Division of Critical Care Medicine , The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Lance B Becker
- a Department of Emergency Medicine , Center for Mitochondrial Bioenergetics in Emergency Medicine and Critical Care (MitoEM), University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
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