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 re...
Feb 15, 2023•1 hr 36 min•Ep. 19
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 Spiller 1994: Review of instant-release bupropion overdoses...
Feb 15, 2023•31 min
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 ...
Feb 15, 2023•18 min
All published abstracts can be found here Abstracts Category 1: Amlodipine Vasoplegia Abstract 1: Vasodilation in patients with calcium channel blocker poisoning treated with high dose insulin: a comparison of amlodipine versus non-dihydropyridines Study of HDI on propranolol poisoned pigs Study of Minnesota HDI protocol Abstract 2: Amlodipine anxiety: a 10-year review of amlodipine associated fatalities Abstract 3: Extracorporeal membrane oxygenation utilization for vasoplegic shock due to pedi...
Dec 29, 2022•1 hr 33 min•Ep. 18
Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 19 Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game Landing Page! Tox trinkets (Rep the show at home!) Reach the show Email: Toxtalk1@gmail.com More Show Resources Get Messages from Toxo (Newsletter)...
Dec 10, 2022•7 min
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). Recent Healthcare poisoning in the news Nurse reportedly feeding children insulin (all information is uncomfirmed) and killing 7 neonates (not all insulin related) Anesthesiologis...
Nov 09, 2022•1 hr 31 min•Ep. 17
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 ...
Sep 12, 2022•1 hr 10 min•Ep. 16
Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 16 Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game Landing Page! Tox trinkets (Rep the show at home!) Reach the show Email: Toxtalk1@gmail.com More Show Resources Get Messages from Toxo (Newsletter)...
Aug 03, 2022•1 min
Dr. Joshua Trebach, MD (@jtrebach) joins the show for some toxic sleuthing of fishy poisonings and answers questions from reddit.com/r/askdrugs. Case report Ryan Feldman wrote about himself Stump the Tox cases Case #1 Case #2 case series from Dr Jillian Theobald Case #3 Case #4 Ask drugs Fanconi syndrome in expired tetracycline Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PI...
Jul 06, 2022•1 hr 21 min•Ep. 15
In this episode Ryan and Toxo dive into a widely available prescription poison with a frightening ability to cause rapid neurologic and cardiovascular decline, and the best part, it looks like candy! Digoxin kinetics Amiodarone overdose Post market safety review Review of published exposures and severe outcomes from US poison center Case from the show Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts a...
May 04, 2022•46 min•Ep. 14
Send in your guesses to toxtalk1@gmail.com Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game Landing Page! Tox trinkets (Rep the show at home!) Reach the show Email: Toxtalk1@gmail.com More Show Resources Get Messages from Toxo (Newsletter) Ryan's Medical Games and Resources Show Website...
Mar 30, 2022•1 min
Dr. Howard Greller, MD (Sirius XM Doctor Radio Emergency Medicine Show, Dantastic Mr Tox & Howard, Tox & Hound) joins the show. A FANTASTIC episode complete with toxic sleuthing of fatal poisoning cases and answering questions from reddit.com/r/askdrugs. Music from Pixabay Additional information on toxins from fatal poisoning cases Toxin 1 Toxin 2 Toxin 3 Toxin 4 Popper article referenced by Dr. Greller Support the show Review the show where ever your listening Join as a supporting membe...
Mar 02, 2022•1 hr 27 min•Ep. 13
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 Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game Landing Page! Tox trinkets (Rep the show at home!)...
Feb 02, 2022•14 min
In this episode Ryan and Toxo dissect the fascinating underbelly of illegal cosmetic procedures and breakdown the toxicities that arise from them. Intro Case report of hemolysis after sodium deoxycholate injection History Epidemiology ASPS stats Florida Unlicensed Activity Unit Cost of surgeon fee for buttock implant 2018 Recent new stories Botox and Bubbles grifter Quick bio on cases mentioned in show Common injection practices Feminizing body contouring (pumping parties) Synthol muscles Capsul...
Dec 08, 2021•1 hr 1 min•Ep. 12
Send in your guesses to toxtalk1@gmail.com Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game Landing Page! Tox trinkets (Rep the show at home!) Reach the show Email: Toxtalk1@gmail.com More Show Resources Get Messages from Toxo (Newsletter) Ryan's Medical Games and Resources Show Website...
Oct 06, 2021•1 min
In this episode of toxicologist vs internet guest Dr. Andrew Farkas, MD joins the show. This a great episode that covers everything from the drugs you would need in the apocalypse to what to worry about if your cats are dying. Complete with toxic sleuthing of fatal poisoning cases and answering questions from reddit.com/r/askdrugs. Research from Dr Farkas Additional information on toxins from Fatal poisoning cases Toxin 1 Toxin 2 Toxin 3 Toxin 4 "Toxicologist vs the internet" segment Cocaethylen...
Oct 06, 2021•1 hr 8 min•Ep. 11
In this episode Ryan and Toxo take a closer look at ketamine induced irreversible bladder damage. History Discovery of Ketamine Melamine outbreaks Clinical Effects Index cases Survey of Ketamine use prior to symptoms Mechanism/Treatment Mechanism/Treatment systematic review Rat models Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poi...
Aug 04, 2021•33 min•Ep. 10
What substance could cause these symptoms? Send your guesses to Toxtalk1@gmail.com to participate in episode 10! Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game Landing Page! Tox trinkets (Rep the show at home!) Reach the show Email: Toxtalk1@gmail.com More Show Resources Get Messages from Toxo (Newsletter) Ryan...
Jun 02, 2021•2 min
In this episode of toxicologist vs the internet Ryan Is joined by special guest Dr. Justin Corcoran, MD an emergency medicine physician and medical toxicologist. They take turns answering questions from reddit.com/r/askdrugs (the internet, really, really needs a toxicologist) and challenge each others toxic sleuthing by presenting cases of poisoning and allowing the other to determine the toxin responsible. "Toxicologist vs the internet" segment Everythingisosm.com (Blog post) Biased Mu Receptor...
Jun 02, 2021•1 hr 11 min•Ep. 9
Ryan and Toxo dive in to Delta 8 THC, a new (maybe?) legal drug sweeping the U.S. Delta-8 THC: Key Resources and Studies New York Times Coverage Comprehensive article on Delta-8 THC, its growing popularity, and concerns: https://www.nytimes.com/2021/02/27/health/marijuana-hemp-delta-8-thc.html Studies of Delta-8 THC in Humans Systematic Review: Summarizes findings from a single key study on Delta-8 THC. https://pubmed.ncbi.nlm.nih.gov/29385080/ Original Study (may not be accessible): Investigate...
Apr 19, 2021•21 min
Case from the show https://pubmed.ncbi.nlm.nih.gov/22163140/ Mithradates https://www.wemjournal.org/article/S1080-6032(11)00043-3/pdf Case series on mad honey effects https://pubmed.ncbi.nlm.nih.gov/20575670/ Blog post on sodium channel openers https://emcrit.org/toxhound/ff-plant-sodium-channel-openers/ Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game ...
Mar 31, 2021•42 min•Ep. 8
In this second rendition of toxicologist vs the internet Ryan Is joined by special guest Dr. Jillian Theobald, MD, PHD an emergency medicine physician and medical toxicologist. They take turns answering questions from reddit.com/r/askdrugs (the internet, really, really needs a toxicologist) and challenge each others toxic sleuthing by presenting cases of poisoning and allowing the other to determine the toxin responsible. Listen in to hear about the clinical effects of benzodiazepine on TV watch...
Feb 03, 2021•1 hr 21 min•Ep. 7
Quick Review: Chloroquine and Hydroxychloroquine Toxicity Toxic Dose Chloroquine: >5 g is associated with severe toxicity (though toxicity can occur at lower doses). Hydroxychloroquine (HCQ): Toxic dose is less well-defined. Clinical Effects Seizures: Due to sodium channel blockade. Arrhythmias: Resulting from sodium channel blockade. Hypotension: Caused by alpha-adrenergic blockade. Hypokalemia: Often a notable feature. Management Decontamination: Administer activated charcoal if the patient...
Dec 16, 2020•10 min
In this episode Ryan and Toxo discuss some potential toxic spices and break down the toxicity and treatment of a once well known medicine Cinchona Bark, Quinine, and Associated Toxicities Historical Perspective Use of Cinchona Bark Powder for Malaria: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973170/ Evolutionary Pressure of Malaria on Sickle Cell Traits: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499995/ Cinchonism Definition: Classic toxicities caused by ingestion of quinoline derivativ...
Dec 16, 2020•1 hr 12 min•Ep. 6
In this episode Ryan Is joined by a special guest Dr. Matthew Stanton PharmD, BCPS, DABAT, an emergency medicine pharmacist and clinical toxicologist. Ryan and Matt take turns answering questions from reddit.com/r/askdrugs (the internet, really, really needs a toxicologist) and finally they challenge each others toxic sleuthing by presenting some cases of poisoning and allowing the other to try to determine the toxin responsible. Episode Show NotesArticles by the Host and Collaborators Potential...
Nov 05, 2020•1 hr 13 min•Ep. 5
Action potential Sodium/Potassium ATPase pumps create more positively charged ions outside the cell than inside the cell, this creates a relative negative charge in the cell Phase 4- Resting (~ -90 mv) Phase 0- Sodium enters the cell (+10 mv) Phase 1- Potassium efflux from cell as now there is no negative charge holding it in (0 mv) Phase 2- Calcium channels open and allow calcium in, calcium triggers the ryandoine receptor and allows for calcium dependent calcium release from the sarcoplasmic r...
Aug 26, 2020•15 min
Ryan and Toxo go in depth on an old substance that has begun to resurface with new toxicity due to users taking massive amounts. Loperamide. Dive into the regulatory history, mechanisms of its toxic cardiac effects, and a brief discussion of treatment in episode 4. Buying as much loperamide as you possibly can Loperamide History 1969 : Synthesized. (1) 1976 : FDA Approved as Schedule V. (2) "IMODIUM FDA Application No.(NDA) 017694". U.S. Food and Drug Administration (FDA). 1976. https://www.dead...
Aug 26, 2020•1 hr 4 min•Ep. 4
Great review of potential torsades mechanisms based off experimental data- https://www.sciencedirect.com/science/article/pii/S1880427611800050 Support the show Review the show where ever your listening Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game The GOTTA PICCEM Poisonous Mushroom Game Landing Page! Tox trinkets (Rep the show at home!) Reach the show Email: Toxtalk1@gmail.com More Show Resources Get Messag...
Aug 26, 2020•12 min
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 Pediatric ingestion case study discussed at the beginning of the episode: https://pediatrics.aappublications.org/content/130/6/e1700 "One Pill Can Kill" Resources Missouri P...
Jul 22, 2020•1 hr 12 min•Ep. 3
Get ready for a HEAVY subject, literally. Ryan and Toxo talk about the toxic mechanisms, signs of poisoning, and treatment of one of the worlds most ubiquitous poisons. This is a long, but interesting one, consider listening in chunks. Excellent Review Sources Calello DP, Henretig FM. "Lead." In: Goldfrank's Toxicologic Emergencies, 10th ed, Hoffman RS, Howland MA, Lewin NA, et al (Eds), McGraw Hill Education, New York, 2015. p.1219. Toxic Substances Database for Lead: https://www.atsdr.cdc.gov/...
Jun 24, 2020•1 hr 16 min•Ep. 2
