<![CDATA[The Poison Lab]]>0b5d6739-1508-51e3-a870-e7b2bcfdc09cWed, 11 Feb 2026 18:05:14 +0000Captivate.fmClinical Toxicology LLChttps://artwork.captivate.fm/1e23765f-40b1-4c56-a469-5a201f035d2a/pod-thumbnail.jpgThe Poison LabClinical Toxicology LLCClinical Toxicology LLCDive into the captivating world of poisons with The Poison Lab! Hosted by Clinical Toxicologist Ryan Feldman (@EMPoisonPharmD), who has over a decade of managing poisoning and drug overdose via poison centers and in the emergency department. Also occasional co-hosted by his robo cohost Toxo! (@LabPoison). This show unpacks the fascinating history, cutting-edge science, and life-saving medical management of toxins from around the globe. From stories of those impacted to expert insights from pioneers in poisoning treatment, each episode brings you closer to understanding the poisons that lurk in plain sight. Explore episodes, med videos, games, and more at thepoisonlab.com—every poison has a story to tell! https://www.thepoisonlab.comfalseepisodichttps://feeds.captivate.fm/the-poison-lab/nopodcastSupport the show!The PoisonverseIf I had a Nickel (Mystery Case) & Toxicologist vs The internet (#13) with Dr. Damilola Idowu-EllsworthIf I had a Nickel (Mystery Case) & Toxicologist vs The internet (#13) with Dr. Damilola Idowu-EllsworthIn this episode of The Poison Lab, host Ryan Feldman is joined by medical toxicologist Damilola Idowu‑Ellsworth for a fast-moving, case-heavy conversation packed with clinical pearls, listener participation, and classic toxicology weirdness.

The show opens with listener guesses for the previously released mystery case before diving headfirst into a rapid-fire series of Stump the Toxicologist cases—questions pulled straight from the internet and real-world toxicology problem-solving. Along the way, Ryan and Dami cover everything from rodenticides and drug-testing myths to how to clean a benzodiazepine bottle, plus one of the most toxic substances you’ve probably never heard of.

One lucky listener also wins a copy of Poisonous Fungus Amongus, and a shout-out to the newly released second edition featuring photography from expert mycologists.

Skip the listener guesses and jump straight to the mystery toxin: 38:15

Mystery toxin case

The rest of the episode is Dr. Idowu and Ryan discuss the topics below. Looking for timestamps? Join the supporting member feed!

  1. Looking for time stamps for the rest of the show? Join as a supporting member

Stump the Toxicologist – Case Discussions

(Looking for timestamps? Join the supporting member feed!)

Case #1

  1. A methemoglobinemia, renal failure inducing enema

Case #2

  1. Wide-complex dysrhythmia from an over-the-counter topical
  2. Bonus - Paper from Ryan on the topical toxicity (or lack there of) of this product

Case #3

  1. Black stools, seizures, high sodium and low potassium after trying to beat a drug test.

Case #4

  1. GCS 15 and normal vitals… until they’re not — delayed seizures, neurologic collapse, and a toxicologic time bomb.
  2. Paper from Ryan on this tricky toxic time bomb

Internet & Listener Questions

  1. Do GLP-1 agonists release toxins from fat and how might that impact drugged driving laws with THC?
  2. Why do sedatives make you twitch?
  3. Not all benzos are Xanax
  4. What shape is a ketamine crystal

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

In this episode of The Poison Lab, host Ryan Feldman is joined by medical toxicologist Damilola Idowu‑Ellsworth for a fast-moving, case-heavy conversation packed with clinical pearls, listener participation, and classic toxicology weirdness.

The show opens with listener guesses for the previously released mystery case before diving headfirst into a rapid-fire series of Stump the Toxicologist cases—questions pulled straight from the internet and real-world toxicology problem-solving. Along the way, Ryan and Dami cover everything from rodenticides and drug-testing myths to how to clean a benzodiazepine bottle, plus one of the most toxic substances you’ve probably never heard of.

One lucky listener also wins a copy of Poisonous Fungus Amongus, and a shout-out to the newly released second edition featuring photography from expert mycologists.

Skip the listener guesses and jump straight to the mystery toxin: 38:15

Mystery toxin case

The rest of the episode is Dr. Idowu and Ryan discuss the topics below. Looking for timestamps? Join the supporting member feed!

  1. Looking for time stamps for the rest of the show? Join as a supporting member

Stump the Toxicologist – Case Discussions

(Looking for timestamps? Join the supporting member feed!)

Case #1

  1. A methemoglobinemia, renal failure inducing enema

Case #2

  1. Wide-complex dysrhythmia from an over-the-counter topical
  2. Bonus - Paper from Ryan on the topical toxicity (or lack there of) of this product

Case #3

  1. Black stools, seizures, high sodium and low potassium after trying to beat a drug test.

Case #4

  1. GCS 15 and normal vitals… until they’re not — delayed seizures, neurologic collapse, and a toxicologic time bomb.
  2. Paper from Ryan on this tricky toxic time bomb

Internet & Listener Questions

  1. Do GLP-1 agonists release toxins from fat and how might that impact drugged driving laws with THC?
  2. Why do sedatives make you twitch?
  3. Not all benzos are Xanax
  4. What shape is a ketamine crystal

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

  1. Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

  1. Email: Toxtalk1@gmail.com

More Show Resources

  1. Ryan's Medical Games and Resources
  2. Show Website

]]>9bab5e9e-f341-437b-9abd-12ba1f7d4999Wed, 11 Feb 2026 00:00:00 -060001:40:54falsefull4848Poison Lab Update: Mushroom Poisoning Radio RoundupPoison Lab Update: Mushroom Poisoning Radio RoundupHey everybody, you’re listening to The Poison Lab—well, almost.

We’ve got a new episode coming next week, but we’re running a little behind on our usual release schedule because… life happens. That said, if you’re looking for some toxicology content right now, I’ve got you covered.

Recently, I had the chance to appear on two local and state radio shows talking about one of my favorite topics: mushroom poisoning 🍄—and both were an absolute blast.

🌱 Garden Talk (Call-In Episode) (Ryan starts @ 1 hour and 14 min)

The first appearance was on Garden Talk, a fun, live call-in show where we covered:

  1. Mushroom poisoning basics
  2. Listener questions
  3. My game GOTTA PICCEM
  4. The book Poisonous Fungus Among Us

It was lively, unpredictable, and a great example of how curious people are about mushrooms once you open the door.

📻 Local Health Update Radio Segment

After that, I joined a local radio health update to talk specifically about mushroom poisoning from a public-health perspective. It’s always interesting to hear how radio hosts approach such a niche topic—and how quickly it turns into something broadly relevant.

🔬 Want a Quick Toxicology Fix?

If you’re itching for some Poison Lab content while you wait for the next full episode, these two appearances are a great place to start.

And don’t worry—we’ll be back next week with a full episode and answers to our mystery case.

Thanks, as always, for listening.

Hope to see you there.

— Ryan

]]>Hey everybody, you’re listening to The Poison Lab—well, almost.

We’ve got a new episode coming next week, but we’re running a little behind on our usual release schedule because… life happens. That said, if you’re looking for some toxicology content right now, I’ve got you covered.

Recently, I had the chance to appear on two local and state radio shows talking about one of my favorite topics: mushroom poisoning 🍄—and both were an absolute blast.

🌱 Garden Talk (Call-In Episode) (Ryan starts @ 1 hour and 14 min)

The first appearance was on Garden Talk, a fun, live call-in show where we covered:

  1. Mushroom poisoning basics
  2. Listener questions
  3. My game GOTTA PICCEM
  4. The book Poisonous Fungus Among Us

It was lively, unpredictable, and a great example of how curious people are about mushrooms once you open the door.

📻 Local Health Update Radio Segment

After that, I joined a local radio health update to talk specifically about mushroom poisoning from a public-health perspective. It’s always interesting to hear how radio hosts approach such a niche topic—and how quickly it turns into something broadly relevant.

🔬 Want a Quick Toxicology Fix?

If you’re itching for some Poison Lab content while you wait for the next full episode, these two appearances are a great place to start.

And don’t worry—we’ll be back next week with a full episode and answers to our mystery case.

Thanks, as always, for listening.

Hope to see you there.

— Ryan

]]>34546622-e996-4654-b4e6-f0417c9e259cWed, 04 Feb 2026 00:00:00 -060001:36falsebonus4949Sick at Work? A Poisonous Cause of Coworker Illness?Sick at Work? A Poisonous Cause of Coworker Illness?Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

  1. Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

  1. Email: Toxtalk1@gmail.com

More Show Resources

  1. Ryan's Medical Games and Resources
  2. Show Website

]]>Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

  1. Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

  1. Email: Toxtalk1@gmail.com

More Show Resources

  1. Ryan's Medical Games and Resources
  2. Show Website

]]>b2eaa5ea-d5c6-4938-9dea-9289bdd22e75Thu, 18 Dec 2025 20:54:00 -060001:55falsebonusOutbreak: Thebaine Poisoning from Poppy Seed Tea in AustraliaOutbreak: Thebaine Poisoning from Poppy Seed Tea in AustraliaIn November 2022, hospitals across Australia began seeing patients with sudden rigidity, spasms, seizures—and in some cases cardiac arrest—after drinking homemade poppy seed tea. The source? Food-shelf poppy seeds contaminated with extraordinarily high levels of thebaine, an opioid alkaloid that acts nothing like morphine. In this Outbreak episode, host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, investigates how pharmaceutical-grade, thebaine-rich poppy seeds were mistakenly repackaged into the food supply—and how poison centers, clinicians, labs, and public health teams traced and contained the threat within days.

You’ll hear firsthand from the experts who responded:

  • Dr. Katherine Isoardi, Emergency Physician, Clinical Toxicologist, Medical Director, Queensland Poisons Information Centre
  • Dr. Amanda Holford, Clinical Toxicology Fellow & Emergency Physician, Princess Alexandra Hospital
  • Dr. Darren Roberts, Medical Director, NSW Poisons Information Centre; Nephrologist; Clinical Pharmacologist

Together, they walk us through the outbreak timeline—from the first ICU cases and puzzling “strych­nine-like” neuroexcitation to the multi-state investigation, product recall, and lessons for future foodborne poisonings.

Looking for timestamps?

A fully timestamped version—so you can jump to any topic—is available to our supporting members.

💡 Key topics:

  • Clinical presentation of thebaine toxicity (rigidity, spasms, seizures, metabolic acidosis) and how it differs from classic opioid effects
  • Why thebaine behaves like a glycine receptor antagonist (strych­nine-like) rather than a sedating mu agonist
  • How early-warning networks (e.g., PRISE in NSW; EDNA in QLD), poison centers, and forensic labs coordinated a rapid response
  • Public health trace-back: mislabeled/repacked pharmaceutical poppy seeds entering the food supply; national recalls
  • Practical ED management pearls (benzodiazepines, airway/ICU support; recognizing recurrent symptoms) and communication pitfalls during mass poisonings

📍 Resources & Mentions:


🎧 Listen now: www.ThePoisonLab.com

💬 Have thoughts or questions?

Instagram @tox_talk • Twitter @LabPoison • Email toxtalk1@gmail.com

Disclaimer: The Poison Lab is for educational purposes only and does not provide medical advice. If you suspect a poisoning, contact your local poison center. In the U.S., call 1-800-222-1222.

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

In November 2022, hospitals across Australia began seeing patients with sudden rigidity, spasms, seizures—and in some cases cardiac arrest—after drinking homemade poppy seed tea. The source? Food-shelf poppy seeds contaminated with extraordinarily high levels of thebaine, an opioid alkaloid that acts nothing like morphine. In this Outbreak episode, host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, investigates how pharmaceutical-grade, thebaine-rich poppy seeds were mistakenly repackaged into the food supply—and how poison centers, clinicians, labs, and public health teams traced and contained the threat within days.

You’ll hear firsthand from the experts who responded:

  • Dr. Katherine Isoardi, Emergency Physician, Clinical Toxicologist, Medical Director, Queensland Poisons Information Centre
  • Dr. Amanda Holford, Clinical Toxicology Fellow & Emergency Physician, Princess Alexandra Hospital
  • Dr. Darren Roberts, Medical Director, NSW Poisons Information Centre; Nephrologist; Clinical Pharmacologist

Together, they walk us through the outbreak timeline—from the first ICU cases and puzzling “strych­nine-like” neuroexcitation to the multi-state investigation, product recall, and lessons for future foodborne poisonings.

Looking for timestamps?

A fully timestamped version—so you can jump to any topic—is available to our supporting members.

💡 Key topics:

  • Clinical presentation of thebaine toxicity (rigidity, spasms, seizures, metabolic acidosis) and how it differs from classic opioid effects
  • Why thebaine behaves like a glycine receptor antagonist (strych­nine-like) rather than a sedating mu agonist
  • How early-warning networks (e.g., PRISE in NSW; EDNA in QLD), poison centers, and forensic labs coordinated a rapid response
  • Public health trace-back: mislabeled/repacked pharmaceutical poppy seeds entering the food supply; national recalls
  • Practical ED management pearls (benzodiazepines, airway/ICU support; recognizing recurrent symptoms) and communication pitfalls during mass poisonings

📍 Resources & Mentions:


🎧 Listen now: www.ThePoisonLab.com

💬 Have thoughts or questions?

Instagram @tox_talk • Twitter @LabPoison • Email toxtalk1@gmail.com

Disclaimer: The Poison Lab is for educational purposes only and does not provide medical advice. If you suspect a poisoning, contact your local poison center. In the U.S., call 1-800-222-1222.

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

  1. Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

  1. Email: Toxtalk1@gmail.com

More Show Resources

  1. Ryan's Medical Games and Resources
  2. Show Website

]]>f3c83eba-3f84-4e3e-a37a-c2f51fb05cb3Wed, 03 Dec 2025 00:00:00 -060001:17:13falsefull4545Poisonous Fungus Amongus is Here— The Rhyming Kid (or Adult) Book For Mushroom SafetyPoisonous Fungus Amongus is Here— The Rhyming Kid (or Adult) Book For Mushroom SafetyGet your copy here! https://a.co/d/8QUBmQy

Want to hear it with insights from the author?:

 • Poisonous Fungus Among Us | Full Children’...  

Don't have time for the full thing: check the highlights:

 • Poisonous Fungus Amongus Highlights Reel  

Want a clearer picture: Full reading large scale here:

 • Poisonous Fungus Amongus- Children's Book ...  

From the mind of a toxicologist who treats real mushroom poisonings alongside doctors and poison centers comes Poisonous Fungus Amongus—a playful, rhyming adventure into the fascinating world of poisonous mushrooms!

Inside, readers will find a colorful introduction to mushroom anatomy and ecology—learning the parts of a mushroom and discovering helpful hints for safe foraging and identifying dangerous look-alikes. Every species featured in these pages is a real poisonous mushroom, brought to life through vivid illustrations and engaging verse.

This beautifully illustrated book goes beyond the basics, exploring how mushrooms grow, reproduce, and take shape in nature—from tiny spores to sprawling mycelium to the fruiting bodies we find in forests and fields.

Through rhymes and clear explanations, readers learn to recognize essential mushroom features—caps, gills, pores, rings, bulbs (volvas), veils, warts, scales, spore prints, and gill types like free, adnate, and decurrent. Each detail helps distinguish the edible from the toxic—and shows how some features can fool us!

The story encourages safe and curious observation: note each feature, dig gently to look for bulbs, observe nearby trees and seasons, and check for bruising or color changes. Along the way, readers also discover fungi’s hidden ecological roles, from tree-nurturing mycorrhizae to the saprotrophs that recycle the forest floor.

With rhythm, rhyme, and a spark of scientific wonder, Poisonous Fungus Amongus blends accuracy with imagination—inviting kids and adults alike to explore and respect the natural world, while learning that curiosity and caution must always grow together when it comes to mushrooms.

Perfect for young readers, nature lovers, teachers, and families who want to explore the mysterious and magical world of fungi!

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The...]]>Get your copy here! https://a.co/d/8QUBmQy

Want to hear it with insights from the author?:

 • Poisonous Fungus Among Us | Full Children’...  

Don't have time for the full thing: check the highlights:

 • Poisonous Fungus Amongus Highlights Reel  

Want a clearer picture: Full reading large scale here:

 • Poisonous Fungus Amongus- Children's Book ...  

From the mind of a toxicologist who treats real mushroom poisonings alongside doctors and poison centers comes Poisonous Fungus Amongus—a playful, rhyming adventure into the fascinating world of poisonous mushrooms!

Inside, readers will find a colorful introduction to mushroom anatomy and ecology—learning the parts of a mushroom and discovering helpful hints for safe foraging and identifying dangerous look-alikes. Every species featured in these pages is a real poisonous mushroom, brought to life through vivid illustrations and engaging verse.

This beautifully illustrated book goes beyond the basics, exploring how mushrooms grow, reproduce, and take shape in nature—from tiny spores to sprawling mycelium to the fruiting bodies we find in forests and fields.

Through rhymes and clear explanations, readers learn to recognize essential mushroom features—caps, gills, pores, rings, bulbs (volvas), veils, warts, scales, spore prints, and gill types like free, adnate, and decurrent. Each detail helps distinguish the edible from the toxic—and shows how some features can fool us!

The story encourages safe and curious observation: note each feature, dig gently to look for bulbs, observe nearby trees and seasons, and check for bruising or color changes. Along the way, readers also discover fungi’s hidden ecological roles, from tree-nurturing mycorrhizae to the saprotrophs that recycle the forest floor.

With rhythm, rhyme, and a spark of scientific wonder, Poisonous Fungus Amongus blends accuracy with imagination—inviting kids and adults alike to explore and respect the natural world, while learning that curiosity and caution must always grow together when it comes to mushrooms.

Perfect for young readers, nature lovers, teachers, and families who want to explore the mysterious and magical world of fungi!

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

  1. Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

  1. Email: Toxtalk1@gmail.com

More Show Resources

  1. Ryan's Medical Games and Resources
  2. Show Website

]]>b6a13a12-620b-4e46-af12-f6c46b82a2d7Mon, 17 Nov 2025 14:22:00 -060003:17falsebonus4545LIVE from Chicago: 2025 NACCT Research Review – Insights from the North American Congress of Clinical ToxicologyLIVE from Chicago: 2025 NACCT Research Review – Insights from the North American Congress of Clinical ToxicologyShow Notes

In this special live episode from the 2025 North American Congress of Clinical Toxicology (NACCT), Ryan takes you inside the conference to hear directly from the researchers themselves. Covering 11 abstracts that span high-stakes management decisions, surprising case reports, and challenges to toxicology dogma, this year’s highlights feature everything from amlodipine overdoses to naturopathic misadventures, metformin-associated blindness, and more. The show kicks off with a foreword from Ryan and Dr. Jon Cole (abstract co-chair for AACT) discussing some of their favorite research from the conference.

If you couldn’t make it to NACCT or just want to catch up on some of the most impactful new research in our field, this episode will give you a front-row seat. Check below for links to the published abstracts, the full list of studies discussed, and timestamps for where you can hear each one.

Link to published abstract manuscript

Foreword with Dr. Jon Cole

10:43 #7. Is beta blocker toxicity associated with hypoglycemia?

  • Lead author: Dr. Megan Audette, MD

18:17 #237. V-A ECMO as a treatment for vasoplegic shock in amlodipine poisoning: a comparison

  • Lead author: Dr. Daniel Tirado, MD

27:59 #247. Blocked but not beaten: ECMO’s role in severe amlodipine toxicity – a poison center case series

  • Lead author: Dr. Carlos Saldarriaga, MD

28:18 #26. Amlodipine double-dose therapeutic errors reported to Poison Centers

  • Lead author: Johanne Freeman

30:38 #27. Dosing on the edge: unpacking inadvertent amlodipine ingestions reported to a single poison center

  • Lead author: Dr. Tiana Patriarca, PharmD

34:03 #292. Intravenous administration of sodium zirconium cyclosilicate resulting in death

  • Lead author: Dr. Stephen Thornton, MD

Researcher interviews

44:16 – #21. Quantitative analysis of amlodipine removal by plasmapheresis

  • Guest: Dr. Keahi Horowitz, MD – Acute and Intensive Care Research Award winner

48:33– #23. Relationship between reported ingestion dose and outcome in amlodipine poisoning

  • Guest: Dr. Colleen Cowdery, MD

51:37 – #24. Management of severe amlodipine toxicity with high-dose calcium alone


56:56– #70. Iatrogenic exposure to long-acting buprenorphine injectable in an opioid-naïve patient

  • Guest: Dr. Conor Young, MD

01:00:11 – #182. Left in the dark: a case of blindness in the setting of metformin toxicity

  • Guest: Dr. Madison Bombard, MD

01:12:11 – #169. Just because it’s natural doesn’t mean it’s safe: a case of pediatric toxicity from topical and herbal remedies

  • Guest: Dr. Aria Darling, MD

01:04:31 – #203. Serotonin syndrome after vaping Moocah

  • Guest: Dr. Connor Murphy, MD

01:07:06 – #307. Intravenous ozone autohemotherapy: a retrospective observational case series

  • Guest: Nicole McLarty

01:11:25 – #134. Do they really need n-acetylcysteine? Exploratory analysis of outcomes in patients with elevated...]]>Show Notes

In this special live episode from the 2025 North American Congress of Clinical Toxicology (NACCT), Ryan takes you inside the conference to hear directly from the researchers themselves. Covering 11 abstracts that span high-stakes management decisions, surprising case reports, and challenges to toxicology dogma, this year’s highlights feature everything from amlodipine overdoses to naturopathic misadventures, metformin-associated blindness, and more. The show kicks off with a foreword from Ryan and Dr. Jon Cole (abstract co-chair for AACT) discussing some of their favorite research from the conference.

If you couldn’t make it to NACCT or just want to catch up on some of the most impactful new research in our field, this episode will give you a front-row seat. Check below for links to the published abstracts, the full list of studies discussed, and timestamps for where you can hear each one.

Link to published abstract manuscript

Foreword with Dr. Jon Cole

10:43 #7. Is beta blocker toxicity associated with hypoglycemia?

  • Lead author: Dr. Megan Audette, MD

18:17 #237. V-A ECMO as a treatment for vasoplegic shock in amlodipine poisoning: a comparison

  • Lead author: Dr. Daniel Tirado, MD

27:59 #247. Blocked but not beaten: ECMO’s role in severe amlodipine toxicity – a poison center case series

  • Lead author: Dr. Carlos Saldarriaga, MD

28:18 #26. Amlodipine double-dose therapeutic errors reported to Poison Centers

  • Lead author: Johanne Freeman

30:38 #27. Dosing on the edge: unpacking inadvertent amlodipine ingestions reported to a single poison center

  • Lead author: Dr. Tiana Patriarca, PharmD

34:03 #292. Intravenous administration of sodium zirconium cyclosilicate resulting in death

  • Lead author: Dr. Stephen Thornton, MD

Researcher interviews

44:16 – #21. Quantitative analysis of amlodipine removal by plasmapheresis

  • Guest: Dr. Keahi Horowitz, MD – Acute and Intensive Care Research Award winner

48:33– #23. Relationship between reported ingestion dose and outcome in amlodipine poisoning

  • Guest: Dr. Colleen Cowdery, MD

51:37 – #24. Management of severe amlodipine toxicity with high-dose calcium alone


56:56– #70. Iatrogenic exposure to long-acting buprenorphine injectable in an opioid-naïve patient

  • Guest: Dr. Conor Young, MD

01:00:11 – #182. Left in the dark: a case of blindness in the setting of metformin toxicity

  • Guest: Dr. Madison Bombard, MD

01:12:11 – #169. Just because it’s natural doesn’t mean it’s safe: a case of pediatric toxicity from topical and herbal remedies

  • Guest: Dr. Aria Darling, MD

01:04:31 – #203. Serotonin syndrome after vaping Moocah

  • Guest: Dr. Connor Murphy, MD

01:07:06 – #307. Intravenous ozone autohemotherapy: a retrospective observational case series

  • Guest: Nicole McLarty

01:11:25 – #134. Do they really need n-acetylcysteine? Exploratory analysis of outcomes in patients with elevated liver function tests but no detectable acetaminophen

  • Guest: Dr. Seth Carroll, PharmD

01:15:33 – #130. Outcomes of acute acetaminophen-poisoned patients treated with and without fomepizole: a Toxic registry study

  • Guest: Dr. Jordan Woollum, PharmD

01:21:23 – #295. Evaluation of onset and resolution of complications after chronic methotrexate poisoning

  • Guest: Dr. Van Quach, PharmD

01:24:51 – #325. Implications of potassium in salicylate toxicity treated with urinary alkalinization

  • Guest: Dr. Andrew Yetka, PharmD

Bonus Content

  • Stick around to the very end of the episode for a teaser of Stump the Tox and the brand-new game Tox Wavelength, recorded on the train to NACCT. The full episode is available now for supporting members.

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

  1. Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

  1. Email: Toxtalk1@gmail.com

More Show Resources

  1. Ryan's Medical Games and Resources
  2. Show Website

]]>6b90bcb4-12e7-410f-9566-ed1f657b4b78Mon, 06 Oct 2025 00:00:00 -060001:41:48falsefull4343Toxicologist vs The internet (#12) with Dr. Joe Kennedy MDToxicologist vs The internet (#12) with Dr. Joe Kennedy MDIn this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Joe Kennedy, medical toxicologist at the University of Vermont and consultant for the Northern New England Poison Center. Together they work through real poisoning cases to sharpen toxic differentials, sum up practical resuscitation priorities, and connect first-principles pharmacology to bedside decisions. They also answer listener questions on THAM vs bicarbonate, when to dialyze even with “normal” kidneys, and why rattlesnake antivenom costs so much—plus the real-world logistics of sourcing exotic antivenoms in the U.S.

Dr. Kennedy and Ryan discuss the topics below. Looking for timestamps? Join the subscribed feed!

  • Case set #1: Shock with hyperglycemia, big pupils, and probably NOT what you think it is.
  • Case set #2: Massive bleeding after gas-station “herbal” products
  • Case set #3: Refractory wide-complex rhythms in a teen overdose
  • Case set #4: Sudden collapse at a hog farm- (SPOLIER) Recent outbreak of deaths as related to case 4

Want the cases summarized and sent to you so you can come up with your differential before the show? SIGN UP FOR THE NEWS LETTER!

Listener Q&A

  • THAM vs bicarbonate (closed vs open buffering; “breathe for bicarb, tinkle for THAM”)
  • Why dialyze if the kidneys work? (EXTRIP-style thinking, gradients, and properties)
  • Snake antivenom pricing & how zoos help hospitals obtain non-U.S. antivenoms

Call outs from the show


Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

  1. Ad free episodes
  2. Bonus content and early access
  3. Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

  1. In this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Joe Kennedy, medical toxicologist at the University of Vermont and consultant for the Northern New England Poison Center. Together they work through real poisoning cases to sharpen toxic differentials, sum up practical resuscitation priorities, and connect first-principles pharmacology to bedside decisions. They also answer listener questions on THAM vs bicarbonate, when to dialyze even with “normal” kidneys, and why rattlesnake antivenom costs so much—plus the real-world logistics of sourcing exotic antivenoms in the U.S.

    Dr. Kennedy and Ryan discuss the topics below. Looking for timestamps? Join the subscribed feed!

    • Case set #1: Shock with hyperglycemia, big pupils, and probably NOT what you think it is.
    • Case set #2: Massive bleeding after gas-station “herbal” products
    • Case set #3: Refractory wide-complex rhythms in a teen overdose
    • Case set #4: Sudden collapse at a hog farm- (SPOLIER) Recent outbreak of deaths as related to case 4

    Want the cases summarized and sent to you so you can come up with your differential before the show? SIGN UP FOR THE NEWS LETTER!

    Listener Q&A

    • THAM vs bicarbonate (closed vs open buffering; “breathe for bicarb, tinkle for THAM”)
    • Why dialyze if the kidneys work? (EXTRIP-style thinking, gradients, and properties)
    • Snake antivenom pricing & how zoos help hospitals obtain non-U.S. antivenoms

    Call outs from the show


    Support the show

    Review the show where ever your listening

    Get Messages from Toxo (Join the Newsletter!)

    Join as a supporting member

    1. Ad free episodes
    2. Bonus content and early access
    3. Discounts and give aways on GOTA PICCEM Mushroom card game

    The GOTTA PICCEM Poisonous Mushroom Game!

    The Poisonus Fungus Amongus Children's Book!

    1. Full book reading (6 minutes!)

    Tox trinkets (Rep the show at home!)

    Reach the show

    1. Email: Toxtalk1@gmail.com

    More Show Resources

    1. Ryan's Medical Games and Resources
    2. Show Website

    ]]>    17ee3ab7-bd3c-48b4-8da6-a313086fe24aWed, 10 Sep 2025 00:00:00 -060001:34:49falsefull4242GOTTA PICCEM is Here! — The Poisonous Mushroom Card Game LaunchGOTTA PICCEM is Here! — The Poisonous Mushroom Card Game LaunchGOTTA PICCEM: The Poisonous Mushroom Card Game

    👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

    Why this is awesome

    What started as a nerdy teaching tool made to teach mushroom poisoning by folks who treat mushroom poisoning is now a full-fledged card game—equally great for Friday game night and the classroom.

    What’s inside the deck

    • 58 Poisonous Mushroom Cards
    • Full-color pictures, toxin info, clinical syndromes, key anatomy, U.S. + global distribution, and spore print colors.
    • 88 Play Cards + 30 Bonus Cards
    • Collect mushrooms, play antidotes and modifiers, stack combos, and score big.
    • Toxin-Based Scoring
    • Point systems reflect real-world toxicity—every round plays differently based on your hand and bonus cards.
    • Endless Replayability
    • Rule variants at gottapiccem.com keep things fresh.

    Learn while you play

    Dive into the companion blog at www.gottapiccem.com for:

    • Deep-dive toxin explainers for each mushroom
    • Case reports & real-world clinical notes
    • Controversies and mysteries in mushroom poisoning

    📖 Start here: gottapiccem.com (Companion Blog → “Learn the Mushrooms”)

    How to get it

    👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

    • Multiple box options (pick your fancy)
    • Ships direct from our manufacturer in South Korea
    • 🌍 Global availability (shipping costs + tariffs may apply)

    P.S. We’re exploring U.S. manufacturing to lower costs and expand distribution—timeline TBD—so we made the game available now.

    Join the fun

    If you grab a copy:

    📸 Snap a photo of your first round

    ✉️ Send it to toxtalk1@gmail.com or tag @LabPoison / @tox_talk

    Nothing would make Ryan happier than seeing the community play!

    ]]>    GOTTA PICCEM: The Poisonous Mushroom Card Game

    👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

    Why this is awesome

    What started as a nerdy teaching tool made to teach mushroom poisoning by folks who treat mushroom poisoning is now a full-fledged card game—equally great for Friday game night and the classroom.

    What’s inside the deck

    • 58 Poisonous Mushroom Cards
    • Full-color pictures, toxin info, clinical syndromes, key anatomy, U.S. + global distribution, and spore print colors.
    • 88 Play Cards + 30 Bonus Cards
    • Collect mushrooms, play antidotes and modifiers, stack combos, and score big.
    • Toxin-Based Scoring
    • Point systems reflect real-world toxicity—every round plays differently based on your hand and bonus cards.
    • Endless Replayability
    • Rule variants at gottapiccem.com keep things fresh.

    Learn while you play

    Dive into the companion blog at www.gottapiccem.com for:

    • Deep-dive toxin explainers for each mushroom
    • Case reports & real-world clinical notes
    • Controversies and mysteries in mushroom poisoning

    📖 Start here: gottapiccem.com (Companion Blog → “Learn the Mushrooms”)

    How to get it

    👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

    • Multiple box options (pick your fancy)
    • Ships direct from our manufacturer in South Korea
    • 🌍 Global availability (shipping costs + tariffs may apply)

    P.S. We’re exploring U.S. manufacturing to lower costs and expand distribution—timeline TBD—so we made the game available now.

    Join the fun

    If you grab a copy:

    📸 Snap a photo of your first round

    ✉️ Send it to toxtalk1@gmail.com or tag @LabPoison / @tox_talk

    Nothing would make Ryan happier than seeing the community play!

    ]]>    539f4fd3-33dd-48f0-a15b-c03a42b4f76dWed, 03 Sep 2025 15:17:00 -060003:21falsefull4141    Ryan is LIVE on the Radio Thursday July 17th 11:45AM-12:30 PM CST WPR Larry Meiller Show!Ryan is LIVE on the Radio Thursday July 17th 11:45AM-12:30 PM CST WPR Larry Meiller Show!Listen here (https://www.wpr.org/shows/larry-meiller-show) to hear Ryan Live on AIR for the Larry Meiller show, Thursday July 17th 11:45AM-12:30 PM CST.

    Check this "Listen Live" link if your having trouble!

    ]]>    Listen here (https://www.wpr.org/shows/larry-meiller-show) to hear Ryan Live on AIR for the Larry Meiller show, Thursday July 17th 11:45AM-12:30 PM CST.

    Check this "Listen Live" link if your having trouble!

    ]]>    888ef3dd-8416-4397-a66d-1808e053489eWed, 16 Jul 2025 17:43:00 -060000:54falsebonus3939    Poisoning Outbreak: Aconite Poisoning at Markham, Ontario RestaurantPoisoning Outbreak: Aconite Poisoning at Markham, Ontario Restaurant

    Support the show

    Review the show where ever your listening

    Get Messages from Toxo (Join the Newsletter!)

    Join as a supporting member

    1. Ad free episodes
    2. Bonus content and early access
    3. Discounts and give aways on GOTA PICCEM Mushroom card game

    The GOTTA PICCEM Poisonous Mushroom Game!

    The Poisonus Fungus Amongus Children's Book!

    1. Full book reading (6 minutes!)

    Tox trinkets (Rep the show at home!)

    Reach the show

    1. Email: Toxtalk1@gmail.com

    More Show Resources

    1. Ryan's Medical Games and Resources
    2. Show Website

    The Poison Lab: Outbreak – Markham Aconite Poisoning

    On August 29, 2022, twelve diners at a Markham, Ontario restaurant fell critically ill with vomiting, numbness, and life-threatening arrhythmias. The culprit? A deadly plant toxin: aconite.

    In this episode—the first of a new Poison Lab Outbreak series—we go inside the Markham mass poisoning case. Join host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, as he investigates how a rare and lethal toxin ended up in a restaurant spice jar and nearly cost lives.

    You’ll hear firsthand from the experts who responded to the outbreak:

    • Dr. Jessica Kent, toxicology fellow at the time at the University of Toronto
    • Dr. Abinhay Sathya, intensivist at Markham Stouffville Hospital
    • Dr. Margaret Thompson, toxicologist and on-call consultant for the Ontario Poison Centre
    • Dr. Randy Purves, research scientist at the Canadian Food Inspection Agency (CFIA)
    • Bryn Shurmer, MS- analytical chemist at the Canadian Food Inspection Agency (CFIA) 

    Together, they walk us through the outbreak timeline—from the first patients in VT to the public health investigation that uncovered a mislabeled spice bag full of pure aconite root.

    Looking for timestamps?

    A fully timestamped version of the episode—so you can jump to any topic—is available to our supporting members.

    💡 Key topics:

    • Clinical presentation and toxic effects of aconite
    • Challenges in mass poisoning recognition and coordination
    • The crucial role of poison centers in outbreak response
    • Public health trace-back to contaminated galangal powder
    • Lessons for emergency departments and toxicologists

    📍 Resources & Mentions:

    • Support the show

      Review the show where ever your listening

      Get Messages from Toxo (Join the Newsletter!)

      Join as a supporting member

      1. Ad free episodes
      2. Bonus content and early access
      3. Discounts and give aways on GOTA PICCEM Mushroom card game

      The GOTTA PICCEM Poisonous Mushroom Game!

      The Poisonus Fungus Amongus Children's Book!

      1. Full book reading (6 minutes!)

      Tox trinkets (Rep the show at home!)

      Reach the show

      1. Email: Toxtalk1@gmail.com

      More Show Resources

      1. Ryan's Medical Games and Resources
      2. Show Website

      The Poison Lab: Outbreak – Markham Aconite Poisoning

      On August 29, 2022, twelve diners at a Markham, Ontario restaurant fell critically ill with vomiting, numbness, and life-threatening arrhythmias. The culprit? A deadly plant toxin: aconite.

      In this episode—the first of a new Poison Lab Outbreak series—we go inside the Markham mass poisoning case. Join host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, as he investigates how a rare and lethal toxin ended up in a restaurant spice jar and nearly cost lives.

      You’ll hear firsthand from the experts who responded to the outbreak:

      • Dr. Jessica Kent, toxicology fellow at the time at the University of Toronto
      • Dr. Abinhay Sathya, intensivist at Markham Stouffville Hospital
      • Dr. Margaret Thompson, toxicologist and on-call consultant for the Ontario Poison Centre
      • Dr. Randy Purves, research scientist at the Canadian Food Inspection Agency (CFIA)
      • Bryn Shurmer, MS- analytical chemist at the Canadian Food Inspection Agency (CFIA) 

      Together, they walk us through the outbreak timeline—from the first patients in VT to the public health investigation that uncovered a mislabeled spice bag full of pure aconite root.

      Looking for timestamps?

      A fully timestamped version of the episode—so you can jump to any topic—is available to our supporting members.

      💡 Key topics:

      • Clinical presentation and toxic effects of aconite
      • Challenges in mass poisoning recognition and coordination
      • The crucial role of poison centers in outbreak response
      • Public health trace-back to contaminated galangal powder
      • Lessons for emergency departments and toxicologists

      📍 Resources & Mentions:


      🎧 Listen now at: www.ThePoisonLab.com

      💬 Have thoughts or questions? Connect on Instagram @tox_talk, Twitter @LabPoison, or email toxtalk1@gmail.com.

      ]]>81b1ead3-5936-4d12-8ff9-618da50ad02bThu, 10 Jul 2025 16:39:00 -060001:20:27falsefull3838MURDER for Lunch: Toxicologist vs The internet (#11) with Dr. Amy Zosel MDMURDER for Lunch: Toxicologist vs The internet (#11) with Dr. Amy Zosel MDIn this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Amy Zosel, a medical toxicologist, emergency physician, and educator. Together, they use real poisoning cases to practice identifying toxins and flexing their toxic differential The conversation dives into intriguing and challenging toxicology cases, with a focus on educating listeners about real-world poisoning scenarios, myth-busting internet misinformation, and providing practical clinical insights.

      Mini episode with Dr. Robert Bassett on Remembering Poisonous Mushrooms

      Dr. Zosel and Ryan discuss:

      14:15 Case 1

      33:04 Case 2


      37:00 Case 3


      48:00 Case 4


      "Robocough"

      Study about Naloxone in Clonidine overdose

      ++Spoiler++:

      Below this will be key takeaways regarding managing the poisonings discussed, it may ruin your experience if you are guessing the poisons

      Key Takeaways:

      • Amatoxin Mushroom Poisoning: The classic delayed onset of severe GI symptoms, followed by a latent phase, can mask progressive liver damage. Early recognition and treatment with hydration, silibinin, and possible liver transplant are critical.
      • Tetramine Toxicity: Known for causing refractory seizures, tetramine is a rare but serious poisoning often requiring aggressive supportive care and anticonvulsants.

      A Lethal mushroom hiding in edible mushrooms

      Mushroom foraging danger

      Resources Mentioned:

      • National Poison Control Hotline: 1-800-222-1222
      • National Suicide Prevention Lifeline: 1-800-273-8255
      • SAMHSA Free Helpline: 1-800-662-HELP (4357)

      Follow The Poison Lab:


      Subscribe and Review:

      Love what you're hearing? Help us reach more toxicology enthusiasts by leaving a review on Apple Podcasts, Spotify, or wherever you listen. Don’t forget to share this episode with...]]>In this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Amy Zosel, a medical toxicologist, emergency physician, and educator. Together, they use real poisoning cases to practice identifying toxins and flexing their toxic differential The conversation dives into intriguing and challenging toxicology cases, with a focus on educating listeners about real-world poisoning scenarios, myth-busting internet misinformation, and providing practical clinical insights.

      Mini episode with Dr. Robert Bassett on Remembering Poisonous Mushrooms

      Dr. Zosel and Ryan discuss:

      14:15 Case 1

      33:04 Case 2


      37:00 Case 3


      48:00 Case 4


      "Robocough"

      Study about Naloxone in Clonidine overdose

      ++Spoiler++:

      Below this will be key takeaways regarding managing the poisonings discussed, it may ruin your experience if you are guessing the poisons

      Key Takeaways:

      • Amatoxin Mushroom Poisoning: The classic delayed onset of severe GI symptoms, followed by a latent phase, can mask progressive liver damage. Early recognition and treatment with hydration, silibinin, and possible liver transplant are critical.
      • Tetramine Toxicity: Known for causing refractory seizures, tetramine is a rare but serious poisoning often requiring aggressive supportive care and anticonvulsants.

      A Lethal mushroom hiding in edible mushrooms

      Mushroom foraging danger

      Resources Mentioned:

      • National Poison Control Hotline: 1-800-222-1222
      • National Suicide Prevention Lifeline: 1-800-273-8255
      • SAMHSA Free Helpline: 1-800-662-HELP (4357)

      Follow The Poison Lab:


      Subscribe and Review:

      Love what you're hearing? Help us reach more toxicology enthusiasts by leaving a review on Apple Podcasts, Spotify, or wherever you listen. Don’t forget to share this episode with your colleagues and friends!

      Support the show

      Review the show where ever your listening

      Get Messages from Toxo (Join the Newsletter!)

      Join as a supporting member

      1. Ad free episodes
      2. Bonus content and early access
      3. Discounts and give aways on GOTA PICCEM Mushroom card game

      The GOTTA PICCEM Poisonous Mushroom Game!

      The Poisonus Fungus Amongus Children's Book!

      1. Full book reading (6 minutes!)

      Tox trinkets (Rep the show at home!)

      Reach the show

      1. Email: Toxtalk1@gmail.com

      More Show Resources

      1. Ryan's Medical Games and Resources
      2. Show Website

      ]]>7aab3992-0d78-42d8-8ffd-3aa3a3d89740Wed, 30 Apr 2025 02:00:00 -060001:29:20falsefull3737      A Mnemonic For Poisonous Mushrooms and Their Effects- GOTAA PPICEMA Mnemonic For Poisonous Mushrooms and Their Effects- GOTAA PPICEM

      Support the show

      Review the show where ever your listening

      Get Messages from Toxo (Join the Newsletter!)

      Join as a supporting member

      1. Ad free episodes
      2. Bonus content and early access
      3. Discounts and give aways on GOTA PICCEM Mushroom card game

      The GOTTA PICCEM Poisonous Mushroom Game!

      The Poisonus Fungus Amongus Children's Book!

      1. Full book reading (6 minutes!)

      Tox trinkets (Rep the show at home!)

      Reach the show

      1. Email: Toxtalk1@gmail.com

      More Show Resources

      1. Ryan's Medical Games and Resources
      2. Show Website

      If you are looking for links to Dr. Basset's initiatives check back later, they are not fully launched yet!

      Check it out on Dr. Hamilton's website as well

      Poison Mushrooms! Got’a Pic’em (GOTAAPPICEM) A mnemonic device to sort through mushroom ingestions – The Hot Stove League of EM/Tox

      The GOTAA PPICCEM Mnemonic

      Late-Onset (Severe) Toxic Mushrooms ("GOTA")

      These mushrooms have delayed symptoms (>6 hours) and are associated with significant toxicity:

      G – Gyromitrin (Gyromitra esculenta) – False morels; inhibits GABA, leading to seizures.

      O – Orellanine (Cortinarius spp.) – Causes renal failure; famously poisoned The Horse Whisperer author.

      T – Tricholoma equestre (Man on Horseback) – Leads to rhabdomyolysis.

      A – Amatoxin (Amanita phalloides, Galerina spp.) – Causes liver failure; the most lethal mushroom toxicity.

       

      Early Onset Nausea, Late Toxicity Mushrooms ("A²P²")

      A² – Allenic norleucine (Amanita smithiana) – Found in the Pacific Northwest; early GI symptoms followed by renal failure.

      These may present early but still cause significant toxicity.

      P² – Paxillus spp. – Can cause hemolytic anemia and multi-organ injury.

       

      Early-Onset Nausea Mushrooms ("PICCEM")

      P– Psilocybin (Psilocybe spp.) – Hallucinogenic, similar to LSD, typically low toxicity but...]]>

      Support the show

      Review the show where ever your listening

      Get Messages from Toxo (Join the Newsletter!)

      Join as a supporting member

      1. Ad free episodes
      2. Bonus content and early access
      3. Discounts and give aways on GOTA PICCEM Mushroom card game

      The GOTTA PICCEM Poisonous Mushroom Game!

      The Poisonus Fungus Amongus Children's Book!

      1. Full book reading (6 minutes!)

      Tox trinkets (Rep the show at home!)

      Reach the show

      1. Email: Toxtalk1@gmail.com

      More Show Resources

      1. Ryan's Medical Games and Resources
      2. Show Website

      If you are looking for links to Dr. Basset's initiatives check back later, they are not fully launched yet!

      Check it out on Dr. Hamilton's website as well

      Poison Mushrooms! Got’a Pic’em (GOTAAPPICEM) A mnemonic device to sort through mushroom ingestions – The Hot Stove League of EM/Tox

      The GOTAA PPICCEM Mnemonic

      Late-Onset (Severe) Toxic Mushrooms ("GOTA")

      These mushrooms have delayed symptoms (>6 hours) and are associated with significant toxicity:

      G – Gyromitrin (Gyromitra esculenta) – False morels; inhibits GABA, leading to seizures.

      O – Orellanine (Cortinarius spp.) – Causes renal failure; famously poisoned The Horse Whisperer author.

      T – Tricholoma equestre (Man on Horseback) – Leads to rhabdomyolysis.

      A – Amatoxin (Amanita phalloides, Galerina spp.) – Causes liver failure; the most lethal mushroom toxicity.

       

      Early Onset Nausea, Late Toxicity Mushrooms ("A²P²")

      A² – Allenic norleucine (Amanita smithiana) – Found in the Pacific Northwest; early GI symptoms followed by renal failure.

      These may present early but still cause significant toxicity.

      P² – Paxillus spp. – Can cause hemolytic anemia and multi-organ injury.

       

      Early-Onset Nausea Mushrooms ("PICCEM")

      P– Psilocybin (Psilocybe spp.) – Hallucinogenic, similar to LSD, typically low toxicity but may cause hyperthermia or seizures.

      Symptoms appear within 6 hours and are usually self-limited.

      I – Ibotenic Acid & Muscimol (Amanita muscaria, Amanita pantherina) – Acts like a “mushroom speedball”, causing both stimulant and sedative effects.

      C – Coprine (Coprinus spp., Inky Caps) – Induces disulfiram-like reaction with alcohol.

      E –  Emetic Mushrooms (LBMs: Little Brown Mushrooms) – Various species that cause self-limited vomiting and diarrhea.

      M – Muscarine (Clitocybe, Inocybe spp.) – Cholinergic crisis (SLUDGE symptoms), similar to nerve agents.

      Ryan's Modified Mnemonic GOTTAAA PICCEM

      The GOTTA3  P2ICCEM Mnemonic (Ryan's Modification)

      Late-Onset (Severe) Toxic Mushrooms ("GOTTAA")

      These mushrooms have delayed symptoms (>6 hours) and are associated with significant toxicity:

      G – Gyromitrin (Gyromitra esculenta) – False morels; inhibits GABA, leading to seizures. While this is classically taught, newer data suggests its extremely rare, GI effects, with or without hepatoxicity or minor neurologic symptoms predominate

      O – Orellanine (Cortinarius spp.) – Causes renal failure; famously poisoned The Horse Whisperer author.

      T – Tricholoma equestre (Man on Horseback) – Leads to rhabdomyolysis.

      T- Tender nesting polypore (Hapalopilus rutilans) causes late GI effects,  altered mental status, acidosis, and purple urine!

      A – Amatoxin (Amanita phalloides, Galerina spp.) – Causes liver failure; the most lethal mushroom toxicity.

      A- Acromelic Acid is found in Clitocybe acromelalga in Japan and C amoenolens in France causes erythromelalgia. It can be treated with IV nicotinic acid!

       

       

      Early Onset Nausea, Late Toxicity Mushrooms ("A²P²")

      A² – Allenic norleucine (Amanita smithiana) – Found in the Pacific Northwest; early GI symptoms followed by renal failure.

      These may present early but still cause significant toxicity.

      P² – Paxillus spp. – Can cause hemolytic anemia and multi-organ injury.

       

      Early-Onset Nausea Mushrooms ("PICCEM")

       

      P– Psilocybin (Psilocybe spp.) – Hallucinogenic, similar to LSD, typically low toxicity but may cause hyperthermia or seizures.

      Symptoms appear within 6 hours and are usually self-limited.

      I – Ibotenic Acid & Muscimol (Amanita muscaria, Amanita pantherina) – Acts like a “mushroom speedball”, causing both stimulant and sedative effects.

      C – Coprine (Coprinus spp., Inky Caps) – Induces disulfiram-like reaction with alcohol. Thee are actually many species that have been implciated here incuding Verpa bohemica (early morel) and Boletus luridus (luride bolete).

      C- Cholinergics (muscarine containing, Clitocybe, Inocybe spp.) Cholinergic crisis (SLUDGE symptoms), similar to nerve agents.

      E –  Emetic Mushrooms (LBMs: Little Brown Mushrooms) – Various species that cause self-limited vomiting and diarrhea.

      M – Morchella (morels) while an edible delicacy, they must be thoroughly cooked, recently multiple deaths have been links to eating morels, and the exact mechanism of toxicity is unclear but they result in incredibly fast GI effects. 

      ]]>4c4faccf-e175-422d-b229-4755965423d3Wed, 30 Apr 2025 02:00:00 -060022:39falsebonus      Leafy Greens & Injured Beans: Natures Nephrotoxins – A Poison Lab & NephMadness CollaborationLeafy Greens & Injured Beans: Natures Nephrotoxins – A Poison Lab & NephMadness CollaborationIn this special collaboration with NephMadness, we're diving into the world of nephrotoxins with an expert panel from Virginia Commonwealth University. NephMadness is an educational competition modeled after March Madness, and this year, one of the featured regions focuses on plant-based nephrotoxins. Together, with our expert panel we break down the competing nephrotoxin teams: Tubular Toxins vs. Oxalate Offenders.

      Joining us are Dr. Anna Vinnokova (Nephrologist), Dr. Rachel Khan PharmD (Neph pharmacist), Dr. Ethan Downes (Nephrology fellow), and the legendary nephrotoxicologist, Dr. Josh King (Board certified Nephrologist and Toxicologist). We ALMOST named this episode "Getting Downe with the Mad Neph King and the Bean Queens"... but we didn't, your welcome.

      After the show, go to the blog and vote for your favorite!

      Expect irreverent musings, deep dives into toxic plant exposures, and a mystery case reveal that will leave you questioning your diet.

      Topics and Timeline of Episode:

      Intro

      Listener Guesses With Josh and Ryan– 8:30

      Listener Winner – 25:42

      NephMadness and Guest Introductions – 28:07

      Toxin Reveal – 33:41


      Tubular Toxins – 35:46


      The Oxalate Offenders Team: How Dietary Oxalates Harm the Kidneys – 52:00

      • Historical Context: First recognized through sheep die-offs when herds grazed on Halogeton glomeratus, a high-oxalate plant, leading to fatal poisoning.
      • Oxalate in Plants: Functions to bind excess calcium in the soil.
      • Impact on the Body: Plants high in oxalate but low in calcium can contribute to oxalate accumulation, this leads to binding calcium in the blood, creating calcium oxalate crystals and acute renal calculi. Chronic inflammation from excess oxalate deposition leads to CKD progression.
      • High-Oxalate Foods: Spinach, Swiss chard, rhubarb, cashews. Everything in moderation!

      Practical Advice for Clinicians & Patients on Herbal Medicine Use – 1:00:00

      • Resources for identifying nephrotoxic herbal products
      • Talk to your patients non judgmentally, open conversations, discuss efficacy (or lack there of, see resources below) and safety
      • Herbal medicines are not FDA approved and may not contain what they claim to

      Herbals may not all be safe: Josh King Discovering Contaminants– 1:01:11

      Wrap up– 1:08

      Key Takeaways:

      • Aristolochic acid is a direct nephrotoxin, associated with progressive kidney damage and urothelial cancers.
      • Black licorice toxicity results from...]]>In this special collaboration with NephMadness, we're diving into the world of nephrotoxins with an expert panel from Virginia Commonwealth University. NephMadness is an educational competition modeled after March Madness, and this year, one of the featured regions focuses on plant-based nephrotoxins. Together, with our expert panel we break down the competing nephrotoxin teams: Tubular Toxins vs. Oxalate Offenders.

        Joining us are Dr. Anna Vinnokova (Nephrologist), Dr. Rachel Khan PharmD (Neph pharmacist), Dr. Ethan Downes (Nephrology fellow), and the legendary nephrotoxicologist, Dr. Josh King (Board certified Nephrologist and Toxicologist). We ALMOST named this episode "Getting Downe with the Mad Neph King and the Bean Queens"... but we didn't, your welcome.

        After the show, go to the blog and vote for your favorite!

        Expect irreverent musings, deep dives into toxic plant exposures, and a mystery case reveal that will leave you questioning your diet.

        Topics and Timeline of Episode:

        Intro

        Listener Guesses With Josh and Ryan– 8:30

        Listener Winner – 25:42

        NephMadness and Guest Introductions – 28:07

        Toxin Reveal – 33:41


        Tubular Toxins – 35:46


        The Oxalate Offenders Team: How Dietary Oxalates Harm the Kidneys – 52:00

        • Historical Context: First recognized through sheep die-offs when herds grazed on Halogeton glomeratus, a high-oxalate plant, leading to fatal poisoning.
        • Oxalate in Plants: Functions to bind excess calcium in the soil.
        • Impact on the Body: Plants high in oxalate but low in calcium can contribute to oxalate accumulation, this leads to binding calcium in the blood, creating calcium oxalate crystals and acute renal calculi. Chronic inflammation from excess oxalate deposition leads to CKD progression.
        • High-Oxalate Foods: Spinach, Swiss chard, rhubarb, cashews. Everything in moderation!

        Practical Advice for Clinicians & Patients on Herbal Medicine Use – 1:00:00

        • Resources for identifying nephrotoxic herbal products
        • Talk to your patients non judgmentally, open conversations, discuss efficacy (or lack there of, see resources below) and safety
        • Herbal medicines are not FDA approved and may not contain what they claim to

        Herbals may not all be safe: Josh King Discovering Contaminants– 1:01:11

        Wrap up– 1:08

        Key Takeaways:

        • Aristolochic acid is a direct nephrotoxin, associated with progressive kidney damage and urothelial cancers.
        • Black licorice toxicity results from 11β-hydroxysteroid dehydrogenase inhibition, leading to excess cortisol activity, hypertension, potassium wasting, and rhabdomyolysis.
        • Regulatory gaps in herbal supplements can lead to unexpected toxicities, making consumer awareness essential.
        • High dietary oxalate intake increases the risk of kidney stone formation and chronic kidney disease.
        • NephMadness is open to everyone—vote for your favorite nephrotoxin team and join the conversation!

        Resources Mentioned:


        Follow The Poison Lab:


        Don’t forget to rate and review the podcast on Apple Podcasts, Spotify, or your preferred platform. Share this episode with your fellow nephrology and toxicology enthusiasts!

        Thanks for tuning in, and remember: If it sounds too good to be true, it might just be nephrotoxic. Stay safe and stay curious!

        ]]>        1c289942-e43e-49fa-a9c4-6aaf868ee610Sat, 01 Mar 2025 00:00:00 -060001:21:41falsefull3636A Mysterious Case of Weakness, Low Potassium, and Kidney InjuryA Mysterious Case of Weakness, Low Potassium, and Kidney InjuryDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode 


        ]]>        Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode 


        ]]>        5c49010e-afaf-4835-a27e-b0d332d64146Wed, 12 Feb 2025 00:00:00 -060001:55falsebonus        Should we Give Naloxone in Cardiac Arrest? Insights From the Authors of Three Key StudiesShould we Give Naloxone in Cardiac Arrest? Insights From the Authors of Three Key StudiesFinally, the journal club to rule ALL journal clubs.

        In this episode of The Poison Lab, we tackle one of the biggest topics in emergency medicine and toxicology: Should naloxone be given during opioid-associated cardiac arrest? With three fantastic studies published in 2024, we’re diving into the data and hearing directly from the authors themselves.

        Join host Ryan Feldman as he interviews Dr. Eric Quinn, Dr. Joshua Lupton, and Dr. David Dillon, some of the minds behind the latest research exploring the role of naloxone in out-of-hospital cardiac arrest (OHCA). With perspectives ranging from clinical outcomes to practical implementation, this episode offers a deep dive into what these studies tell us—and what remains unanswered.

        But that’s not all! Featuring special guests Spencer Oliver and Chris Pfingston from EMS 2020, this roundtable discussion incorporates the real-world insights of prehospital EMS professionals who face these decisions every day. Together, the panel unpacks:

        • Conflicting evidence on naloxone’s impact on ROSC and survival.
        • The challenges of interpreting retrospective studies in a high-stakes setting.
        • Ethical dilemmas surrounding randomized trials for naloxone.
        • Practical considerations for paramedics and emergency physicians in the field.

        Whether you’re a toxicologist, EMS professional, or just curious about the intersection of drugs, overdose, and resuscitation, this episode is packed with actionable insights, expert opinions, and engaging discussions.

        Tune in now to explore the science, controversy, and future directions for naloxone in cardiac arrest care!

        Studies discussed in the show


        Studies and guidelines mentioned


        Shows mentioned


        Timestamps and chapters

        Introduction (0:00–12:25)

        • Podcast]]>Finally, the journal club to rule ALL journal clubs.

          In this episode of The Poison Lab, we tackle one of the biggest topics in emergency medicine and toxicology: Should naloxone be given during opioid-associated cardiac arrest? With three fantastic studies published in 2024, we’re diving into the data and hearing directly from the authors themselves.

          Join host Ryan Feldman as he interviews Dr. Eric Quinn, Dr. Joshua Lupton, and Dr. David Dillon, some of the minds behind the latest research exploring the role of naloxone in out-of-hospital cardiac arrest (OHCA). With perspectives ranging from clinical outcomes to practical implementation, this episode offers a deep dive into what these studies tell us—and what remains unanswered.

          But that’s not all! Featuring special guests Spencer Oliver and Chris Pfingston from EMS 2020, this roundtable discussion incorporates the real-world insights of prehospital EMS professionals who face these decisions every day. Together, the panel unpacks:

          • Conflicting evidence on naloxone’s impact on ROSC and survival.
          • The challenges of interpreting retrospective studies in a high-stakes setting.
          • Ethical dilemmas surrounding randomized trials for naloxone.
          • Practical considerations for paramedics and emergency physicians in the field.

          Whether you’re a toxicologist, EMS professional, or just curious about the intersection of drugs, overdose, and resuscitation, this episode is packed with actionable insights, expert opinions, and engaging discussions.

          Tune in now to explore the science, controversy, and future directions for naloxone in cardiac arrest care!

          Studies discussed in the show


          Studies and guidelines mentioned


          Shows mentioned


          Timestamps and chapters

          Introduction (0:00–12:25)

          • Podcast Introduction
          • Overview of The Poison Lab and this episode’s focus.
          • Introduction of the Topic
          • Exploring naloxone use during out-of-hospital cardiac arrest (OHCA).
          • Introduction of Guests
          • Drs. Eric Quinn, Joshua Lupton, and David Dillon: authors of 2024 studies on naloxone in OHCA.
          • Spencer Oliver and Chris Phingston: paramedics and co-hosts of EMS 2020.

          Background (12:26–26:08)

          Rationale for Studying Naloxone in OHCA

          • Addressing the lack of evidence for naloxone use.
          • High prevalence of opioid overdoses in study regions.
          • EMS provider questions about naloxone’s role in suspected opioid-associated OHCA.

          Overview of Existing Guidelines and Research

          • 2021 AHA guidelines and scientific statement on opioid-associated OHCA.

          Challenges in Determining Opioid Overdose as the Cause of OHCA

          • Difficulties with pulse checks and drug testing limitations.

          Summary of the Three 2024 Studies

          • Dr. Quinn’s study: No significant benefit of naloxone.
          • Dr. Lupton’s study: Benefit in early naloxone use for non-shockable rhythms vs no or late naloxone.
          • Dr. Dillon’s study: Benefits of Naloxone in OOHCA, even in presumed non-drug-related OHCA cases.

          Discussion (26:09–48:31)

          Identifying Potential Opioid Overdose

          • Importance of scene cues and patient history.

          Study Methodologies and Confounding Factors

          • Age as a significant confounder.
          • Techniques used to control confounding (logistic regression, propensity score matching).

          Potential Benefits and Harms of Naloxone in OHCA

          • Risks of administering naloxone unnecessarily.
          • Ethical concerns about withholding naloxone in trials.
          • Broader physiological effects of naloxone.
          • Challenges with current CPR ventilation techniques and naloxone’s potential role in improving respiratory drive.

          Review of Current Guidelines

          • AHA: Consider naloxone for high-risk cases.
          • ILCOR: Does not recommend naloxone due to insufficient evidence.

          Future Directions and Conclusion (48:32–55:00)

          Need for a Randomized Controlled Trial (RCT)

          • Importance of defining naloxone’s role in OHCA.
          • Challenges in RCT design, including ethical concerns and patient selection.

          Final Takeaways

          • Cautious optimism, but more research needed.
          • Emphasis on standard ACLS protocols while awaiting further evidence.

          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
          2. Bonus content and early access
          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
          2. Show Website

          ]]>          f3cefde7-a2a5-4bed-96e8-6b670135e806Mon, 06 Jan 2025 07:45:00 -060001:25:38falsefull3535The Poison Lab Holiday Bonus- Stump The Toxicologist Reel 2022The Poison Lab Holiday Bonus- Stump The Toxicologist Reel 2022In this special holiday bonus episode, Ryan takes a look back at some of the most captivating episodes of The Poison Lab from 2022. Get ready for an ultimate test of your toxicology differential diagnosis skills as we compile all the "Stump the Toxicologist" segments into one streamlined, binge-worthy episode. Explore eight unique poisoning cases, be sure to check the show notes for a description of each case. time stamp of where it begins, and links to the original episodes, where you can dive deeper into the discussions and unravel the mysteries behind these intriguing cases!

          Case Teasers and Time Stamps

          Episode 13, March 2nd, 2022: Dr. Howard Greller

          • 0:06:19 Case 1: A 19-year-old male collapses at home and presents to the ED unresponsive, tachycardic, and hypotensive, with a wide QRS complex on EKG and a serum lactate of 20.
          • 0:22:58 Case 2: A 16-year-old female presents to the ED 9 hours after ingesting 100 tablets of an unknown medication in a suicide attempt. She presents with vomiting, lethargy, bloody diarrhea, and a metabolic acidosis. An abdominal x-ray shows numerous radiopaque tablets in her GI tract. She is treated with a redacted antidote and whole bowel irrigation, but her condition worsens and she develops liver failure. She is transferred to a tertiary care center for a liver transplant, but recovers. On day 12, she develops a lower GI bleed and bowel perforation and dies.
          • 0:34:42 Case 3: A seven-month-old child presents with crying, cough, vomiting, and respiratory distress.
          • 0:37:42 Case 4: A 32-year-old male with a history of alcohol use and depression presents to the ED seven hours after ingesting two handfuls of an unknown medication and alcohol in a suicide attempt. He is initially anxious and tremulous, but has normal vital signs and labs, aside from an elevated ethanol level. He has a seizure nine hours after ingestion. His EKG shows a widened QRS, and he becomes hypotensive. He is intubated, placed on vasopressors, and undergoes extracorporeal membrane oxygenation (ECMO) and targeted temperature management (TTM), but dies three days later.

          Episode 15, July 6th, 2022: Dr. Josh Trebach

          • 0:46:11 Case 1: Two British medical students present to the ED after developing nausea, vomiting, paresthesias, myalgias, pruritus, and cold allodynia 12 hours after sharing a meal. Their neurological symptoms persisted for 4 weeks and the cold allodynia for 10 weeks.
          • 0:54:18 - 1:05:23 Case 2: A 16-year-old female presents to the ED unresponsive and cyanotic after intentionally ingesting a substance purchased online. Her oxygen saturation is in the 70s and a methemoglobin level is greater than 30%.
          • 1:05:25 - 1:10:18 Case 3: A 48-year-old female, and co-author of the published case report, presents to the ED 10 minutes after eating a “peppery” tuna steak. She is tachycardic, hypotensive, flushed, and has conjunctival erythema. She also experiences abdominal pain, nausea, vomiting, diarrhea, headache, and chest pain. Her EKG shows tachycardia with ST depression. She requires phenylephrine to maintain her blood pressure. She is treated with famotidine and discharged from the hospital 43 hours later.
          • 1:10:20 – 1:13:16 Case 4: A 63-year-old female presents to the ED 12 hours after ingesting five capsules of a weight loss product. She is bradycardic and has nausea, vomiting, and hyperkalemia.

          Episode 17, November 9th, 2022: Dr. Emily Kieran

          • 1:16:35 Case 1: A 34-year-old female presents to a clinic in West Bengal, India, with a three-year history of skin changes. She has hypo-pigmented macules on a background of hyperpigmentation, creating a “raindrop” like appearance on her...]]>In this special holiday bonus episode, Ryan takes a look back at some of the most captivating episodes of The Poison Lab from 2022. Get ready for an ultimate test of your toxicology differential diagnosis skills as we compile all the "Stump the Toxicologist" segments into one streamlined, binge-worthy episode. Explore eight unique poisoning cases, be sure to check the show notes for a description of each case. time stamp of where it begins, and links to the original episodes, where you can dive deeper into the discussions and unravel the mysteries behind these intriguing cases!

            Case Teasers and Time Stamps

            Episode 13, March 2nd, 2022: Dr. Howard Greller

            • 0:06:19 Case 1: A 19-year-old male collapses at home and presents to the ED unresponsive, tachycardic, and hypotensive, with a wide QRS complex on EKG and a serum lactate of 20.
            • 0:22:58 Case 2: A 16-year-old female presents to the ED 9 hours after ingesting 100 tablets of an unknown medication in a suicide attempt. She presents with vomiting, lethargy, bloody diarrhea, and a metabolic acidosis. An abdominal x-ray shows numerous radiopaque tablets in her GI tract. She is treated with a redacted antidote and whole bowel irrigation, but her condition worsens and she develops liver failure. She is transferred to a tertiary care center for a liver transplant, but recovers. On day 12, she develops a lower GI bleed and bowel perforation and dies.
            • 0:34:42 Case 3: A seven-month-old child presents with crying, cough, vomiting, and respiratory distress.
            • 0:37:42 Case 4: A 32-year-old male with a history of alcohol use and depression presents to the ED seven hours after ingesting two handfuls of an unknown medication and alcohol in a suicide attempt. He is initially anxious and tremulous, but has normal vital signs and labs, aside from an elevated ethanol level. He has a seizure nine hours after ingestion. His EKG shows a widened QRS, and he becomes hypotensive. He is intubated, placed on vasopressors, and undergoes extracorporeal membrane oxygenation (ECMO) and targeted temperature management (TTM), but dies three days later.

            Episode 15, July 6th, 2022: Dr. Josh Trebach

            • 0:46:11 Case 1: Two British medical students present to the ED after developing nausea, vomiting, paresthesias, myalgias, pruritus, and cold allodynia 12 hours after sharing a meal. Their neurological symptoms persisted for 4 weeks and the cold allodynia for 10 weeks.
            • 0:54:18 - 1:05:23 Case 2: A 16-year-old female presents to the ED unresponsive and cyanotic after intentionally ingesting a substance purchased online. Her oxygen saturation is in the 70s and a methemoglobin level is greater than 30%.
            • 1:05:25 - 1:10:18 Case 3: A 48-year-old female, and co-author of the published case report, presents to the ED 10 minutes after eating a “peppery” tuna steak. She is tachycardic, hypotensive, flushed, and has conjunctival erythema. She also experiences abdominal pain, nausea, vomiting, diarrhea, headache, and chest pain. Her EKG shows tachycardia with ST depression. She requires phenylephrine to maintain her blood pressure. She is treated with famotidine and discharged from the hospital 43 hours later.
            • 1:10:20 – 1:13:16 Case 4: A 63-year-old female presents to the ED 12 hours after ingesting five capsules of a weight loss product. She is bradycardic and has nausea, vomiting, and hyperkalemia.

            Episode 17, November 9th, 2022: Dr. Emily Kieran

            • 1:16:35 Case 1: A 34-year-old female presents to a clinic in West Bengal, India, with a three-year history of skin changes. She has hypo-pigmented macules on a background of hyperpigmentation, creating a “raindrop” like appearance on her chest, hands, and soles.
            • 1:19:17 Case 2: An 85-year-old male with a history of Alzheimer’s dementia, COPD, and depression calls 911 for symptomatic hypoglycemia and goes into cardiac arrest after EMS mistakenly administers an unknown substance instead of dextrose 10% (D10). He is asystolic upon arrival to the ED, but achieves return of spontaneous circulation (ROSC) after receiving sodium bicarbonate and 100 mL of 20% intralipid. He subsequently develops wide-complex tachycardia, hypertension, and hypotension, and dies 12 hours later.
            • 1:25:05 Case 3: A 22-month-old female with no past medical history is found altered by a caretaker and brought to the ED. She is tachycardic, with a normal blood pressure and oxygen saturation. She does not respond to naloxone and a CT scan shows severe anoxic brain injury and herniation. She is treated with vasopressors and anticonvulsants, but is declared brain dead several days later.
            • 1:29:26 Case 4: A 45-year-old male with a history of hypertension presents to the ED with severe vomiting and diarrhea that began the morning after he ate two dozen oysters he had caught and cooked two days prior. He initially presents with tachycardia and borderline low blood pressure, but his labs are normal. He becomes increasingly confused over the next several hours and develops a tonic-clonic seizure. He has persistent neurological sequelae, including short-term memory loss, and is discharged from the hospital after 86 days.

            Support the show

            Review the show where ever your listening

            Get Messages from Toxo (Join the Newsletter!)

            Join as a supporting member

            1. Ad free episodes
            2. Bonus content and early access
            3. Discounts and give aways on GOTA PICCEM Mushroom card game

            The GOTTA PICCEM Poisonous Mushroom Game!

            The Poisonus Fungus Amongus Children's Book!

            1. Full book reading (6 minutes!)

            Tox trinkets (Rep the show at home!)

            Reach the show

            1. Email: Toxtalk1@gmail.com

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            ]]>            e40321b1-4e0d-4658-9c91-a3ac0887ff66Wed, 25 Dec 2024 00:00:00 -060002:10:04falsefull3434What Should We Do About Forever Chemicals? With Dr John Downs (The Wizard of PFAS)What Should We Do About Forever Chemicals? With Dr John Downs (The Wizard of PFAS)Join host Ryan Feldman in an insightful episode of "The Poison Lab" as he sits down with Dr. John Downs, Director of the Virginia Poison Center, and one of the leading experts on per- and polyfluoroalkyl substances (PFAS), commonly known as "forever chemicals." Known for their persistence in the environment and human body, PFAS have raised significant public health concerns over the past few decades. Dr. Downs shares his journey through occupational medicine, toxicology, and public health, which uniquely positioned him to provide expertise on PFAS exposure, health risks, and ongoing regulatory efforts. Together, they delve into the origins, uses, and potential health effects of these ubiquitous compounds, while examining government policies, environmental impact, and strategies to reduce exposure. A must-listen for anyone interested in the intersection of environmental health and toxicology!

            Episode Breakdown:

            • 2:42 – What Are Forever Chemicals?
            • 8:01 – History of PFAS and Associated Health Concerns
            • 15:41 – Government Regulation of PFAS
            • 20:42 – Shortcomings in PFAS Regulation
            • 25:20 – How Individuals Can Mitigate Risk
            • 31:15 – Testing for PFAS Levels and Exploring Treatment Options
            • 41:14 – Future Directions and Research Needs for PFAS
            • 45:29 – Conclusion and Outro

            Key Topics Discussed

            2:42 – What Are Forever Chemicals?

            • PFAS are a large group of man-made chemicals that are persistent in the environment and human body.
            • The podcast focuses primarily on PFOA (perfluorooctanoic acid) and PFOS (perfluorooctanoic sulfonic acid), as these were the first compounds identified as having very long elimination half-lives, measured in years, and not undergoing significant human metabolism
            • The podcast mentions that there are potentially thousands of different PFAS compounds and that more research is needed to determine if they all induce the same health effects as PFOA and PFOS
            • Commonly used for their water- and oil-resistant properties in nonstick cookware, fast food wrappers, firefighting foams, and more.

            8:01 – History of PFAS and Associated Health Concerns

            • First created by Dupont chemical, used widely in 1940's in Teflon
            • Large contamination of water by PFAS identified in West Virginia town
            • Led to landmark study in West Virginia (the C8 study) on epidemiological data of PFAS-related health risks.
            • Effects noted: High cholesterol, thyroid dysfunction, ulcerative colitis, hypertension in pregnancy, decreased immune response to vaccine, and certain cancers (testicular and kidney cancer).

            PFAS in the Environment

            • PFAS are not easily degraded, leading to bioaccumulation in humans and animals.
            • Non-stick cookware: Teflon, the trade name for non-stick cookware, was one of the earliest applications of PFAS, utilizing PFOA.
            • Firefighting foam: PFAS was used in firefighting foams, particularly for aviation fuel fires. This has led to contamination of groundwater around military installations and airports.
            • Fast food wrappers and other consumer products: PFAS are used to make products water and oil resistant, including fast food wrappers, clothing, upholstery, and popcorn bags.
            • Biosolids: The nitrogenous waste produced after wastewater treatment, have been found to contain concentrated PFAS. These biosolids are sometimes sold to farms as fertilizer, potentially contaminating water and crops.
            • Ski wax: Ski waxers have been found to have a high degree of PFAS...]]>Join host Ryan Feldman in an insightful episode of "The Poison Lab" as he sits down with Dr. John Downs, Director of the Virginia Poison Center, and one of the leading experts on per- and polyfluoroalkyl substances (PFAS), commonly known as "forever chemicals." Known for their persistence in the environment and human body, PFAS have raised significant public health concerns over the past few decades. Dr. Downs shares his journey through occupational medicine, toxicology, and public health, which uniquely positioned him to provide expertise on PFAS exposure, health risks, and ongoing regulatory efforts. Together, they delve into the origins, uses, and potential health effects of these ubiquitous compounds, while examining government policies, environmental impact, and strategies to reduce exposure. A must-listen for anyone interested in the intersection of environmental health and toxicology!

              Episode Breakdown:

              • 2:42 – What Are Forever Chemicals?
              • 8:01 – History of PFAS and Associated Health Concerns
              • 15:41 – Government Regulation of PFAS
              • 20:42 – Shortcomings in PFAS Regulation
              • 25:20 – How Individuals Can Mitigate Risk
              • 31:15 – Testing for PFAS Levels and Exploring Treatment Options
              • 41:14 – Future Directions and Research Needs for PFAS
              • 45:29 – Conclusion and Outro

              Key Topics Discussed

              2:42 – What Are Forever Chemicals?

              • PFAS are a large group of man-made chemicals that are persistent in the environment and human body.
              • The podcast focuses primarily on PFOA (perfluorooctanoic acid) and PFOS (perfluorooctanoic sulfonic acid), as these were the first compounds identified as having very long elimination half-lives, measured in years, and not undergoing significant human metabolism
              • The podcast mentions that there are potentially thousands of different PFAS compounds and that more research is needed to determine if they all induce the same health effects as PFOA and PFOS
              • Commonly used for their water- and oil-resistant properties in nonstick cookware, fast food wrappers, firefighting foams, and more.

              8:01 – History of PFAS and Associated Health Concerns

              • First created by Dupont chemical, used widely in 1940's in Teflon
              • Large contamination of water by PFAS identified in West Virginia town
              • Led to landmark study in West Virginia (the C8 study) on epidemiological data of PFAS-related health risks.
              • Effects noted: High cholesterol, thyroid dysfunction, ulcerative colitis, hypertension in pregnancy, decreased immune response to vaccine, and certain cancers (testicular and kidney cancer).

              PFAS in the Environment

              • PFAS are not easily degraded, leading to bioaccumulation in humans and animals.
              • Non-stick cookware: Teflon, the trade name for non-stick cookware, was one of the earliest applications of PFAS, utilizing PFOA.
              • Firefighting foam: PFAS was used in firefighting foams, particularly for aviation fuel fires. This has led to contamination of groundwater around military installations and airports.
              • Fast food wrappers and other consumer products: PFAS are used to make products water and oil resistant, including fast food wrappers, clothing, upholstery, and popcorn bags.
              • Biosolids: The nitrogenous waste produced after wastewater treatment, have been found to contain concentrated PFAS. These biosolids are sometimes sold to farms as fertilizer, potentially contaminating water and crops.
              • Ski wax: Ski waxers have been found to have a high degree of PFAS exposure10.
              • Major sources contaminated drinking water, military bases, and consumer product (Teflon, waterproof jackets, popcorn bags etc...)

              15:41 – Government Regulation of PFAS

              • EPA Health Advisory Limits (2009): These were the first non-enforceable limits set for PFOA and PFOS in drinking water. These limits were revised several times over the next 15 years, becoming progressively lower.
              • EPA Enforceable Limits (2024): The EPA published its final rule for enforceable limits, known as maximum contaminant levels (MCLs), in April 2024.
              • The goal is for PFOA and PFOS to be completely non-detectable in drinking water
              • Recognizing that non-detect is difficult to achieve, the EPA set an MCL of 4 parts per trillion for both PFOA and PFOS.
              • A combined limit of 10 parts per trillion was set for four other unspecified PFAS compounds.

              Practical Steps for Individuals

              • Tips for reducing personal PFAS exposure, such as using alternative cookware, avoiding certain fast-food packaging, and considering home water filtration.

              The Future of PFAS Management

              • Ongoing need for more research to fully understand PFAS health impacts and develop effective mitigation strategies.
              • He discusses potential alternatives to PFAS and the importance of balancing industrial needs with public health concerns.

              Additional Resources


              ]]>              18464126-3d2e-4570-9d10-414f03b8c01eWed, 27 Nov 2024 00:00:00 -060001:21:55falsefull3333Poison Updates: Newsletter, Poison Ads?, and Guest Spots on 22 at the Lips and The Continuing Studies PodcastPoison Updates: Newsletter, Poison Ads?, and Guest Spots on 22 at the Lips and The Continuing Studies PodcastRyan on others shows


              Support the show

              Review the show where ever your listening

              Get Messages from Toxo (Join the Newsletter!)

              Join as a supporting member

              1. Ad free episodes
              2. Bonus content and early access
              3. Discounts and give aways on GOTA PICCEM Mushroom card game

              The GOTTA PICCEM Poisonous Mushroom Game!

              The Poisonus Fungus Amongus Children's Book!

              1. Full book reading (6 minutes!)

              Tox trinkets (Rep the show at home!)

              Reach the show

              1. Email: Toxtalk1@gmail.com

              More Show Resources

              1. Ryan's Medical Games and Resources
              2. Show Website

              ]]>              Ryan on others shows


              Support the show

              Review the show where ever your listening

              Get Messages from Toxo (Join the Newsletter!)

              Join as a supporting member

              1. Ad free episodes
              2. Bonus content and early access
              3. Discounts and give aways on GOTA PICCEM Mushroom card game

              The GOTTA PICCEM Poisonous Mushroom Game!

              The Poisonus Fungus Amongus Children's Book!

              1. Full book reading (6 minutes!)

              Tox trinkets (Rep the show at home!)

              Reach the show

              1. Email: Toxtalk1@gmail.com

              More Show Resources

              1. Ryan's Medical Games and Resources
              2. Show Website

              ]]>              1bcce0f8-5986-4a6d-b476-f62e320aca3dSun, 10 Nov 2024 19:52:00 -060013:10falsebonusRyan wants to let you know about some new shows he joined, a new poison newsletter to keep you informed and some changes coming to the show to help with operational costs and improving the show quality!              LIVE from Denver: 2024 NACCT Research Review – Insights from the North American Congress of Clinical ToxicologyLIVE from Denver: 2024 NACCT Research Review – Insights from the North American Congress of Clinical ToxicologyIn 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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                3. 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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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

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                ]]>                0c243d6f-c848-4150-9fc8-6ea24b381d63Fri, 04 Oct 2024 05:00:00 -060001:27:54falsefull3232In 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.The Poison Letter To The Editor: Listener Critiques and Author Responses for The AHA 2023 Life Threatening Poisoning Guidelines with Dr. Michael Mullins, Dr. Donna Seger, Dr. Leon Gussow, and Dr. Eric LavonasThe Poison Letter To The Editor: Listener Critiques and Author Responses for The AHA 2023 Life Threatening Poisoning Guidelines with Dr. Michael Mullins, Dr. Donna Seger, Dr. Leon Gussow, and Dr. Eric LavonasIn 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!


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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

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                1. Email: Toxtalk1@gmail.com

                More Show Resources

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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!


                Support the show

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                Join as a supporting member

                1. Ad free episodes
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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

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                1. Email: Toxtalk1@gmail.com

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                1. Ryan's Medical Games and Resources
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                ]]>                7cda6f31-2a11-4505-91b8-16d72bef141fWed, 28 Aug 2024 05:00:00 -060023:47falsebonusIn 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!                Send in Your Questions For "Ask a Toxicologist"Send in Your Questions For "Ask a Toxicologist"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 toxtalk1@gmail.com to take part in a future episode! (If you would like to be anonymous simply state it in the email)

                Support the show

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                Join as a supporting member

                1. Ad free episodes
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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

                Reach the show

                1. Email: Toxtalk1@gmail.com

                More Show Resources

                1. Ryan's Medical Games and Resources
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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 toxtalk1@gmail.com to take part in a future episode! (If you would like to be anonymous simply state it in the email)

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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

                Reach the show

                1. Email: Toxtalk1@gmail.com

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                1. Ryan's Medical Games and Resources
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                ]]>                876a9efa-6e69-4404-b915-4aa9b97ba263Tue, 13 Aug 2024 12:54:00 -060002:07falsebonusHave 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 toxtalk1@gmail.com to take part in a future episode! (If you would like to be anonymous simply state it in the email)                Open and Shut (Mystery case 31) with Guests Dr. Dan McCabe and Dr. Crissy LawsonOpen and Shut (Mystery case 31) with Guests Dr. Dan McCabe and Dr. Crissy LawsonIn 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). 


                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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                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

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                More Show Resources

                1. Ryan's Medical Games and Resources
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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). 


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

                Support the show

                Review the show where ever your listening

                Get Messages from Toxo (Join the Newsletter!)

                Join as a supporting member

                1. Ad free episodes
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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

                Reach the show

                1. Email: Toxtalk1@gmail.com

                More Show Resources

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                ]]>                ff030b48-7aa8-44ed-8b6f-69b0d2ea06dcFri, 02 Aug 2024 18:10:00 -060001:47:36falsefull3131In 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 (emergency medicine pharmacist).                The Poison Lab - Stump The Toxicologist Reel 2023The Poison Lab - Stump The Toxicologist Reel 2023In 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. 


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                1. Ad free episodes
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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

                Reach the show

                1. Email: Toxtalk1@gmail.com

                More Show Resources

                1. Ryan's Medical Games and Resources
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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. 


                Support the show

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                1. Ad free episodes
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                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

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                1. Email: Toxtalk1@gmail.com

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                ]]>                9351ff9c-24f5-4e4c-b1e3-598bf6768877Mon, 01 Jul 2024 12:45:00 -060001:43:56falsebonusIn 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.                A Mysterious Case of Fatal Arrhythmia in a Newly Wed (Episode #31 Mystery Case)Episode #31 Mystery CaseDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode 


                ]]>                Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode 


                ]]>                184ebe22-0910-42b4-b3d1-b1829118bfbdFri, 14 Jun 2024 20:50:00 -060006:54falsebonusDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode                Where is Episode #31 and Bonus Episodes- Ryan Joins "The Larry Meiller Radio Show" and The "EMS2020" PodcastWhere is Episode #31 and Bonus Episodes- Ryan Joins "The Larry Meiller Radio Show" and The "EMS2020" PodcastA 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


                Ryan on EMS2020 talking prehospital overdose



                ]]>                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


                Ryan on EMS2020 talking prehospital overdose



                ]]>                192eb2a9-6334-4aaf-92a5-c2dabb8ebb88Thu, 06 Jun 2024 16:58:00 -060021:54falsebonusA 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!                Bromazolam, Etonitazene, and Carfentanil Walk into a Bar – Trends in Novel Illicit Drugs with Dr. Alex KrotulskiBromazolam, Etonitazene, and Carfentanil Walk into a Bar – Trends in Novel Illicit Drugs with Dr. Alex KrotulskiIn 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

                Support the show

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                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

                Reach the show

                1. 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

                  Support the show

                  Review the show where ever your listening

                  Get Messages from Toxo (Join the Newsletter!)

                  Join as a supporting member

                  1. Ad free episodes
                  2. Bonus content and early access
                  3. Discounts and give aways on GOTA PICCEM Mushroom card game

                  The GOTTA PICCEM Poisonous Mushroom Game!

                  The Poisonus Fungus Amongus Children's Book!

                  1. Full book reading (6 minutes!)

                  Tox trinkets (Rep the show at home!)

                  Reach the show

                  1. Email: Toxtalk1@gmail.com

                  More Show Resources

                  1. Ryan's Medical Games and Resources
                  2. Show Website

                  ]]>                  75a048c4-449d-4c43-9770-8185767cafe3Wed, 01 May 2024 15:26:00 -060001:46:50falsefull3030In 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.Inefficient Heat (Mystery Case 29) & Toxicologists vs The internet (#10) with Dr. Ann ArensInefficient Heat (Mystery Case 29) & Toxicologists vs The internet with Dr. Ann ArensDr. 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. 


                  Support the show

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                  The GOTTA PICCEM Poisonous Mushroom Game!

                  The Poisonus Fungus Amongus Children's Book!

                  1. Full book reading (6 minutes!)

                  Tox trinkets (Rep the show at home!)

                  Reach the show

                  1. 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. 


                    Support the show

                    Review the show where ever your listening

                    Get Messages from Toxo (Join the Newsletter!)

                    Join as a supporting member

                    1. Ad free episodes
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                    3. Discounts and give aways on GOTA PICCEM Mushroom card game

                    The GOTTA PICCEM Poisonous Mushroom Game!

                    The Poisonus Fungus Amongus Children's Book!

                    1. Full book reading (6 minutes!)

                    Tox trinkets (Rep the show at home!)

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                    ]]>                    e6554560-38c1-40c2-a12e-894326938d37Thu, 29 Feb 2024 06:00:00 -060001:40:07falsefull2929Dr. 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.A Mysterious Case of Fatally High Temperature and Organ Failure in a Young Woman (Episode #29 Mystery Case)Episode #29 Mystery PoisoningDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 29

                    Support the show

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                    The GOTTA PICCEM Poisonous Mushroom Game!

                    The Poisonus Fungus Amongus Children's Book!

                    1. Full book reading (6 minutes!)

                    Tox trinkets (Rep the show at home!)

                    Reach the show

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                    ]]>                    Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 29

                    Support the show

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                    The GOTTA PICCEM Poisonous Mushroom Game!

                    The Poisonus Fungus Amongus Children's Book!

                    1. Full book reading (6 minutes!)

                    Tox trinkets (Rep the show at home!)

                    Reach the show

                    1. Email: Toxtalk1@gmail.com

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                    1. Ryan's Medical Games and Resources
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                    ]]>                    0781cda6-ea2d-4557-a5c5-65f0e31335faFri, 22 Dec 2023 13:36:00 -060006:14falsebonusDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 18                    A very NACCT Holiday-2023 North American Congress of Clinical Toxicology High Yield Abstract ReviewA very NACCT Holiday-2023 North American Congress of Clinical Toxicology High Yield Abstract ReviewIn this episode Ryan is joined by a guest panel (Dr. Grant Comstock MD, Dr. Joshua Trebach MD, Dr. Emily Kiernan DO, and Dr Frank Paloucek PharmD, DABAT) to review nine of the most interesting or clinically impactful research abstracts that were presented at the 2023 North American Congress of Clinical Toxicology (NACCT) in Montreal Canada. If you didn't get a chance to read all 363 research abstracts from some of Toxicology's best and brightest this year, tune in for a high yield review as well as clinical a break down of the studies and their relevance from the expert panel.  

                    Check the show notes for a link to the published abstracts and the list of all studies discussed in the show

                    Abstracts available here

                    10:40- Abstract 1 (PDF #225) Methotrexate toxicity in the setting of therapeutic error, a multicenter retrospective review

                    • Lead author: Andrew Chambers

                    24:12- Abstract #2 (PDF #251) Oleander seeds in candlenut weight loss product strike again

                    • Lead author: Masha Yemets

                    31:16- Abstract #3 (PDF #2) Efficacy of sodium tetrathionate when administered intramuscularly for the treatment of acute oral cyanide toxicity in a swine model (Sus scrofa)

                    • Lead author: Brooke Lajeunesse

                    39:45- Abstract #4 (PDF #10) Is HOUR enough after out-of hospital naloxone for opioid overdose? Prospective preliminary data from real-world implementation of the modified St. Paul’s early discharge rule

                    • Lead author: Stephen Douglas

                    49:05- Abstract #5- Poster titles at NACCT 2013–2022: is NACCT experiencing a pun-demic?

                    • Lead author: Dayne Laskey

                    52:40- Rivastigmine discussion

                    • Lead author: none

                    58:40- Abstract #6 (PDF #5)  Randomized controlled trial of ANEB-001 as an antidote for acute cannabinoid intoxication in healthy adults

                    • Lead author: Andrew Monte

                    1:08:00- Abstract #7 (PDF#216) Successful use of expired physostigmine to treat anticholinergic delirium in a pediatric patient

                    • Lead author: Bryan Hayes

                    01:20:00- Abstract #8 (PDF #202) Enough negativity? Clinically significant salicylism with first detectable concentration twelve hours )post-ingestion

                    • Lead author: Stacey Bangh

                    01:25:24 - Abstract #9 (PDF #267) High sensitivity troponin is frequently elevated after carbon monoxide exposure

                    • Lead author: Abdullatif Aloumi

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                    Review the show where ever your listening

                    Get Messages from Toxo (Join the Newsletter!)

                    Join as a supporting member

                    1. Ad free episodes
                    2. Bonus content and early access
                    3. Discounts and give aways on GOTA PICCEM Mushroom card game

                    The GOTTA PICCEM Poisonous Mushroom Game!

                    The Poisonus Fungus Amongus Children's Book!

                    1. Full book reading (6 minutes!)

                    In this episode Ryan is joined by a guest panel (Dr. Grant Comstock MD, Dr. Joshua Trebach MD, Dr. Emily Kiernan DO, and Dr Frank Paloucek PharmD, DABAT) to review nine of the most interesting or clinically impactful research abstracts that were presented at the 2023 North American Congress of Clinical Toxicology (NACCT) in Montreal Canada. If you didn't get a chance to read all 363 research abstracts from some of Toxicology's best and brightest this year, tune in for a high yield review as well as clinical a break down of the studies and their relevance from the expert panel.  

                    Check the show notes for a link to the published abstracts and the list of all studies discussed in the show

                    Abstracts available here

                    10:40- Abstract 1 (PDF #225) Methotrexate toxicity in the setting of therapeutic error, a multicenter retrospective review

                    • Lead author: Andrew Chambers

                    24:12- Abstract #2 (PDF #251) Oleander seeds in candlenut weight loss product strike again

                    • Lead author: Masha Yemets

                    31:16- Abstract #3 (PDF #2) Efficacy of sodium tetrathionate when administered intramuscularly for the treatment of acute oral cyanide toxicity in a swine model (Sus scrofa)

                    • Lead author: Brooke Lajeunesse

                    39:45- Abstract #4 (PDF #10) Is HOUR enough after out-of hospital naloxone for opioid overdose? Prospective preliminary data from real-world implementation of the modified St. Paul’s early discharge rule

                    • Lead author: Stephen Douglas

                    49:05- Abstract #5- Poster titles at NACCT 2013–2022: is NACCT experiencing a pun-demic?

                    • Lead author: Dayne Laskey

                    52:40- Rivastigmine discussion

                    • Lead author: none

                    58:40- Abstract #6 (PDF #5)  Randomized controlled trial of ANEB-001 as an antidote for acute cannabinoid intoxication in healthy adults

                    • Lead author: Andrew Monte

                    1:08:00- Abstract #7 (PDF#216) Successful use of expired physostigmine to treat anticholinergic delirium in a pediatric patient

                    • Lead author: Bryan Hayes

                    01:20:00- Abstract #8 (PDF #202) Enough negativity? Clinically significant salicylism with first detectable concentration twelve hours )post-ingestion

                    • Lead author: Stacey Bangh

                    01:25:24 - Abstract #9 (PDF #267) High sensitivity troponin is frequently elevated after carbon monoxide exposure

                    • Lead author: Abdullatif Aloumi

                    Support the show

                    Review the show where ever your listening

                    Get Messages from Toxo (Join the Newsletter!)

                    Join as a supporting member

                    1. Ad free episodes
                    2. Bonus content and early access
                    3. Discounts and give aways on GOTA PICCEM Mushroom card game

                    The GOTTA PICCEM Poisonous Mushroom Game!

                    The Poisonus Fungus Amongus Children's Book!

                    1. Full book reading (6 minutes!)

                    Tox trinkets (Rep the show at home!)

                    Reach the show

                    1. Email: Toxtalk1@gmail.com

                    More Show Resources

                    1. Ryan's Medical Games and Resources
                    2. Show Website

                    ]]>6e1ec322-1533-4bc5-8ff1-4eb0d69cb356Thu, 21 Dec 2023 06:00:00 -060001:39:01falsefull2828In this episode Ryan is joined by a guest panel (Dr. Grant Comstock MD, Dr. Joshua Trebach MD, Dr. Emily Kiernan DO, and Dr Frank Paloucek PharmD, DABAT) to review 9 of the most interesting or clinically impactful research abstracts that were presented at the 2023 North American Congress of Clinical Toxicology (NACCT) in Montreal Canada. If you didn't get a chance to read all 363 research abstracts from some of Toxicology's best and brightest this year, tune in for a high yield review as well as clinical a break down of the studies and their relevance from the expert panel. Check the show notes for a link to the published abstracts and the list of all studies discussed in the show.                    APAPalooza. A North American Congress of Clinical Toxicology 2023 Acetaminophen Research HighlightAPAPalooza. A North American Congress of Clinical Toxicology 2023 Acetaminophen Research Highlight
                  2. Support the show!
                  3. Rep the show!
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            In this episode, Ryan dives into cutting-edge research on the treatment of acetaminophen (APAP) overdose, featuring interviews with authors of several key abstracts from the North American Congress of Clinical Toxicology (NACCT) in Montreal Canada (Abstracts and posters available in the show notes). We get first looks insights into research evaluating the impact of fomepizole high risk acetaminophen overdose, as well as who gets fomepizole for acetaminophen overdose and dies. Then we evaluate the effectiveness of standard N-acetylcysteine (NAC) treatment in high risk patients and high dose NAC in high risk patients. Join us for an insightful discussion on these advancements that are reshaping the management of APAP toxicity. Guests include Dr. Masha Yemets PharmD, Dr. Molly Stott PharmD, Dr. Alexandru Ulici PharmD, and Dr. Michael Moss MD.  

             

            • Link to published abstracts
            • (First guest) Abstract #126 Characterizing fomepizole use in acetaminophen deaths reported to US poison centers- Dr. Yemets
            • (Second guest) Abstract #125 Clinical impact of fomepizole as an adjunct therapy in massive acetaminophen overdose- Dr. Stott
            • (Third guest) Abstract #131 Comparison of low-risk and high risk acetaminophen ingestions using the standard prescott protocol of intravenous N-acetylcysteine- Dr. Ulici
            • (Fourth guest) Abstract #130 High-risk acetaminophen overdose outcomes after treatment with standard dose vs. increased dose N-acetylcysteine- Dr. Moss
            • Other studies discussed regarding NAC dosing
            • ATOM 2 Angela Chiew
            • Outcomes of massive APAP treated with regular NAC (Virginia group, lead author Dr. Downes)

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            1. Ad free episodes
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            The GOTTA PICCEM Poisonous Mushroom Game!

            The Poisonus Fungus Amongus Children's Book!

            1. Full book reading (6 minutes!)

            Tox trinkets (Rep the show at home!)

            Reach the show

            1. Email: Toxtalk1@gmail.com

            More Show...]]>

          • Support the show!
          • Rep the show!
          • Show website

          In this episode, Ryan dives into cutting-edge research on the treatment of acetaminophen (APAP) overdose, featuring interviews with authors of several key abstracts from the North American Congress of Clinical Toxicology (NACCT) in Montreal Canada (Abstracts and posters available in the show notes). We get first looks insights into research evaluating the impact of fomepizole high risk acetaminophen overdose, as well as who gets fomepizole for acetaminophen overdose and dies. Then we evaluate the effectiveness of standard N-acetylcysteine (NAC) treatment in high risk patients and high dose NAC in high risk patients. Join us for an insightful discussion on these advancements that are reshaping the management of APAP toxicity. Guests include Dr. Masha Yemets PharmD, Dr. Molly Stott PharmD, Dr. Alexandru Ulici PharmD, and Dr. Michael Moss MD.  

           

          • Link to published abstracts
          • (First guest) Abstract #126 Characterizing fomepizole use in acetaminophen deaths reported to US poison centers- Dr. Yemets
          • (Second guest) Abstract #125 Clinical impact of fomepizole as an adjunct therapy in massive acetaminophen overdose- Dr. Stott
          • (Third guest) Abstract #131 Comparison of low-risk and high risk acetaminophen ingestions using the standard prescott protocol of intravenous N-acetylcysteine- Dr. Ulici
          • (Fourth guest) Abstract #130 High-risk acetaminophen overdose outcomes after treatment with standard dose vs. increased dose N-acetylcysteine- Dr. Moss
          • Other studies discussed regarding NAC dosing
          • ATOM 2 Angela Chiew
          • Outcomes of massive APAP treated with regular NAC (Virginia group, lead author Dr. Downes)

          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
          2. Bonus content and early access
          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
          2. Show Website

          ]]>5fa6de81-9f4f-4fa4-81db-3b0accc47a7dSun, 19 Nov 2023 07:00:00 -060056:33falsefull2727In this episode, Ryan dives into cutting-edge research on the treatment of acetaminophen (APAP) overdose, featuring interviews with authors of several key abstracts from the North American Congress of Clinical Toxicology (NACCT) in Montreal Canada (Abstracts and posters available in the show notes). We get first looks insights into research evaluating the impact of fomepizole high risk acetaminophen overdose, as well as who gets fomepizole for acetaminophen overdose and dies. Then we evaluate the effectiveness of standard N-acetylcysteine (NAC) treatment in high risk patients and high dose NAC in high risk patients. Join us for an insightful discussion on these advancements that are reshaping the management of APAP toxicity. Guests include Dr. Masha Yemets PharmD, Dr. Molly Stott PharmD, Dr. Alexandru Ulici PharmD, and Dr. Michael Moss MD.          AHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity Guidelines with Co-Author Dr. Eric Lavonas MDAHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity Guidelines with Co-Author Dr. Eric Lavonas MDIn this episode, Ryan sits down with Dr. Eric Lavonas MD, a seasoned EM resuscitation guideline writer, emergency medicine physician, medical toxicologist, and lead author of the latest update to the American Heart Association's guidelines for the management of cardiac arrest and life-threatening toxicity due to poisoning. They have an in-depth discussion as they explore the key aspects of the 2023 AHA treatment recommendations and the rationale behind each decision point. A great review to discover how to effectively apply these guidelines in real-world scenarios and find out what knowledge gaps exist in the realm of toxin resuscitation. Be sure to also check out the accompanying mini-episode for a high-yield review of the major treatment recommendations. 


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          1. Ad free episodes
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          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
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          ]]>          In this episode, Ryan sits down with Dr. Eric Lavonas MD, a seasoned EM resuscitation guideline writer, emergency medicine physician, medical toxicologist, and lead author of the latest update to the American Heart Association's guidelines for the management of cardiac arrest and life-threatening toxicity due to poisoning. They have an in-depth discussion as they explore the key aspects of the 2023 AHA treatment recommendations and the rationale behind each decision point. A great review to discover how to effectively apply these guidelines in real-world scenarios and find out what knowledge gaps exist in the realm of toxin resuscitation. Be sure to also check out the accompanying mini-episode for a high-yield review of the major treatment recommendations. 


          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
          2. Bonus content and early access
          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
          2. Show Website

          ]]>          2ef7d693-780c-4d24-af60-80c0598a5b8aSun, 15 Oct 2023 05:31:00 -060055:39falsefull2525In this episode, Ryan sits down with Dr. Eric Lavonas MD, a seasoned EM resuscitation guideline writer, emergency medicine physician, medical toxicologist, and lead author of the latest update to the American Heart Association's guidelines for the management of cardiac arrest and life-threatening toxicity due to poisoning. They have an in-depth discussion as they explore the key aspects of the 2023 AHA treatment recommendations and the rationale behind each decision point. A great review to discover how to effectively apply these guidelines in real-world scenarios and find out what knowledge gaps exist in the realm of toxin resuscitation. Be sure to also check out the accompanying mini-episode for a high-yield review of the major treatment recommendations .          High Yield Highlight- 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to PoisoningHigh Yield Highlight- 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to PoisoningIn this episode Ryan does a high yield "just the facts" break down of the recently released "2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Tune in to learn about the most recent treatment recommendations made by AHA via a panel of toxicology experts. This was released alongside a full interview with the lead author Dr. Eric Lavonas MD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).


          Support the show

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          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
          2. Show Website

          ]]>          In this episode Ryan does a high yield "just the facts" break down of the recently released "2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Tune in to learn about the most recent treatment recommendations made by AHA via a panel of toxicology experts. This was released alongside a full interview with the lead author Dr. Eric Lavonas MD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).


          Support the show

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          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

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          ]]>          84361002-eb72-4651-b553-ee2baec08777Sun, 15 Oct 2023 05:31:00 -060020:31falsebonusIn this episode Ryan does a high yield "just the facts" break down of the recently released "2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Tune in to learn about the most recent treatment recommendations made by AHA via a panel of toxicology experts. This was released alongside a full interview with the lead author Dr. Eric Lavonas MD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).          The Poison Lab Does Psilocybin- A Deep Dive with Psilocybin Research Pharmacist Dr. Paul HutsonThe Poison Lab Does Psilocybin- A Deep Dive with Psilocybin Research Pharmacist Dr. Paul HutsonIn this enlightening episode, Ryan engages in a deep conversation with Dr. Paul Hutson, PharmD, a renowned researcher in the field of psilocybin and director of the Transdisciplinary Center for Research in Psychoactive Substances at the University of Wisconsin Madison. Dr. Hutson shares his extensive knowledge and insights into the promising role of psilocybin in the treatment of depression and substance use disorder.  

          Throughout the discussion, they delve into the research that supports the use of psilocybin in medical therapy, shedding light on the rigorous processes involved in conducting such studies. Dr. Hutson elucidates the efficacy and safety findings that have emerged from his and others research, offering listeners a glimpse into the potential future of psilocybin in mainstream medical practices. Listeners will gain a deeper understanding of the meticulous approach to research that ensures both safety and effectiveness. Dr. Hutson shares firsthand experiences and observations, providing a rich and detailed perspective on the current state of psilocybin research. Moreover, the conversation ventures into the practical aspects of integrating psilocybin into contemporary medical practices, discussing the potential frameworks and guidelines that would govern its use. They explore what the future might hold for patients and practitioners alike as they stand on the cusp of a revolutionary shift in mental health treatment.

          Whether you're a healthcare professional keen on the latest developments in medical research or someone interested in the evolving landscape of mental health treatment, this episode promises to be a rich source of information and insight. Tune in to be informed and to foster a deeper understanding of the promising horizon that psilocybin research is unveiling in the medical community.


          Support the show

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          Join as a supporting member

          1. In this enlightening episode, Ryan engages in a deep conversation with Dr. Paul Hutson, PharmD, a renowned researcher in the field of psilocybin and director of the Transdisciplinary Center for Research in Psychoactive Substances at the University of Wisconsin Madison. Dr. Hutson shares his extensive knowledge and insights into the promising role of psilocybin in the treatment of depression and substance use disorder.  

            Throughout the discussion, they delve into the research that supports the use of psilocybin in medical therapy, shedding light on the rigorous processes involved in conducting such studies. Dr. Hutson elucidates the efficacy and safety findings that have emerged from his and others research, offering listeners a glimpse into the potential future of psilocybin in mainstream medical practices. Listeners will gain a deeper understanding of the meticulous approach to research that ensures both safety and effectiveness. Dr. Hutson shares firsthand experiences and observations, providing a rich and detailed perspective on the current state of psilocybin research. Moreover, the conversation ventures into the practical aspects of integrating psilocybin into contemporary medical practices, discussing the potential frameworks and guidelines that would govern its use. They explore what the future might hold for patients and practitioners alike as they stand on the cusp of a revolutionary shift in mental health treatment.

            Whether you're a healthcare professional keen on the latest developments in medical research or someone interested in the evolving landscape of mental health treatment, this episode promises to be a rich source of information and insight. Tune in to be informed and to foster a deeper understanding of the promising horizon that psilocybin research is unveiling in the medical community.


            Support the show

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            The GOTTA PICCEM Poisonous Mushroom Game!

            The Poisonus Fungus Amongus Children's Book!

            1. Full book reading (6 minutes!)

            Tox trinkets (Rep the show at home!)

            Reach the show

            1. Email: Toxtalk1@gmail.com

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            ]]>            e7e0e38e-9382-4312-9d59-3d99192f6b70Wed, 20 Sep 2023 08:00:00 -060001:42:40falsefull2424In this enlightening episode, Ryan engages in a deep conversation with Dr. Paul Hutson, PharmD, a renowned researcher in the field of psilocybin and director of the Transdisciplinary Center for Research in Psychoactive Substances at the University of Wisconsin Madison. Dr. Hutson shares his extensive knowledge and insights into the promising role of psilocybin in the treatment of depression and substance use disorder. Throughout the discussion, they delve into the research that supports the use of psilocybin in medical therapy, shedding light on the rigorous processes involved in conducting such studies. Dr. Hutson elucidates the efficacy and safety findings that have emerged from his and others research, offering listeners a glimpse into the potential future of psilocybin in mainstream medical practices. Listeners will gain a deeper understanding of the meticulous approach to research that ensures both safety and effectiveness. Dr. Hutson shares firsthand experiences and observations, providing a rich and detailed perspective on the current state of psilocybin research. Moreover, the conversation ventures into the practical aspects of integrating psilocybin into contemporary medical practices, discussing the potential frameworks and guidelines that would govern its use. They explore what the future might hold for patients and practitioners alike as they stand on the cusp of a revolutionary shift in mental health treatment. Whether you're a healthcare professional keen on the latest developments in medical research or someone interested in the evolving landscape of mental health treatment, this episode promises to be a rich source of information and insight. Tune in to be informed and to foster a deeper understanding of the promising horizon that psilocybin research is unveiling in the medical community.New Podcast Artwork & Tox Trinkets!New Podcast Artwork & Tox Trinkets!New Art and New Tox Trinkets. If you want to share your tox joy in the real world, find some trinkets here: https://www.etsy.com/shop/thepoisonlab

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            1. Ad free episodes
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            The GOTTA PICCEM Poisonous Mushroom Game!

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            1. Full book reading (6 minutes!)

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            ]]>            New Art and New Tox Trinkets. If you want to share your tox joy in the real world, find some trinkets here: https://www.etsy.com/shop/thepoisonlab

            Support the show

            Review the show where ever your listening

            Get Messages from Toxo (Join the Newsletter!)

            Join as a supporting member

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            The GOTTA PICCEM Poisonous Mushroom Game!

            The Poisonus Fungus Amongus Children's Book!

            1. Full book reading (6 minutes!)

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            ]]>            95d01ed9-6caa-4cee-a57a-6072708e7e86Mon, 04 Sep 2023 05:38:00 -060002:21falsebonusNew Art and New Tox Trinkets. If you want to share your tox joy in the real world, find some trinkets here: https://www.etsy.com/shop/thepoisonlab            Acetaminophen Poisoning Management: US & Canada Consensus Statement with Co-Author Dr. Richard Dart, MD, PhDAcetaminophen Poisoning Management: US & Canada Consensus Statement with Co-Author Dr. Richard Dart, MD, PhD
          2. Mini episode- High-yield over view of Management of Acetaminophen Poisoning in the US and Canada Consensus Statement 

        In this Ryan sits down with Dr. Richard Dart MD, PhD. He is the lead author of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informed on the most recent treatment recommendations.  They dive in to the definitions established by the guideline and notable treatment recommendations, dissecting the ratinonale for each desiscion point and how to apply the guidelines. A mini episode was released along side this episode that is a high yield review of major treatment recommendations and definitions estabilished by the consensus statement.  

        Links :


        Definitions made by the guideline

        • Acute ingestion
        • Any overdose taken with 24 hours period
        • Overdose "dose" not defined
        • >7.5 g in 24 h was criteria for Rumack Matthew nomogram
        • Consensus statement
        • Adult overdose at 10g/d or 200 mg/kg/d in <24 hours= potentially toxic
        • Pediatric <6 year at 150 mg/kg/d in <24 h = potentially toxic
        • Repeated Supra Therapeutic Ingestion (RSTI)
        • Overdose "dose"
        • Repeated dosing totaling
        • 6g/d or 150 mg/kg/day x 24-48 h = potential toxic
        • 4g/d or 100 mg/kg/day x >48 h = potential toxic (Recognize this means some people could be toxic at therapeutic dosing, but if they do not have symptoms not likely)
        • High risk ingestion
        • Reported dose >30 grams OR
        • [APAP] 2 x Rummack-Matthew nomogram treatment line
        • NAC stopping criteria
        • APAP<10
        • INR<2
        • AST/ALT Normal for patient or decreased by 25-50%
        • Patient clinically well

        Notable treatment recommendations

        • RSTI
        • If patient has history of RSTI (>6 g x 24-48 h, >4 g x >48 hours) AND signs of APAP toxicity (vomiting, RUQ abd pain, AMS)
        • Treat if APAP >20 ug/ml OR AST/ALT elevated
        • Acute
        • Non-detectable [APAP] between 2 and 4 hours excludes ingestion
        • Give SDAC w/in 4 hours (something I’ve been a proponent of since ATOM2)
        • Treat
        • Start treatment with NAC if unable to plot on nomogram by 8 hours
        • NAC dose
        • “Higher dose” NAC (undefined) for high risk ingestion
        • Minimum NAC regimen should include 300 mg/kg orally or within 20-24 hours
        • CAP NAC dose at 100 kg (this was known with PO, but IV there was always some question since it delivers less overall)
        • Unique scenarios
        • Line crossers
        • APAP with anticholinergic or opioid
        • If 1st  concentration below treatment line repeat in 4-6 hours
        • APAP Extended release
        • If 1st  concentration below treatment line @ 4-12 hours, repeat in 4-6 hours
        • Dialysis-
        • Dialyze If APAP...]]>
        • Mini episode- High-yield over view of Management of Acetaminophen Poisoning in the US and Canada Consensus Statement 

        In this Ryan sits down with Dr. Richard Dart MD, PhD. He is the lead author of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informed on the most recent treatment recommendations.  They dive in to the definitions established by the guideline and notable treatment recommendations, dissecting the ratinonale for each desiscion point and how to apply the guidelines. A mini episode was released along side this episode that is a high yield review of major treatment recommendations and definitions estabilished by the consensus statement.  

        Links :


        Definitions made by the guideline

        • Acute ingestion
        • Any overdose taken with 24 hours period
        • Overdose "dose" not defined
        • >7.5 g in 24 h was criteria for Rumack Matthew nomogram
        • Consensus statement
        • Adult overdose at 10g/d or 200 mg/kg/d in <24 hours= potentially toxic
        • Pediatric <6 year at 150 mg/kg/d in <24 h = potentially toxic
        • Repeated Supra Therapeutic Ingestion (RSTI)
        • Overdose "dose"
        • Repeated dosing totaling
        • 6g/d or 150 mg/kg/day x 24-48 h = potential toxic
        • 4g/d or 100 mg/kg/day x >48 h = potential toxic (Recognize this means some people could be toxic at therapeutic dosing, but if they do not have symptoms not likely)
        • High risk ingestion
        • Reported dose >30 grams OR
        • [APAP] 2 x Rummack-Matthew nomogram treatment line
        • NAC stopping criteria
        • APAP<10
        • INR<2
        • AST/ALT Normal for patient or decreased by 25-50%
        • Patient clinically well

        Notable treatment recommendations

        • RSTI
        • If patient has history of RSTI (>6 g x 24-48 h, >4 g x >48 hours) AND signs of APAP toxicity (vomiting, RUQ abd pain, AMS)
        • Treat if APAP >20 ug/ml OR AST/ALT elevated
        • Acute
        • Non-detectable [APAP] between 2 and 4 hours excludes ingestion
        • Give SDAC w/in 4 hours (something I’ve been a proponent of since ATOM2)
        • Treat
        • Start treatment with NAC if unable to plot on nomogram by 8 hours
        • NAC dose
        • “Higher dose” NAC (undefined) for high risk ingestion
        • Minimum NAC regimen should include 300 mg/kg orally or within 20-24 hours
        • CAP NAC dose at 100 kg (this was known with PO, but IV there was always some question since it delivers less overall)
        • Unique scenarios
        • Line crossers
        • APAP with anticholinergic or opioid
        • If 1st  concentration below treatment line repeat in 4-6 hours
        • APAP Extended release
        • If 1st  concentration below treatment line @ 4-12 hours, repeat in 4-6 hours
        • Dialysis-
        • Dialyze If APAP >900 w/ AMS or acidosis.
        • NAC IV rate during HD 12.5 mg/kg/hr minimum. No dose change for PO (not new but good reminders)
        • Consult liver transplant for rapid AST/ALT inc w/ coagulopathy, AMS, or mulistytem organ failure
        • The addition of fomepizole to acetylcysteine in the treatment of serious acetaminophen ingestions has been proposed. The panel concluded that the data available did not support a standard recommendation. As for any complicated or serious acetaminophen poisoning, a PC or clinical toxicologist should be consulted.

        Support the show

        Review the show where ever your listening

        Get Messages from Toxo (Join the Newsletter!)

        Join as a supporting member

        1. Ad free episodes
        2. Bonus content and early access
        3. Discounts and give aways on GOTA PICCEM Mushroom card game

        The GOTTA PICCEM Poisonous Mushroom Game!

        The Poisonus Fungus Amongus Children's Book!

        1. Full book reading (6 minutes!)

        Tox trinkets (Rep the show at home!)

        Reach the show

        1. Email: Toxtalk1@gmail.com

        More Show Resources

        1. Ryan's Medical Games and Resources
        2. Show Website

        ]]>493020f8-9624-47f2-9ed3-46daa63b60a2Fri, 18 Aug 2023 08:00:00 -060058:05falsefull2323In this Ryan sits down with Dr. Richard Dart MD, PhD. He is the lead author of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informed on the most recent treatment recommendations. They dive in to the definitions established by the guideline and notable treatment recommendations, dissecting the rationale for each decision point and how to apply the guidelines. A mini episode was released along side this episode that is a high yield review of major treatment recommendations and definitions established by the consensus statement.        High Yield Highlight-Consensus Statement on Management of Acetaminophen Poisoning in the US and CanadaHigh Yield Highlight-Consensus Statement on Management of Acetaminophen Poisoning in the US and CanadaThis episode is a a high yield "just the facts" break down of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informed on the most recent treatment recommendations. This was released alongside a full interview with the consensus statement corresponding author Dr. Richard Dart MD, PhD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).

        Link to the guidelines:


        Definitions made by the guideline

        • Acute ingestion
        • >7.5 g in 24 h per Rummack Matthew initial studies
        • 10 g/d or 200 mg/kg/day in <24 h also suggested 
        • Repeated Supra Therapeutic Ingestion (RSTI)
        • Repeated dosing totaling
        • 10g or 200 mg/kg in 24 hour
        • 6g/d or 150 mg/kg/day x 48 h
        • 4g/d or 100 mg/kg/day x >48 h
        • High risk ingestion
        • Reported dose >30 grams OR
        • [APAP] 2 x Rummack-Matthew nomogram treatment line
        • NAC stopping criteria
        • APAP<10
        • INR<2
        • AST/ALT Normal for patient or decreased by 25-50%
        • Patient clinically well

        Notable treatment recommendations

        • RSTI
        • If patient has history of RSTI (>6 g x 24-48 h, >4 g x >48 hours) AND signs of APAP toxicity (vomiting, RUQ abd pain, AMS)
        • Treat if APAP >20 ug/ml OR AST/ALT elevated
        • Acute
        • Non-detectable [APAP] between 2 and 4 hours excludes ingestion
        • Give SDAC w/in 4 hours (something I’ve been a proponent of since ATOM2)
        • Start treatment with NAC if unable to plot on nomogram by 8 hours
        • NAC dose
        • “Higher dose” NAC (undefined) for high risk ingestion
        • Minimum NAC regimen should include 300 mg/kg orally or within 20-24 hours
        • CAP NAC dose at 100 kg (this was known with PO, but IV there was always some question since it delivers less overall)
        • Unique scenarios
        • Line crossers
        • APAP with anticholinergic or opioid
        • If 1st  concentration below treatment line repeat in 4-6 hours
        • APAP Extended release
        • If 1st  concentration below treatment line @ 4-12 hours, repeat in 4-6 hours
        • Dialysis-
        • Dialyze If APAP >900 w/ AMS or acidosis.
        • NAC IV rate during HD 12.5 mg/kg/hr minimum. No dose change for PO (not new but good reminders)
        • Consult liver transplant for rapid AST/ALT inc w/ coagulopathy, AMS, or mulistytem organ failure
        • The addition of fomepizole to acetylcysteine in the treatment of serious acetaminophen ingestions has been proposed. The panel concluded that the data available did not support a standard recommendation. As for any complicated or serious acetaminophen poisoning, a PC or clinical toxicologist should be consulted.

        Support the show

        Review the show where ever your listening

        Get Messages from Toxo (Join the Newsletter!)

        Join as a supporting member

        1. This episode is a a high yield "just the facts" break down of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informed on the most recent treatment recommendations. This was released alongside a full interview with the consensus statement corresponding author Dr. Richard Dart MD, PhD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).

          Link to the guidelines:


          Definitions made by the guideline

          • Acute ingestion
          • >7.5 g in 24 h per Rummack Matthew initial studies
          • 10 g/d or 200 mg/kg/day in <24 h also suggested 
          • Repeated Supra Therapeutic Ingestion (RSTI)
          • Repeated dosing totaling
          • 10g or 200 mg/kg in 24 hour
          • 6g/d or 150 mg/kg/day x 48 h
          • 4g/d or 100 mg/kg/day x >48 h
          • High risk ingestion
          • Reported dose >30 grams OR
          • [APAP] 2 x Rummack-Matthew nomogram treatment line
          • NAC stopping criteria
          • APAP<10
          • INR<2
          • AST/ALT Normal for patient or decreased by 25-50%
          • Patient clinically well

          Notable treatment recommendations

          • RSTI
          • If patient has history of RSTI (>6 g x 24-48 h, >4 g x >48 hours) AND signs of APAP toxicity (vomiting, RUQ abd pain, AMS)
          • Treat if APAP >20 ug/ml OR AST/ALT elevated
          • Acute
          • Non-detectable [APAP] between 2 and 4 hours excludes ingestion
          • Give SDAC w/in 4 hours (something I’ve been a proponent of since ATOM2)
          • Start treatment with NAC if unable to plot on nomogram by 8 hours
          • NAC dose
          • “Higher dose” NAC (undefined) for high risk ingestion
          • Minimum NAC regimen should include 300 mg/kg orally or within 20-24 hours
          • CAP NAC dose at 100 kg (this was known with PO, but IV there was always some question since it delivers less overall)
          • Unique scenarios
          • Line crossers
          • APAP with anticholinergic or opioid
          • If 1st  concentration below treatment line repeat in 4-6 hours
          • APAP Extended release
          • If 1st  concentration below treatment line @ 4-12 hours, repeat in 4-6 hours
          • Dialysis-
          • Dialyze If APAP >900 w/ AMS or acidosis.
          • NAC IV rate during HD 12.5 mg/kg/hr minimum. No dose change for PO (not new but good reminders)
          • Consult liver transplant for rapid AST/ALT inc w/ coagulopathy, AMS, or mulistytem organ failure
          • The addition of fomepizole to acetylcysteine in the treatment of serious acetaminophen ingestions has been proposed. The panel concluded that the data available did not support a standard recommendation. As for any complicated or serious acetaminophen poisoning, a PC or clinical toxicologist should be consulted.

          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
          2. Bonus content and early access
          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
          2. Show Website

          ]]>          e2c48f98-07b4-4dd4-b98b-57884d19eca0Fri, 18 Aug 2023 08:00:00 -060013:12falsebonusIn this episode Ryan does a high yield "just the facts" break down of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the AACT, ACMT, APC, and the Canadian Association of Poison Centers. Tune in to learn about the most recent treatment recommendations made by the premier U.S. toxicology organizations. This was released alongside a full interview with the consensus statement corresponding author Dr. Richard Dart MD, PhD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).Toxicologists vs the Internet (#9) With Guest Dr Frank Paloucek PharmD DABAT FAACTToxicologists vs the Internet (#9) With Guest Dr Frank Paloucek PharmD DABAT FAACTDr. Frank Paloucek, PharmD, DABAT (@itsalltox) joins the show. He was one of the very first emergency medicine pharmacists and one of the original board-certified clinical toxicologists (DABAT). He is now a proudly retired professor emeritus at The Univeristy of Illinois at Chicago. In his tenure there he spent nearly 20 years as the program director for their clinical pharmacy residency, was an integral part of the Toxikon Consortium toxicology fellowship, and coauthored the text book "Poisoning and Toxicology Handbook (Poisoning and Toxicology Handbook (Leiken & Paloucek's)) 4th Edition. Frank and Ryan kick off the show hearing about Frank's fledgling years working in an emergency department without EM attendings. Then they bust some toxicology myths (do you REALLY need BAL before Calcium disodium edetate in severe lead poisoning? Frank thinks no...) before jumping into solving some toxic cases. Finally, the episode ends with Frank and Ryan solving a case of poisoned AI. They ask GPT to take on the role of a poisoned patient and work together to identify the culprit. Enjoy and don't forget to leave a review. 

          Introduction


          Stump the toxicologist

          Case 1


          Case 2


          Case 3


          Case 4


          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
          2. Bonus content and early access
          3. Dr. Frank Paloucek, PharmD, DABAT (@itsalltox) joins the show. He was one of the very first emergency medicine pharmacists and one of the original board-certified clinical toxicologists (DABAT). He is now a proudly retired professor emeritus at The Univeristy of Illinois at Chicago. In his tenure there he spent nearly 20 years as the program director for their clinical pharmacy residency, was an integral part of the Toxikon Consortium toxicology fellowship, and coauthored the text book "Poisoning and Toxicology Handbook (Poisoning and Toxicology Handbook (Leiken & Paloucek's)) 4th Edition. Frank and Ryan kick off the show hearing about Frank's fledgling years working in an emergency department without EM attendings. Then they bust some toxicology myths (do you REALLY need BAL before Calcium disodium edetate in severe lead poisoning? Frank thinks no...) before jumping into solving some toxic cases. Finally, the episode ends with Frank and Ryan solving a case of poisoned AI. They ask GPT to take on the role of a poisoned patient and work together to identify the culprit. Enjoy and don't forget to leave a review. 

            Introduction


            Stump the toxicologist

            Case 1


            Case 2


            Case 3


            Case 4


            Support the show

            Review the show where ever your listening

            Get Messages from Toxo (Join the Newsletter!)

            Join as a supporting member

            1. Ad free episodes
            2. Bonus content and early access
            3. Discounts and give aways on GOTA PICCEM Mushroom card game

            The GOTTA PICCEM Poisonous Mushroom Game!

            The Poisonus Fungus Amongus Children's Book!

            1. Full book reading (6 minutes!)

            Tox trinkets (Rep the show at home!)

            Reach the show

            1. Email: Toxtalk1@gmail.com

            More Show Resources

            1. Ryan's Medical Games and Resources
            2. Show Website

            ]]>            6913e87c-9e74-463a-aff2-4bd3a8e14102Wed, 09 Aug 2023 08:00:00 -060001:33:34falsefull2323Dr. Frank Paloucek, PharmD, DABAT (@itsalltox) joins the show. He was one of the very first emergency medicine pharmacists and one of the original board-certified clinical toxicologists (DABAT). He is now a proudly retired professor emeritus at The Univeristy of Illinois at Chicago. In his tenure there he spent nearly 20 years as the program director for their clinical pharmacy residency, was an integral part of the Toxikon Consortium toxicology fellowship, and coauthored the text book "Poisoning and Toxicology Handbook (Poisoning and Toxicology Handbook (Leiken & Paloucek's)) 4th Edition. Frank and Ryan kick off the show hearing about Frank's fledgling years working in an emergency department without EM attendings. Then they bust some toxicology myths (do you REALLY need BAL before Calcium disodium edetate in severe lead poisoning? Frank thinks no...) before jumping into solving some toxic cases. Finally, the episode ends with Frank and Ryan solving a case of poisoned AI. They ask GPT to take on the role of a poisoned patient and work together to identify the culprit. Enjoy and don't forget to leave a review.The Undead Patient: The Complexity of Brain Death Determination in Drug OverdoseThe Undead Patient: The Complexity of Brain Death Determination in Drug OverdoseIn this episode Ryan explores the concept of brain death and the implications of drug overdoses causing false positive diagnosis of brain death. He is joined by an author of the ACMT Position statement on brain death in overdose (Dr. Andrew Stolbach MD) as well as authors of two case reports (neuro critical care physician Dr. Ranier Reyes and emergency physician Dr. Doug Stranges) involving bupropion where patients had absent brain stem reflexes after overdose but made a full neurologic recovery. We delve into the criteria used to determine brain death and the challenges faced by families and healthcare professionals when dealing with this sensitive topic. 

            • 00:00-19:00 Introduction to brain death guidelines
            • 19:00-28:00 Introduction to limitations in guidelines regarding overdose
            • 28:30-38:00 Interview with ACMT Position statement author
            • 39:00- End- Interview with Bupropion brain death mimic authors and summary

            Links references in show


            Support the show

            Review the show where ever your listening

            Get Messages from Toxo (Join the Newsletter!)

            Join as a supporting member

            1. Ad free episodes
            2. Bonus content and early access
            3. Discounts and give...]]>In this episode Ryan explores the concept of brain death and the implications of drug overdoses causing false positive diagnosis of brain death. He is joined by an author of the ACMT Position statement on brain death in overdose (Dr. Andrew Stolbach MD) as well as authors of two case reports (neuro critical care physician Dr. Ranier Reyes and emergency physician Dr. Doug Stranges) involving bupropion where patients had absent brain stem reflexes after overdose but made a full neurologic recovery. We delve into the criteria used to determine brain death and the challenges faced by families and healthcare professionals when dealing with this sensitive topic. 

              • 00:00-19:00 Introduction to brain death guidelines
              • 19:00-28:00 Introduction to limitations in guidelines regarding overdose
              • 28:30-38:00 Interview with ACMT Position statement author
              • 39:00- End- Interview with Bupropion brain death mimic authors and summary

              Links references in show


              Support the show

              Review the show where ever your listening

              Get Messages from Toxo (Join the Newsletter!)

              Join as a supporting member

              1. Ad free episodes
              2. Bonus content and early access
              3. Discounts and give aways on GOTA PICCEM Mushroom card game

              The GOTTA PICCEM Poisonous Mushroom Game!

              The Poisonus Fungus Amongus Children's Book!

              1. Full book reading (6 minutes!)

              Tox trinkets (Rep the show at home!)

              Reach the show

              1. Email: Toxtalk1@gmail.com

              More Show Resources

              1. Ryan's Medical Games and Resources
              2. Show Website

              ]]>              dc3bd959-d3ad-45b4-b638-67afbec75e89Tue, 06 Jun 2023 05:00:00 -060001:22:05falsefull2121In this episode Ryan explores the concept of brain death and the implications of drug overdoses causing false positive diagnosis of brain death. He is joined by an author of the ACMT Position statement on brain death in overdose (Dr. Andrew Stolbach MD) as well as authors of two case reports (neuro critical care physician Dr. Ranier Reyes and emergency physician Dr. Doug Stranges) involving bupropion where patients had absent brain stem reflexes after overdose but made a full neurologic recovery. We delve into the criteria used to determine brain death and the challenges faced by families and healthcare professionals when dealing with this sensitive topic.Toxicologists vs the Internet (#8) With Guest Dr Adam Blumenberg MDToxicologists vs the Internet (#8) With Guest Dr Adam Blumenberg MDDr. Adam Blumenberg, MD (@ABlumenbergMD) Join's the show. He is an emergency medicine physician, medical toxicologist, and Assistant Professor at Columbia University Medical Center in New York City. He hosts his own toxicology youtube series (www.ToxicHistory.com) and has developed multiple free medical education software programs in toxicology (www.toxicrunner.net) and medical simulation (www.medsimstudio.com). Most impressively, he has produced his own free base lidocaine crystals on a stove top, if you ask nicely he might just loan you one. He joins the show to sleuth the cause of fatal poisoning cases and tackle internet questions from reddit.com/r/askdrugs

               


              Cases

              Case 1


              Case 2


              Case 3


              Case 4


              Case 5


              Questions


              Support the show

              Review the show where ever your listening

              Get Messages from Toxo (Join the Newsletter!)

              Join as a supporting member

              1. Ad free episodes
              2. Bonus content and early access
              3. Discounts and give aways on GOTA PICCEM Mushroom card...]]>Dr. Adam Blumenberg, MD (@ABlumenbergMD) Join's the show. He is an emergency medicine physician, medical toxicologist, and Assistant Professor at Columbia University Medical Center in New York City. He hosts his own toxicology youtube series (www.ToxicHistory.com) and has developed multiple free medical education software programs in toxicology (www.toxicrunner.net) and medical simulation (www.medsimstudio.com). Most impressively, he has produced his own free base lidocaine crystals on a stove top, if you ask nicely he might just loan you one. He joins the show to sleuth the cause of fatal poisoning cases and tackle internet questions from reddit.com/r/askdrugs

                 


                Cases

                Case 1


                Case 2


                Case 3


                Case 4


                Case 5


                Questions


                Support the show

                Review the show where ever your listening

                Get Messages from Toxo (Join the Newsletter!)

                Join as a supporting member

                1. Ad free episodes
                2. Bonus content and early access
                3. Discounts and give aways on GOTA PICCEM Mushroom card game

                The GOTTA PICCEM Poisonous Mushroom Game!

                The Poisonus Fungus Amongus Children's Book!

                1. Full book reading (6 minutes!)

                Tox trinkets (Rep the show at home!)

                Reach the show

                1. Email: Toxtalk1@gmail.com

                More Show Resources

                1. Ryan's Medical Games and Resources
                2. Show Website

                ]]>                af3b0d85-ddbe-498b-9740-ff95d0a89bbaWed, 12 Apr 2023 08:30:00 -060001:35:26falsefull2222Dr. Adam Blumenberg, MD (@ABlumenbergMD) Join's the show. He is an emergency medicine physician, medical toxicologist, and Assistant Professor at Columbia University Medical Center in New York City. He hosts his own toxicology youtube series (www.ToxicHistory.com) and has developed multiple free medical education software programs in toxicology (www.toxicrunner.net) and medical simulation (www.medsimstudio.com). Most impressively, he has produced his own free base lidocaine crystals on a stove top, if you ask nicely he might just loan you one. He joins the show to sleuth the cause of fatal poisoning cases and tackle internet questions from reddit.com/r/askdrugsHigh yield highlight- Managing a Bupropion overdoseHigh yield highlight- Managing a Bupropion overdoseReady for a high-octane dose of knowledge? 🔥🧠 Ryan's got you covered with this electrifying mini-episode on managing a bupropion overdose! 💊💥  Beware - there are plenty of pitfalls you'll want to avoid. Check out the full episode and other mini-episodes for even more tips and tricks! 🎧👀

                1. Bupropion is the #1 antidepressant cause of major (life threatening) reported to U.S. Poison Centers
                2. It is difficult to manage due to
                3. Potential for delayed seizures
                4. Unique cardiogenic shock in overdose
                5. Potential wide complex arrhythmia refractory to Sodium Bicarbonate 
                6. Potential interference with brain death testing
                7. Treatment
                8. Decontamination
                9. Aggressive whole bowel irrigation or charcoal may be indicated if large ingestion
                10. Supportive care
                11. Intubation if airway compromised
                12. Benzodiazepine for agitation
                13. Benzodiazepines and GABA-ergic AED's for status epileptics
                14. Tachycardia, tremor, and agitation are risk factor for seizures
                15. Tachycardia may be masked by alpha 2 agonist co ingestions
                16. Seizures may occur 24 hour out
                17. Sodium bicarbonate for wide QRS (it may be refractory)
                18. Inodilators and vasopressors for cardiogenic shock
                19. ECMO for refractory shock or arrhythmia
                20. Awareness that severe bupropion toxicity can mimic brain death
                21. send analytical confirmation of bupropion if possible to rule out confounding
                22. Enhanced elimination
                23. limited options due to protein binding, not routine
                24. Focused antidote
                25. Consider IV fat emulsion if the patient is peri arrest
                26. Observation times
                27. Talk to a toxicolleague about observation times, decontamination, and use of invasive therapies to avoid falling into a trap


                ]]>                Ready for a high-octane dose of knowledge? 🔥🧠 Ryan's got you covered with this electrifying mini-episode on managing a bupropion overdose! 💊💥  Beware - there are plenty of pitfalls you'll want to avoid. Check out the full episode and other mini-episodes for even more tips and tricks! 🎧👀

                1. Bupropion is the #1 antidepressant cause of major (life threatening) reported to U.S. Poison Centers
                2. It is difficult to manage due to
                3. Potential for delayed seizures
                4. Unique cardiogenic shock in overdose
                5. Potential wide complex arrhythmia refractory to Sodium Bicarbonate 
                6. Potential interference with brain death testing
                7. Treatment
                8. Decontamination
                9. Aggressive whole bowel irrigation or charcoal may be indicated if large ingestion
                10. Supportive care
                11. Intubation if airway compromised
                12. Benzodiazepine for agitation
                13. Benzodiazepines and GABA-ergic AED's for status epileptics
                14. Tachycardia, tremor, and agitation are risk factor for seizures
                15. Tachycardia may be masked by alpha 2 agonist co ingestions
                16. Seizures may occur 24 hour out
                17. Sodium bicarbonate for wide QRS (it may be refractory)
                18. Inodilators and vasopressors for cardiogenic shock
                19. ECMO for refractory shock or arrhythmia
                20. Awareness that severe bupropion toxicity can mimic brain death
                21. send analytical confirmation of bupropion if possible to rule out confounding
                22. Enhanced elimination
                23. limited options due to protein binding, not routine
                24. Focused antidote
                25. Consider IV fat emulsion if the patient is peri arrest
                26. Observation times
                27. Talk to a toxicolleague about observation times, decontamination, and use of invasive therapies to avoid falling into a trap


                ]]>                6086bdf7-d219-40d8-90af-b469eae7be56Sun, 26 Feb 2023 22:58:00 -060012:08falsebonusReady for a high-octane dose of knowledge? 🔥🧠 Ryan's got you covered with this electrifying mini-episode on managing a bupropion overdose! 💊💥 Beware - there are plenty of pitfalls you'll want to avoid. Check out the full episode and other mini-episodes for even more tips and tricks! 🎧👀                A Prescription for Heartache (& Seizures) (Bupropion)A Prescription for Heartache (& Seizures) (Bupropion)What Do Bath Salts, Face-Eating Zombies, and Antidepressants Have in Common?

                In this episode of The Poison Lab, Ryan is joined by Dr. Filip, Dr. Olives, and Dr. Reyes to discuss a unique and heartbreaking poisoning scenario involving an antidepressant now recognized as the #1 cause of major life-threatening effects in antidepressant overdoses in the U.S. Check out the mini-episodes for more details!

                Key Highlights

                This Antidepressant:

                • #1 Cause of Major (Life-Threatening) Effects in overdoses reported to U.S. Poison Centers.
                • Difficult to manage due to:
                • Delayed seizures.
                • Unique cardiogenic shock in overdose.
                • Wide complex arrhythmia refractory to sodium bicarbonate.
                • Potential interference with brain death testing.

                Mechanism of Toxicity

                • Increases dopamine and norepinephrine.
                • Blocks gap junctions in cardiac myocytes:
                • Rohr 2004: Gap junction blockade causes a wide QRS.
                • Vink 2004: Connexin 43 is critical for cardiac signal transmission.
                • Callier 2012: Similar effects on cardiac action potential as other gap junction blockers.
                • Burnham 2014: Bupropion's IC50 for connexin 43 is >50 µM, higher than fluoxetine and lamotrigine.
                • Shaikh Quereshi 2014: Bupropion interferes with connexin 43 production/localization in chicken cardiac myocytes at >50 µM.

                Clinical Effects

                Sympathetic Toxidrome

                • Seizures: Delayed, typically occurring 8–24 hours post-ingestion.
                • Tachycardia: May precede seizures but could be masked by co-ingestions.

                Takeaway (TL;DR):

                • Patients often present with neurologic symptoms and tachycardia before seizures.
                • Do not discharge patients without consulting a toxicologist or poison center regarding observation time.
                • Avoid dismissing tachycardia and anxiety as situational in bupropion overdose cases.

                Key Literature Insights

                • Shepherd 2004: Seizures primarily associated with sustained-release products; often preceded by neuropsychiatric symptoms.
                • Starr 2009:
                • XL products linked to seizures.
                • Tachycardia, tremor, and agitation are predictors.
                • Seizures occurred as late as 24 hours; 25% occurred after 8 hours.
                • Offerman 2020:
                • Tachycardia >120 bpm predicts seizures.
                • Late seizures occurred only in symptomatic patients.
                • Prehospital seizure correlated with cardiac arrest.
                • Rianprakaisang 2021:
                • QTc and HR >140 bpm predict seizures.
                • ToxIC review confirmed tachycardia as a risk factor.

                Treatment Overview

                Decontamination

                • Whole bowel irrigation or activated charcoal may be needed for large ingestions.

                Supportive Care

                • Airway Management: Intubate if compromised.
                • Benzodiazepines for agitation or seizures.
                • Use GABA-ergic AEDs for status epilepticus.

                Cardiogenic Shock

                • Sodium bicarbonate for wide QRS (though may be refractory).
                • Inodilators/Vasopressors for shock.
                • ECMO for refractory shock or...]]>What Do Bath Salts, Face-Eating Zombies, and Antidepressants Have in Common?

                  In this episode of The Poison Lab, Ryan is joined by Dr. Filip, Dr. Olives, and Dr. Reyes to discuss a unique and heartbreaking poisoning scenario involving an antidepressant now recognized as the #1 cause of major life-threatening effects in antidepressant overdoses in the U.S. Check out the mini-episodes for more details!

                  Key Highlights

                  This Antidepressant:

                  • #1 Cause of Major (Life-Threatening) Effects in overdoses reported to U.S. Poison Centers.
                  • Difficult to manage due to:
                  • Delayed seizures.
                  • Unique cardiogenic shock in overdose.
                  • Wide complex arrhythmia refractory to sodium bicarbonate.
                  • Potential interference with brain death testing.

                  Mechanism of Toxicity

                  • Increases dopamine and norepinephrine.
                  • Blocks gap junctions in cardiac myocytes:
                  • Rohr 2004: Gap junction blockade causes a wide QRS.
                  • Vink 2004: Connexin 43 is critical for cardiac signal transmission.
                  • Callier 2012: Similar effects on cardiac action potential as other gap junction blockers.
                  • Burnham 2014: Bupropion's IC50 for connexin 43 is >50 µM, higher than fluoxetine and lamotrigine.
                  • Shaikh Quereshi 2014: Bupropion interferes with connexin 43 production/localization in chicken cardiac myocytes at >50 µM.

                  Clinical Effects

                  Sympathetic Toxidrome

                  • Seizures: Delayed, typically occurring 8–24 hours post-ingestion.
                  • Tachycardia: May precede seizures but could be masked by co-ingestions.

                  Takeaway (TL;DR):

                  • Patients often present with neurologic symptoms and tachycardia before seizures.
                  • Do not discharge patients without consulting a toxicologist or poison center regarding observation time.
                  • Avoid dismissing tachycardia and anxiety as situational in bupropion overdose cases.

                  Key Literature Insights

                  • Shepherd 2004: Seizures primarily associated with sustained-release products; often preceded by neuropsychiatric symptoms.
                  • Starr 2009:
                  • XL products linked to seizures.
                  • Tachycardia, tremor, and agitation are predictors.
                  • Seizures occurred as late as 24 hours; 25% occurred after 8 hours.
                  • Offerman 2020:
                  • Tachycardia >120 bpm predicts seizures.
                  • Late seizures occurred only in symptomatic patients.
                  • Prehospital seizure correlated with cardiac arrest.
                  • Rianprakaisang 2021:
                  • QTc and HR >140 bpm predict seizures.
                  • ToxIC review confirmed tachycardia as a risk factor.

                  Treatment Overview

                  Decontamination

                  • Whole bowel irrigation or activated charcoal may be needed for large ingestions.

                  Supportive Care

                  • Airway Management: Intubate if compromised.
                  • Benzodiazepines for agitation or seizures.
                  • Use GABA-ergic AEDs for status epilepticus.

                  Cardiogenic Shock

                  • Sodium bicarbonate for wide QRS (though may be refractory).
                  • Inodilators/Vasopressors for shock.
                  • ECMO for refractory shock or arrhythmias.

                  Observation Times

                  • Late seizures can occur up to 24 hours post-ingestion.
                  • Discuss observation times with a toxicologist.

                  Additional Considerations

                  • Severe toxicity can mimic brain death—send for analytical confirmation if possible.
                  • Limited enhanced elimination options due to high protein binding.
                  • Consider IV lipid emulsion if the patient is peri-arrest.

                  Don't Fall into Traps:

                  • All ingestions are unique. Collaborate with a toxicologist to guide management and avoid pitfalls.

                  Rohr 2004: "Role of gap junctions in the propagation of the cardiac action potential"


                  Vink 2004: "Connexin 43 is the most important protein for connexon formation and cardiac signal transmission"


                  Callier 2012: "QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile"


                  Shaikh Quereshi 2014: "Bupropion interferes with connexin43 production and localization in chicken cardiac myocytes at concentrations >50 µM"


                  Shepherd 2004: "Seizures after overdose of sustained-release bupropion"


                  Starr 2009: "Seizures in extended-release bupropion overdoses"


                  Offerman 2020: "Predictors of seizures and death in bupropion overdoses: a 10-year retrospective study"


                  Rianprakaisang 2021: "Risk factors for seizures in bupropion overdose: a ToxIC database study"


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                  ]]>                  615095a2-b42c-45ed-b816-132090983410Wed, 15 Feb 2023 09:00:00 -060001:35:41falsefull1919What do bath salts, face eating zombies, and antidepressants have in common? In this episode Ryan has a number of guests (Dr Filip, Dr Olives, Dr Reyes) join to discuss a unique heart breaking poisoning that is now the number one cause of major life threatening effects in antidepressant overdose in the United States. Check out the mini episodes for more!Mini Episode: Bridging the Gap- Bupropion's not your average wide QRS with Dr. Travis OlivesMini Episode: Bridging the Gap- Bupropion's not your average wide QRS with Dr. Travis Olives
                • Rohr 2004- Gap junction blockade can cause a wide QRS 
                • Vink 2004 Connexin 43 is the most important protein for connexon formation and cardiac signal transmission
                • Callier 2012- Bupropion does not block sodium channels, and does exhibit similar effects on the cardiac action potential as known gap junction  
                • Burnham 2014 Bupropion has an IC50 for connexin 43 >50 uMol, larger than other drugs such as fluoextine and lamotrigine
                • Shaikh Quereshi 2014 Bupropion interferes with connexin43 production and localization in chicken cardiac myoctes at concentration >50 uMol

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              ]]>
            4. Rohr 2004- Gap junction blockade can cause a wide QRS 
            5. Vink 2004 Connexin 43 is the most important protein for connexon formation and cardiac signal transmission
            6. Callier 2012- Bupropion does not block sodium channels, and does exhibit similar effects on the cardiac action potential as known gap junction  
            7. Burnham 2014 Bupropion has an IC50 for connexin 43 >50 uMol, larger than other drugs such as fluoextine and lamotrigine
            8. Shaikh Quereshi 2014 Bupropion interferes with connexin43 production and localization in chicken cardiac myoctes at concentration >50 uMol

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            ]]>308317b1-c054-4d88-8330-aeb5f799d9ceWed, 15 Feb 2023 08:55:00 -060018:21falsebonusIn this episode Ryan is Joined by Dr. Travis Olives MD (Associate medical director of Minnesota Poison Center, Medical Toxicologist, Emergency Physician) to discuss the implications of bupropion's effect on gap junctions and its apparent lack of effect on sodium channel, when managing wide QRS arrythmias in bupropion overdose            Mini Episode: Who Seizes in Bupropion Overdose with Dr Ari Filip MDMini Episode: Who Seizes in Bupropion Overdose with Dr Ari Filip MD
          4. Seizure Risk: Patients can seize 8–24 hours post-ingestion. Neurologic symptoms and tachycardia often precede seizures.
          5. Delayed Symptoms: Co-ingestions may mask tachycardia, and symptoms can be significantly delayed.
          6. Key Management Advice:
          7. Do not discharge patients without consulting a toxicologist or poison center about observation times.
          8. Do not dismiss tachycardia and anxiety as situational in cases of bupropion overdose.

      Key Studies


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      More Show...]]>

    • Seizure Risk: Patients can seize 8–24 hours post-ingestion. Neurologic symptoms and tachycardia often precede seizures.
    • Delayed Symptoms: Co-ingestions may mask tachycardia, and symptoms can be significantly delayed.
    • Key Management Advice:
    • Do not discharge patients without consulting a toxicologist or poison center about observation times.
    • Do not dismiss tachycardia and anxiety as situational in cases of bupropion overdose.

    Key Studies


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    ]]>baf012ed-7213-4492-926c-fefb2642114fWed, 15 Feb 2023 08:55:00 -060030:48falsebonusIn this episode guest Dr Ari Filip MD (medical director of Arkansas Poison Center, medical toxicologist, emergency physician) joins Ryan to discuss what symptoms in overdose can help categorize bupropion overdoses as high or lower risk for seizure.    2022 North American Congress of Clinical Toxicology (NACCT) High Yield Abstract Review2022 North American Congress of Clinical Toxicology (NACCT) High Yield Abstract ReviewAll published abstracts can be found here 

    Abstracts

    Category 1: Amlodipine Vasoplegia


    Category 2: Xylazine

    • Abstract 4: “Tranq dope” opioid overdose: clinical outcomes for emergency department patients with illicit opioid overdose adulterated with xylazine

    Category 3: Case Reports with Terrifying Clinical Implications

    • Abstract 5: Recovery after poly-drug overdose despite blood flow imaging demonstrating no brain perfusion
    • Abstract 6: Challenges in diagnosing an environmental cause of recurrent methemoglobinemia
    • Abstract 7: Acute thiamine deficiency as a complication of insulin euglycemic therapy for an amlodipine overdose

    Category 4: Comparative evidence, Prognostication, and Triage

    • Abstract 8: Utility of pre four-hour iron concentration in predicting toxicology
    • Abstract 9: Andexanet alfa vs 4-factor prothrombin complex concentrate for intracranial hemorrhage at a level I trauma hospital

    Category 5: Rapid Review

    • Abstract 10: Fentanyl and fentanyl analogue exposure among emergency personnel and first responders: a systematic review
    • Abstract 11: Significance of falsely low creatinine values in diagnosing massive acetaminophen ingestion
    • Abstract 12: Large dose intentional ciprofloxacin ingestion associated with false-positive urine immunoassay for oxycodone and fentanyl
    • Abstract 13: Don’t make it a double?: a 20- year review of supratherapeutic amlodipine ingestions while on chronic therapy
    • Abstract 14: Evaluation of pediatric lisdexamfetamine exposures reported to a statewide poison control system
    • Abstract 15: An assessment of the reliability of stated quantity in acute acetaminophen overdoses reported to a regional poison center

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    1. Full book...]]>All published abstracts can be found here 

      Abstracts

      Category 1: Amlodipine Vasoplegia


      Category 2: Xylazine

      • Abstract 4: “Tranq dope” opioid overdose: clinical outcomes for emergency department patients with illicit opioid overdose adulterated with xylazine

      Category 3: Case Reports with Terrifying Clinical Implications

      • Abstract 5: Recovery after poly-drug overdose despite blood flow imaging demonstrating no brain perfusion
      • Abstract 6: Challenges in diagnosing an environmental cause of recurrent methemoglobinemia
      • Abstract 7: Acute thiamine deficiency as a complication of insulin euglycemic therapy for an amlodipine overdose

      Category 4: Comparative evidence, Prognostication, and Triage

      • Abstract 8: Utility of pre four-hour iron concentration in predicting toxicology
      • Abstract 9: Andexanet alfa vs 4-factor prothrombin complex concentrate for intracranial hemorrhage at a level I trauma hospital

      Category 5: Rapid Review

      • Abstract 10: Fentanyl and fentanyl analogue exposure among emergency personnel and first responders: a systematic review
      • Abstract 11: Significance of falsely low creatinine values in diagnosing massive acetaminophen ingestion
      • Abstract 12: Large dose intentional ciprofloxacin ingestion associated with false-positive urine immunoassay for oxycodone and fentanyl
      • Abstract 13: Don’t make it a double?: a 20- year review of supratherapeutic amlodipine ingestions while on chronic therapy
      • Abstract 14: Evaluation of pediatric lisdexamfetamine exposures reported to a statewide poison control system
      • Abstract 15: An assessment of the reliability of stated quantity in acute acetaminophen overdoses reported to a regional poison center

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      ]]>7a6f389c-2213-4039-94ba-5514c6c646a5Thu, 29 Dec 2022 09:00:00 -060001:32:47falsefull1818In this episode Ryan is joined by a guest panel to review 15 of the most clinically impactful research abstracts that were presented at the 2022 North American Congress of Clinical Toxicology (NACCT) in San Francisco. If you didn't get a chance to read all 312 research abstracts from some of Toxicology's best and brightest this year, tune in for a high yield review as well as clinical a break down of the studies and their relevance from the expert panel (Dr. Grant Comstock MD, Dr. Daniel McCabe MD, and Dr. Natalija Farrel PharmD, DABAT). Check the show notes for a link to the published abstracts and the list of all studies discussed in the show.Episode 19 Mystery CaseEpisode 19 Mystery CaseDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 19

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      ]]>      Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 19

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      ]]>      ea5d940f-3bbd-4b92-b794-66161495b8ebFri, 09 Dec 2022 19:40:00 -060006:14falsebonusDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 18      Toxicologists vs the Internet (#7) With Guest Dr Emily Kiernan DOToxicologists vs the Internet (#7) With Guest Dr Emily Kiernan DO Dr. Emily Kiernan, DO (@em2kiernan) an emergency medicine physician and medical toxicologist with Emory university school of medicine joins the show to solve toxic cases, opine on recent healthcare related poisoning, and dive head first into the bongwater on this episode. (Remember friends, don't drink the bong water).


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      2. Dr. Emily Kiernan, DO (@em2kiernan) an emergency medicine physician and medical toxicologist with Emory university school of medicine joins the show to solve toxic cases, opine on recent healthcare related poisoning, and dive head first into the bongwater on this episode. (Remember friends, don't drink the bong water).


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        ]]>        c00a0c11-17c7-41b5-9d2f-ef5dd710df69Wed, 09 Nov 2022 09:30:00 -060001:30:41falsefull1717Dr. Emily Kiernan, DO (@em2kiernan) an emergency medicine physician and medical toxicologist with Emory university school of medicine joins the show to solve toxic cases, opine on recent healthcare related poisoning, and dive head first into the bongwater on this episode. (Remember friends, don't drink the bong water).Phenibut. The emerging drug you don’t know about (yet)Phenibut. The emerging drug you don’t know about (yet) Phenibut is an emerging and unfamiliar drug taking hold in the US that is readily available online and legal to obtain. It acts as a GABA-B agonist and carries risks of dependency and withdrawal. In this episode Ryan interviews phenibut users as well as experts involved in phenibut treatment. They explore the history, current trends, toxicity, and management of phenibut, a novel GABA-B agonist. He is joined by guest Dr. Matthew Stanton PharmD and Dr. Benjamin Weston MD who listen in to an audio documentary by that includes clips from Dr. Janessa Graves PhD and Dr. Erica Liebelt MD who wrote a recent report on increasing phenibut exposures, Dr. Dan McCabe MD who is the author of the largest published phenibut case series, and Elliot, a recovered phenibut user who we would like to sincerely thank for sharing his story of use and recovery.

        +Update- a systematic review of phenibut withdrawal treatment strategies authored by the poison lab host himeself, Ryan!+


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          2. Phenibut is an emerging and unfamiliar drug taking hold in the US that is readily available online and legal to obtain. It acts as a GABA-B agonist and carries risks of dependency and withdrawal. In this episode Ryan interviews phenibut users as well as experts involved in phenibut treatment. They explore the history, current trends, toxicity, and management of phenibut, a novel GABA-B agonist. He is joined by guest Dr. Matthew Stanton PharmD and Dr. Benjamin Weston MD who listen in to an audio documentary by that includes clips from Dr. Janessa Graves PhD and Dr. Erica Liebelt MD who wrote a recent report on increasing phenibut exposures, Dr. Dan McCabe MD who is the author of the largest published phenibut case series, and Elliot, a recovered phenibut user who we would like to sincerely thank for sharing his story of use and recovery.

          +Update- a systematic review of phenibut withdrawal treatment strategies authored by the poison lab host himeself, Ryan!+


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          ]]>          bbcc98af-c256-40c9-a0fa-aab613b3344eMon, 12 Sep 2022 08:00:00 -060001:09:58truefull1616Phenibut is an emerging and unfamiliar drug taking hold in the US that is readily available online and legal to obtain. It acts as a GABA-B agonist and carries risks of dependency and withdrawal. In this episode Ryan interviews phenibut users as well as experts involved in phenibut treatment. They explore the history, current trends, toxicity, and management of phenibut, a novel GABA-B agonist. He is joined by guest Dr. Matthew Stanton PharmD and Dr. Benjamin Weston MD who listen in to an audio documentary by that includes clips from Dr. Janessa Graves PhD and Dr. Erica Liebelt MD who wrote a recent report on increasing phenibut exposures, Dr. Dan McCabe MD who is the author of the largest published phenibut case series, and Elliot, a recovered phenibut user who we would like to sincerely thank for sharing his story of use and recovery.Episode 16 Mystery CaseEpisode 16 Mystery CaseDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 16

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          ]]>          Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 16

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          ]]>          bf61c3f2-7e7b-4dbb-a43c-47feea277109Wed, 03 Aug 2022 08:00:00 -060001:26falsebonusDo you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 16          Toxicologists vs the Internet (#6) With Guest Dr Joshua Trebach MDToxicologists vs the Internet (#6) With Guest Dr Joshua Trebach MD Dr. Joshua Trebach, MD (@jtrebach) joins the show for some toxic sleuthing of fishy poisonings and answers questions from reddit.com/r/askdrugs.


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


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          ]]>          4126f2b8-b2df-4d68-80da-eab9821921edWed, 06 Jul 2022 08:30:00 -060001:21:03falsefull1515Dr. Joshua Trebach, MD (@jtrebach) joins the show for some toxic sleuthing of fishy poisonings and answers questions from reddit.com/r/askdrugs.          Fast and FataluriousFast and Fatalurious 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!


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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!


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          Join as a supporting member

          1. Ad free episodes
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          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
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          ]]>          f7c0a506-c987-4415-b3be-9da95e71e56cWed, 04 May 2022 08:30:00 -060046:11falsefull1414In 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!          A Mysterious Case of Rapid Coma and Ventricular Arrythmia in a Young Man (Episode #14 Mystery Case)A Mystery Case of Rapid Seizures and a Fatal Arrythmia in a Young Man (Episode #14 Mystery Case)Send in your guesses to toxtalk1@gmail.com

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          Review the show where ever your listening

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          Join as a supporting member

          1. Ad free episodes
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          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
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          ]]>          Send in your guesses to toxtalk1@gmail.com

          Support the show

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          Join as a supporting member

          1. Ad free episodes
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          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

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          ]]>          925352c3-e535-4a40-8c9a-6aa96461911bWed, 30 Mar 2022 15:20:00 -060001:05falsebonusSend in your guesses to toxtalk1@gmail.com          Toxicologists vs the Internet (#5) With Guest Dr Howard Greller MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound)Toxicologists vs the Internet (#5) With Guest Dr Howard Greller MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound) 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


          Support the show

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          1. Ad free episodes
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          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

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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


          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
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          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

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          ]]>          5447d45c-0d17-4572-bd61-1ac792103884Wed, 02 Mar 2022 10:00:00 -060001:26:50falsefull1313Dr. 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.          Where is Episode 13 ? Bonus Episodes AND Next Episode Guest Dr. Howard Greller MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound),Where is Episode 13 ? Bonus Episodes AND Next Episode Guest Dr. Howard Greller MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound),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 

          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
          2. Bonus content and early access
          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
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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 

          Support the show

          Review the show where ever your listening

          Get Messages from Toxo (Join the Newsletter!)

          Join as a supporting member

          1. Ad free episodes
          2. Bonus content and early access
          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

          Reach the show

          1. Email: Toxtalk1@gmail.com

          More Show Resources

          1. Ryan's Medical Games and Resources
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          ]]>          99c9c2f2-635d-49b6-b0a5-501edf8cba15Wed, 02 Feb 2022 09:30:00 -060014:05falsebonusNo episode today. Head to https://www.wpr.org/shows/pondering-poison-exploring-how-chemicals-illegal-drugs-overdoses-and-even-over-counter for the live radio feature. Join us next show for Dr. Howard Greller of Sirius XM Doctor Radio, Dantastic Mr Tox & Howard, Tox & Hound)          Lethal Buttock Injection (And Other Toxicities of Illegal Cosmetic Body Fillers)Lethal Buttock Injection (And Other Toxicities of Illegal Cosmetic Body Fillers) In this episode Ryan and Toxo dissect the fascinating underbelly of illegal cosmetic procedures and breakdown the toxicities that arise from them.

          Intro


          Epidemiology


          Recent new stories


          Common injection practices


          Toxicity


          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


          Support the show

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          1. Ad free episodes
          2. Bonus content and early access
          3. Discounts and give aways on GOTA PICCEM Mushroom card game

          The GOTTA PICCEM Poisonous Mushroom Game!

          The Poisonus Fungus Amongus Children's Book!

          1. Full book reading (6 minutes!)

          Tox trinkets (Rep the show at home!)

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          ]]>f33b0b82-586b-4b61-9af5-38cb8cff3373Wed, 26 Aug 2020 08:00:00 -060020:27falsebonusRyan goes through the steps of the cardiac action potential using a fun story about a castle under siege, and a war to save a people!          Toddler Time Bombs (Poison Center Triage)Toddler Time Bombs (Poison Center Triage) Ryan and Toxo cover some topics off the "one pill can kill" list, try breaking down the toxic mechanism of opioid induced respiratory depression in a simplistic way (but maybe fail), and walk through the triage and management of poison center case where a child was "potentially" exposed to a lethal toxin at home.

          Case Report


          "One Pill Can Kill" Resources

          1. Missouri Poison Center resource guide:http://missouripoisoncenter.org/wp-content/uploads/2015/02/2011-One-Pill-Can-Kill.pdf
          2. Pediatric poison prevention article:https://pubmed.ncbi.nlm.nih.gov/16419734/
          3. HealthyChildren.org guide on medication safety:https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Poison-Prevention-One-Pill-Can-Kill.aspx

          Respiratory Centers and Drug Effects


          Buprenorphine Studies

          Epidemiology

          1. AAPCC Annual Report on poisoning trends:https://pubmed.ncbi.nlm.nih.gov/31752545/
          2. Trends in pediatric opioid exposures:https://pubmed.ncbi.nlm.nih.gov/32178937/
          3. Trends in ED visits for unsupervised medication exposures:https://pubmed.ncbi.nlm.nih.gov/26347435/

          Exposure Studies

          1. U.S. Poison Center data on buprenorphine: https://pubmed.ncbi.nlm.nih.gov/29941678/
          2. Harvard Emergency Medicine group analysis: https://pubmed.ncbi.nlm.nih.gov/27756148/
          3. Maryland Poison Center/RADARS data:https://pubmed.ncbi.nlm.nih.gov/18381506/
          4. ICU exposures in children:https://pubmed.ncbi.nlm.nih.gov/20921918/

          Triage Considerations for Pediatric Exposures