Online Learning > Webinars > National Journal Club


Welcome to ACMT's National Journal Club (NJC), a bimonthly member webinar hosted by a different fellowship program each session. Host programs: Feel free to infuse your program’s journal club style into the session you sponsor.

All data and information provided in this activity is for informational purposes only. ACMT makes no representations as to accuracy, completeness, currentness, suitability, or validity of the content and will not be liable for any errors or omissions in this information or any losses, injuries, or damages arising from its display or use.

Questions, or suggestions for future topics? Contact . Technical issues? Contact .


Tues. July 12, 2022
12pm ET | Open to: All ACMT Members


Carnitine in Valproic Acid Poisoning

  • Lheureux PE, Hantson P. Carnitine in the treatment of valproic acid-induced toxicity. Clin Toxicol (Phila). 2009 Feb;47(2):101-11. doi: 10.1080/15563650902752376. PMID: 19280426.
  • Glatstein M, Bonifacio Rino P, de Pinho S, Scolnik D, Pivko-Levi D, Hoyte C. Levocarnitine for the Treatment of Valproic Acid-Induced Hyperammonemic Encephalopathy in Children: The Experience of a Large, Tertiary Care Pediatric Hospital and a Poison Center. Am J Ther. 2019 May/Jun;26(3):e344-e349. doi: 10.1097/MJT.0000000000000706. PMID: 29232283.
  • Perrott J, Murphy NG, Zed PJ. L-carnitine for acute valproic acid overdose: a systematic review of published cases. Ann Pharmacother. 2010 Jul-Aug;44(7-8):1287-93. doi: 10.1345/aph.1P135. Epub 2010 Jun 29. PMID: 20587742
  • Nguyen P, Chevillard L, Gouda AS, Gourlain H, Labat L, Malissin I, Deye N, Voicu S, Mégarbane B. L-carnitine does not improve valproic acid poisoning management: a cohort study with toxicokinetics and concentration/effect relationships. Ann Intensive Care. 2022 Jan 29;12(1):7. doi: 10.1186/s13613-022-00984-z. PMID: 35092514; PMCID: PMC8800998.

Presented by Indiana University and led by Dr. Louise Kao

Opioid Overdose and Naltrexone

  • Unintentional buprenorphine and methadone poisoning in children: a matched observational study" and can transition to the two naltrexone articles
  • Effectiveness of Naltrexone in the Prevention of Delayed Respiratory Arrest in Opioid-Naive Methadone-Intoxicated Patients
  • A study of the effectiveness of naltrexone in preventing recurrence of methadone poisoning in opioid-naive children

Presented by the Washington University School of Medicine Program in Medical Toxicology led by Dr. Evan Schwarz.

Caustic Ingestions and Imaging

  • Bruzzi M, Chirica M, Resche-Rigon M, et al: Emergency computed tomography predicts caustic esophageal stricture formation. Ann Surg 2019;270:109-114.
  • Chirica M, Resche-Rigon M, Zagdanski AM, et al: Computed tomography evaluation of esophagogastric necrosis after caustic ingestion Ann Surg 2016;264:107-113.
  • Ryu HH, Jeung KW, Lee BK, et al: Caustic injury: can CT grading system enable prediction of esophageal stricture? Clin Toxicol 2010;48:137-142.

Presented by the Virginia Commonwealth University Program in Medical Toxicology, led by Dr. Brandon Wills.

The Flint Lead Crisis

  • Hanna-Attisha M, LaChance J, Sadler RC, et al: Elevated blood lead levels in children associated with the Flint Drinking Water Crisis: A spatial analysis of risk and public health response. Am J Public Health 2016;106:283-290.
  • Gomez HF, Borgialli DA, Sharman M, et al: Blood lead levels of children in Flint, Michigan: 2006-2016. J Pediatr 2018;197:158-164.
  • Banner W: “Toxicohistrionics”: Flint Michigan and the lead crisis. J Pediatr 2018;197:15-16.

Presented by the Wayne State University Toxicology Fellowship, led by Dr. Andrew King

On Shaky Ground: Predicting Seizures in Bupropion Toxicity

  • Starr P, Klein-Schwartz W, Spiller H, Kern P, Ekleberry SE, Kunkel S. Incidence and onset of delayed seizures after overdoses of extended-release bupropion. Am J Emerg Med 2009; 27 (8): 911-915.
  • Beuhler MC, Spiller HA, Sasser HC. The outcome of unintentional pediatric bupropion ingestions: a NPDS database review. J Med Toxicol 2010; 6 (1): 4-8.
  • Offerman S, Levine M, Gosen J, Thomas SH. Pediatric bupropion ingestions in adolescents vs. younger children- a tale of two populations.  J Med Toxicol 2020; 16 (1): 6-11.
  • Offerman S, Gosen J, Thomas SH, Padilla-Jones A, Ruha AM, Levine M. Bupropion associated seizures following acute overdose: who develops late seizures. Clin Toxicol 2020; 58 (12): 1306-1312.
  • Rianprakaisang TN, Prather CT, Lin AL, Murray BP, Hendrickson RG & TOXIC. Factors associated with seizure development after bupropion overdose: a review of the toxicology investigators consortium. Clin Toxicol 2021; epub ahead of print.

Presented by Harvard Medical Toxicology Fellowship Program, led by Dr. Michele Burns

Pepper Spray and Tear Gas Agents

  • Barry JD, Hennessy R, McManus JG: A randomized controlled trial comparing treatment regimens for acute pain for topical oleoresin capsaicin (pepper spray) exposure in adult volunteers. Prehosp Emerg Care 2009;12:432-437.
  • Brvar M: Chlorobenzylidene malonitrile tear gas exposure: Rinsing with amphoteric, hypertonic, and chelating solution. Hum Exp Toxicol 2016;35:213-218.
  • Stopyra JP, Winslow JE, Johnson JC, et al: Baby shampoo to relieve the discomfort of tear gas and pepper spray  exposure: A randomized controlled trial. West J Emerg Med 2018;19:294-300.

Presented by University of Virginia Program in Medical Toxicology, led by Program Director Heather Borek

Withdrawal and Recent Modalities

  • Anton RF, Latham P, Voronin K, et. Al., Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients with Alcohol Withdrawal Symptoms. JAMA Intern Med 2020;180:728-736.
  • Pizon AF, Lynch MJ, Benedict NJ, et al: Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal. Crit Care Med 2018;46:e768-e771.
  • Nelson AC, Kehoe J, Sankoff J, et al: Benzodiazepines vs Barbiturates for Alcohol Withdrawal: Analysis of Three Different Treatment Protocols. Am J Emerg Med 2019;37:733-736.
Presented by Rutgers Medical Toxicology Program led by Dr. Jeena Jaco

Alternate Antidotes for Methemoglobinemia

  • Tanen DA, LoVecchio F, Curry SC: Failure of Intravenous N-Acetylcysteine to Reduce Produced by Sodium Nitrite in Human Volunteers: A Randomized Controlled Trial. Ann Emerg Med 2000;35:369-373.
  • Dtsch J, Demiraka S, Kratz M, et al: Comparison of Methylene Blue, Riboflavin, and N-acetylcysteine for the Reduction of Nitric Oxide-Induced Methemoglobinemia. Crit Care Med 2000;28:958-961.
  • Rino PB, Scolnik D, Fustiñana A, et al: Ascorbic Acid for the Treatment of Methemoglobinemia: The Experience of a Large Tertiary Care Pediatric Hospital. Am J Therap 2014;21:240-243.
Presented by the Albert Einstein Program in Medical Toxicology

Burn Patients: The Oxalate Nephropathy and Hydroxocobalamin Debate

  • Legrand M, Michel T, Daudon M, et al: Risk of oxalate nephropathy with the use of cyanide antidote hydroxocobalamin in critically ill burn patients. Intensive Care Med 2016;42:1080-1081.
  • Depret F, Hoffmann C, Daoud L, et al: Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study. Critical Care 2019;43:1-10.
  • Buehner M, Pamplin J, Studer L, et al: Oxalate nephropathy after continuous infusion of high-dose vitamin C as an adjunct to burn resuscitation. J Burn Care Res 2016;37:e374-379.
  • Lin WV, Turin CG, McCormick DW, et al: Ascorbic acid-induced oxalate nephropathy: a case report and discussion of pathologic mechanisms. 2019;8:67-70.

Presented by Dr. Robert Cannon, DO and the Lehigh Valley Health Network fellowship

Envenomations and Comparison of Fab and F(ab')2 Antivenoms: November 24, 2020

  • Bush SP, Ruha AM, Seifert S, et al: Comparison of F(ab’)2 versus Fab antivenom for pit viper envenomations: A prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol 2015;53:37-45.
  • Mascarenas DN, Fullerton L, Smolinske SC, et al: Comparison of F(ab’)2 versus Fab antivenom in rattlesnake envenomation: First year’s post-marketing experience with F(ab’)2 in Mexico. Toxicon 2020;186:42-45.
  • Boyer LV, Chase PB, Degan JA, et al: Subacute coagulopathy in a randomized, comparative trial of Fab and F(ab’)2 antivenoms. Toxicon 2013;74:101-108.
Hosted By Steven E. Aks, DO, FACEP, FACMT, Toxikon Consortium.
Presented By Dr. Todd Phillips and the team from UT Southwestern

Fomepizole and Acetaminophen: September 8, 2020

  • Shah KR, Beuhler MC: Fomepizole as an adjunctive treatment in severe acetaminophen toxicity. Am J Emerg Med 2020;410.e5-410.e6.
  • Akakpo JY, Ramachandran A, Duan L, et al: Delayed treatment with 4-methylpyrazole protects against acetaminophen hepatotoxicity in mice by inhibition of c-Jun n-terminal kinase. Toxicolog Sci 2019;170:57-68.
  • Akakpo JY, Ramachandran A, Kandel SE, et al: 4-methylpyrazole protects against acetaminophen hepatotoxicity in mice and primary human hepatocytes. Hum Exp Toxicol 2018;37:1310-1322.
  • Min Kang A, Padilla-Jones A, Fisher ES, et al: The effect of 4-methylpyrazole on oxidative metabolism of acetaminophen in human volunteers. J Med Toxicol 2020;16:169-176.
Hosted By Dr. Christopher Hoyte and the Rocky Mountain Medical Toxicology Fellowship.

CO and Coagulation: May 12, 2020

  • Nielsen VG, Pretorious E: Carbon monoxide: Anticoagulant or procoagulant? Thromb Res 2014;133:315-321.
  • Cho Y, Kang H, Oh J, et al: Risk of venous thromboembolism after carbon monoxide poisoning: A nationwide population-based study. Ann Emerg Med 2019;75:587-596.
  • Chung WS, Lin CL, Kao CH: Carbon monoxide poisoning and risk of deep vein thrombosis and pulmonary embolism: a nationwide retrospective cohort study. J Epidemiol Comm Health 2015;69:557-562.
  • Lee SJ, Cha YS, Lee Y, et al: Life-threatening pulmonary embolism that occurred immediately after acute carbon monoxide poisoning in the emergency department. Amer J Emerg Med 2018; 1718.e1-1718.e3
  • Phinney, et al is background.
Hosted By OHSU Medical Toxicology Fellowship Program in Portland, and led by Drs. Rob Hendrickson and Zane Horowitz. The fellow presenting will be: Adam Blumenberg, Lauren Murphy, Jenn Love, and John Thompson.

Metformin: March 10, 2020

  • Keller G, Cour M, Hernu R, et al: Management of metformin-associated lactic acidosis by continuous renal replacement therapy. Plos One 2011;6:e23200

  • Angioli A, Cabiddu G, Conti M, et al: Metformin associated lactic acidosis: a case series of 28 patients treated with sustained low-efficiency dialysis (SLED) and long-term follow-up. BMC Nephrol 2018;17:77
  • Corchia A, Wynckel A, Journet J, et al: Metformin-related lactic acidosis with acute kidney injury: results of a French observational multicenter study. Clin Toxicol 2019;Online ahead of print DOI: 10.1080/15563650.2019.1648816
Hosted By Dr. Anthony Pizon and the University of Pittsburgh Medical Toxicology Fellowship Program

Levetiracetam and Toxicologically-Induced Seizures: January 14, 2020

  • Lee T, Warrick BJ, Preeyapom S, et al: Levetiracetam in toxic seizures. Clin Toxicol 2018;56:175-181.

  • Myhrer T, Enger S, Jonassen , et al: Enhanced efficacy of anticonvulsants when combined with levetiracetam in soman-exposed rats. Neurotoxicol 2011;32:923-930.
  • Oliveira AA, Nogueira CRA, Nascimento VS, et al: Evaluation of levetiracetam effects on pilocarpine-induced seizures: Cholinergic muscarinic system involvement. Neurosci Let 2005;385:184-188.
Hosted By Toxikon Chicago

Phenobarbital in Alcohol Withdrawal: November 12, 2019

  • Nelson AC, Kehoe J, Sankoff J, et al: Benzodiazepines vs. barbiturates for alcohol withdrawal: Analysis of 3 different treatment protocols. Am J Emerg Med 2019;37:733-736.

  • Rosenson J, Clements C, Simon B, et al: Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J Emerg Med 2013;44:592-598.

  • Tidwell WP, Thomas TL, Pouliot JD, et al: Treatment of alcohol withdrawal syndrome: Phenobarbital vs. CIWA-Ar Protocol. Amer Assoc Critical-Care Nurs 2018;27:454-460.

Hosted By Washington University Medical Toxicology Program

Naloxone and Observation Time: September 10, 2019

  • Christenson J, Etherington J, Grafstein E, et al: Early discharge of patients with presumed opioid overdose: Development of a clinical prediction rule. Acad Emerg Med 2000;7:1110-1118.

  • Clemency BM, Eggleston W, Shaw EW, et al: Hospital observation upon reversal with naloxone: A prospective clinical prediction rule validation study. Acad Emerg Med 2019;26:7-15

  • Scheuermeyer F, DeWitt C, Christenson J, et al: Safety of a brief emergency department observation protocol for patients with presumed fentanyl overdose. Ann Emerg Med 2018;72:1-8.Christenson J, Etherington J, Grafstein E, et al: Early discharge of patients with presumed opioid overdose: Development of a clinical prediction rule. Acad Emerg Med 2000;7:1110-1118.

  • Clemency BM, Eggleston W, Shaw EW, et al: Hospital observation upon reversal with naloxone: A prospective clinical prediction rule validation study. Acad Emerg Med 2019;26:7-15

  • Scheuermeyer F, DeWitt C, Christenson J, et al: Safety of a brief emergency department observation protocol for patients with presumed fentanyl overdose. Ann Emerg Med 2018;72:1-8.

Hosted By Indiana

Pediatric Potpourri: Toxicology Trends in Tots and Teens: March 12, 2019

  • Hwang TJ, Liat Orenstein AB, Kesselheim AS, Bourgeois FT. Completion rate and reporting of mandatory pediatric postmarketing studies under the US pediatric research equity act. JAMA Pediatr 2019; 173 (1): 68-74.

  • Gaither JR, Shabanova V, Leventhal JM. US national trends in pediatric deaths from prescription and illicit opioids.  JAMA Network Open 2018; 1 (8): e186558.

  • Anfang RR, Jatana KR, Linn RL, Rhoades K, Fry J, Jacobs IN. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. The Laryngoscope 2019; 129: 49-57.

  • Hughes A, Hendrickson RG. An epidemiologic and clinical description of e-cigarette toxicity. Clin Toxicol 2018;  epub ahead of print.

Hosted By The Harvard Med Tox Fellowship

Chemotherapeutics and Toxicology: January 8, 2019

  • Dettmeyer R, Driever F, Becker A, et al: Fatal myeloencephalopathy due to accidental intrathecal vincristine administration: a report of two cases. For Sci Intl 2001;122:60-64
  • Wee Ma W, Saif MW, El-Rayes BF, et al: Emergency use of uridine triacetate for the prevention and treatment of life-threatening 5-fluorouracil and capecitabine toxicity. Cancer 2017 Jan 1;123(2):345-356. doi: 10.1002/cncr.30321. Epub 2016 Sep 13.
  • Chan BS, Dawson AH, Buckley NA: What can clinicians learn from therapeutic studies about the treatment of acute oral methotrexate poisoning? Clin Toxicol 2017;55:88-96.
  • Isoardi KZ,Harris K, Carmichael KE, et al: Acute bone marrow suppression and gastrointestinal toxcicity following acute oral methotrexate overdose. Clin Toxicol
Hosted By Toxikon Group

Takotsubo Cardiomyopathy and Toxicology: September 11, 2018

  • Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008 Dec 16;118(25):2754-62 PubMed PMID: 19106400
  • Templin C et al, Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015 Sep 3;373(10):929-38. doi: 10.1056/NEJMoa1406761. PubMed PMID: 26332547.
  • Izumi Y, Okatani H, Shiota M, et al Effects of metoprolol on epinephrine-induced takotsubo-like left ventricular dysfunction in non-human primates. Hypertens Res. 2009 May;32(5):339-46. PubMed PMID: 19300450.
Hosted By Dr. Serge-Emile Simpson and the Albert Einstein Program in Medical Toxicology

Alcohol Withdrawal Adjuncts: July 10, 2018

  • Mueller SW, Preslaski CR, Kiser TH, et al: A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal. Crit Care Med 2014;42:1131-1139.
  • McCowan C, Marik P: Refractory delirium tremens treated with propofol: A case series. Crit Care Med 2000;28:1781-1784.
  • Pizon AF, Lynch MJ, Benedict NJ, et al: Adjunct ketamine use in the management of severe ethanol withdrawal. Crit Care Med 2018: DOI: 10.1097/CCM.0000000000003204.
Hosted By Dr. Anthony Pizon and the University of Pittsburgh Medical Toxicology Fellowship Program

Novel Antidotes in Medical Toxicology: May 8, 2018

  • Eddleston M, Fabresse N, Thompson A, et al:  Anti-colchicine Fab fragments prevent lethal colchicine toxicity in a porcine model: a pharmacokinetic and clinical study.  Clin Toxic DOI: 10.1080/15563650.2017.1422510
  • Pollack CV, Reilly PA, Eikelbloom J, et al: Idarucizumab for Dabigatrian reversal. N Engl J Med 2015;373:511-520.
  • O'Brien J, Lee S-H, Onogi S, et al: Engineering the protein corona of a synthetic polymer nanoparticle for broad-spectrum sequestration and neutralization of venomous biomacromolecules. J Amer Chem Soc 2016;138:16604-7. 
Hosted By Dr. James (Dazhe) Cao and the UT Southwestern Fellowship Program

Thiamine: A beri beri good vitamin: March 13, 2018

  • Thomson AD, Baker H, Leevy CM. Patterns of 35S-thiamine hydrochloride adsorption in the malnourished alcoholic patient. J Lab Clin Med. 1970 Jul;76(1):34-45.

  • Watson AJ, Walker JF, Tomkin GH, Finn MM, Keogh JA. Acute Wernickes encephalopathy precipitated by glucose loading. Ir J Med Sci. 1981 Oct;150(10):301-3.

  • Schoenenberger AW1, Schoenenberger-Berzins R, der Maur CA, Suter PM, Vergopoulos A, Erne P. Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study. Clin Res Cardiol. 2012 Mar;101(3):159-64. doi: 10.1007/s00392-011-0376-2. Epub 2011 Nov 5.

  • Kono S, Miyajima H, Yoshida K, Togawa A, Shirakawa K, Suzuki H. Mutations in a thiamine-transporter gene and Wernicke's-like encephalopathy. N Engl J Med. 2009 Apr 23;360(17):1792-4. doi: 10.1056/NEJMc0809100.

Hosted By Dr. Rana Biary and the NYU / NYCPCC Medical Toxicology Fellowship 

Azithromycin and Cardiac Toxicity: January 9, 2018

  • Ray WA, Murray KT, Hall K, et al:  Azithromycin and the risk of cardiovascular death. N Engl J Med 2012;366:1881-90.

  • Quinn KL, Macdonald EM, Gomes T, Mamdani MM, Huang A, Juurlink DN:  Macrolides, Digoxin toxicity and the risk of sudden death: A population-based study.  Drug Safety 2017;40:835-840. 

Hosted By Dr. Mak Neavyn and the U Mass Medical Toxicology Program

Is “suggamadex for verapamil toxicity??”: November 14, 2017

  • Tulgar S, Kose H, Piroglu ID:  Comparisoin of effects of separate and combined sugammadex and lipid emulsion administration on hemodynamic parameters and survival in a rat model of verapamil toxicity.  Med Sci Monit 2016;22:984-990.
  • Ozbilgin S, Ozbilgin M, Kucukoztas B, et al:  Evaluation of effectiveness for sugammadex for verapamil intoxication.  Basic and Clin Pharmacol Toxicol 2013;113:280-285. 
  • Mottram AR, Bryant SM, Aks SE:  Dose-dependent response to cyclodextrin infusion in a rat model of verapamil toxicity.  West J Emerg Med 2012;13:63-67. 
Hosted By Portland Fellowship Program

Toxicus Maximus: Pediatric Edition: September 12, 2017

  • Gordon RA, Roberts G, Amin Z, Williams RH, Paloucek FP:  Aggressive approach in the treatment of acute lead encephalopathy with an extraordinarily high concentration of lead.  Arch Pediatr Adolesc Med 1998;152:1100-1104. 
  • Agulnik A, Kelly DP, Bruccoleri R, Yuskaitis C, Ebrahimi-Fakhari D, Sahin M, Burns MM, Kohane DS, et al:  Combination clearance therapy and barbiturate coma for severe carbamazepine overdose.  Pediatr 2017:e20161560. 
  • Cheney K, Gumbiner C, Benson B, Tenenbein M:  Survival after a severe iron poisoning treated with intermittent infusion of deferoxamine.  Clin Toxicol 1995;33:61-66. 
  • Lai MW, Boyer EW, Kleimnman ME, Rodig NM, Burns Ewald M: Acute arsenic poisoning in two siblings.  Pediatr 2005;116:249-257.
Hosted By Boston/Harvard Program in Medical Toxicology

Ketamine: July 11, 2017

  • Olives TD, Nystrom PC, Cole, et al:  Intubation of profoundly agitated patients treated with prehospital ketamine.  Prehosp Disaster Med 2016;31:1-10.

  • Riddell J, Tran A, Bengiamin R, et al:  Ketamine as a first-line treatment for severely agitated emergency department patients.  Am J Emerg Med 2017 Epub ahead of print.

  • Cole JB, Moore JC, Nystrom PC, et al:  A prospective study of ketamine versus haloperidol for severe prehospital agitation.  Clin Toxicol 2016;54:556-562. 

Hosted By Washington University, St. Louis

Hydrogen Sulfide: May 9, 2017

  • Smith RP, Gosselin RE: The Influence of Methemoglobinemia on the Lethality of Some Toxic Anions. II Sulfide. Toxicol Appl Pharm 1964;6:584-592. 

  • Chenuel B, Sonobe T, Haouzi P: Effects of Infusion of Human Methemoglobin Solution Following Hydrogen Sulfide Poisoning Clin Toxicol 2015;53:93-101.

  • Haouzi P, Chenuel B, Sonobe T: High-Dose Hydroxocobalamin Adminstered after H2S Exposure Counteracts Sulfide-Poisoning-Induced Cardiac Depression in Sheep.  Clin Toxicol 2015;53:28-36.

  • Guidotti TL:  Hydrogen Sulfide Advances in Understanding Human Toxicity. Int J Toxicol 2010;29:569-581. 

Hosted By Children's Hospital of Michigan Regional Poison Control Center

Naloxone in the Opioid Epidemic: March 14, 2017

  • Willman MW, Liss DB, Schwarz ES, Mullins ME: Do heroin overdose patients require observation after receiving naloxone? Clin Toxicol 2016: epub ahead of print, DOI: 10.1080/15563650.2016.1253846
  • Connors NJ, Nelson LS: The evolution of recommended naloxone dosing for opioid overdose by medical specialty. J Med Toxicol 2016;12:276-281.
  • Schumann H, Erickson TB, Thompson TM, Zautke JL, Denton SD: Fentanyl epidemic in Chicago, Illinois and surrounding Cook County. 2008 46:501-506.
Hosted By Regions Hospital, Minnesota

Osmol: November 8, 2016

  • Inaba H, Hirasawa H, Mizuguchi T:  Serum Osmolality Gap in Postoperative Paitents in Intensive Care.  Lancet 1987;1331-1337.
  • Dorward WV, Chalmers L:  Comparison of Methods for Calculating Serum Osmolality from Chemical Concentrations, and the Prognostic Value of Such Calculations.  1975;21:190-194. 
  • Lynd LD, Richardson KJ, Purssell RA, et al:  An Evaluation of the Osmole Gap as a screening test for Toxic Alcohol Poisoning. BMC Emerg Med 2008;8:1-10. 
Hosted By The Pittsburgh Toxicology Group

Cannabinoids: September 20, 2016

  • Labay LM, Caruso JL, Gilson TP, et al:  Synthetic cannabinoid drug use as a cause or contributory cause of death.  Forens Sci Intl 2016;260:31-39.
  • Odell MS, Frei MY, Gerostamoulos, et al:  Residual Cannabis levels in blood, urine and oral fluid following heavy cannabis use. Forens Sci Intl 2015;249:173-180. 
  • Lemos NP, San Nicolas AC, Volk JA, et al:  Driving under the influence of marijuana versus driving and dying under the influence of marijuana: A comparison of blood concentrations of delta9-tetrahydrocannabinol, 11-hydroxy-delta9-tetrahydrocannabinol, 11-nor-9-carboxy-delta9-tetrahydracannabinol, and other cannabinoids in arrested drivers versus deceased drivers. J Anal Toxicol 2015;39:588-601. 
Hosted By Drs. Keith Baker, Brett Marlin, Niklaus Brandehoff, Christopher Hoyte

Addiction Medicine: July 12, 2016

  • Liebschutz JM, Crooks D, Herman D, et al: Buprenorphine treatment for hospitalized, opioid-dependent patients: A randomized clinical trial.  JAMA Intern Med 2014;174:1369-1376.
  • Mason BJ, Quello S, Goodell V, et al:  Gabapentin treatment for alcohol dependence: A randomized controlled trial.  JAMA Intern Med 2014;174:70-77.
  • Meyer MC, Johnston AM, Crocker AM, et al:  Methadone and buprenorphine for opioid dependence during pregnancy: A retrospective cohort study. J Addict Med 2015;9:81-86.
Hosted By Drs. JoAn Laes,  Michael Hodgman, and Kurt Kleinschmidt with contributions by Dr. Timothy Wiegand

Toxicology Issues in Bariatric Populations: May 10, 2016

  • Rinder HM, Murphy JW, Higgins GL:  Impact of unusual gastrointestinal problems on the treatment of tricyclic antidepressant overdose.  Ann Emerg Med 1988;17:1079-1081.
  • Woodard GA, Downey J, Hernandez-Boussard T, Morton JM:  Impaired alcohol metabolism after gastric bypass surgery:  A case-crossover trial.  J Am Coll Surg 2011;212:209-214.
  • Bhatti JA, Nathens AB, Thiruchelvam D, et al:  Self-harm emergencies after bariatric surgery:  A population-based cohort study.  JAMA Surg 2016;151:226-232.
Background Articles
  • Zuckerman M, Greller HA, Babu K:  A review of the Toxicologic implications of obesity.  J Med Toxicol 2015;11:342-354.
  • Lloret-Linares C, Bellivier F, Heron K, et al:  Treating mood disorders in patients with a history of intestinal surgery: a systematic review. Intl J Psychopharm 2015;30:119-128. 
Hosted By Toxikon Group

Liquid Nicotine Toxicity: New Potential for an Old Poison: March 8, 2016

  • Bassett RA, Osterhoudt K, Brabazon T. Nicotine poisoning in an infant. N Eng J Med 2014; 370 (23): 2249-50 + Letter to Editor: Cantrell FL, Clark RF. More on nicotine poisoning in infants. N Eng J Med 2014; 371 (9): 880.
  • Forrester MB. Pediatric exposures to electronic cigarettes reported to Texas Poison Centers.  J Emerg Med 2014; 49 (2): 136-142.
  • Chen BC, Bright SB, Trivedi AR, Valento M. Death following intentional ingestion of e-liquid. Clin Toxicol 2015; 53 (9): 914-916.
  • Kim JW, Baum CR. Liquid nicotine toxicity. Pediatr Emerg Care 2015; 31 (7): 517-521.
Hosted By Harvard Medical Toxicology Fellowship, MA/RI PCC, Boston Children's Hospital Department of Emergency Medicine

Flumazenil: January 12, 2016

  • Moore PW, Donovan JW, Burkhart KK, et al: Safety and efficacy of flumazenil for reversal of iatrogenic benzodiazepine-assoicated delirium toxicity during treatment of alcohol withdrawal, a retrospective review at one center. J Med Toxicol 2014;10:126-132.
  • Nguyen TT, Troendle M, Cumpston K, et al: Lack of adverse effects from flumazenil administration: an ED observational study. Amer J Emerg Med 2015;33:1677-1679.
  • Gueye PN, Hoffman JR, Taboulet P, et al: Empiric use of flumazenil in comatose patients: Limited applicability of criteria to define low risk. 1996;27:730-735.
Hosted By VCU Medical Center

Black Widow Spider Envenomation: November 10, 2015

  • Dart RC, Bogdan G, Heard K, et al.:  A randomized, double-blind, placebo-controlled trial of a highly purified equine F(ab)2 antibody black widow spider antivenom.  Ann Emerg Med 2013;61:458-467.
  • Clark RF, Wethern-Kestner S, Vance MV, et al:  Clinical presentation and treatment of black widow spider envenomation:  A review of 163 cases.  Ann Emerg Med 1992;21:782-787.
  • Isbister GK, Page CB, Buckley NA, et al.:  Randomized controlled trial of intravenous antivenom versus placebo for Lactrodectism: The second redback antivenom evaluation (RAVE-II) study.  
Hosted By UC San Diego Medical Center

ECMO: September 8, 2015

  • Bellezzo JM, Shinar Z, Davis DP, et al:  Emergency Physician-initiated extracorporeal cardiopulmonary resuscitation.  Resuscit 2012;83:966-970.
  • Lee HMD, Archer JRH, Dargan PI, et al:  What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient?  Clin Toxicol 2015;53:145-150.
  • DE Lange DW, Sikma MA, Meulenbelt J:  Extracorporeal membrane oxygenation in the treatment of poisoned patients.  Clin Toxicol 2013;51:385-393.
Hosted By Banner-University Medical Center Phoenix

Issues in decontamination: July 14, 2015

  • Jayashree M, Singhi S, Gupta A:  Predictors of outcome in children with hydrocarbon poisoning.  Indian Pediatr 2006;43:715-719. 
  • Wang X, Mondal S, Wang J:  Effect of activated charcoal on Apixaban pharmacokinetics in healthy subjects.  Am J Cardiovasc Drugs 2014;14:147-154.
  • Tenenbein M, Cohen S, Sitar DS:  Orogastric lavage, and activated charcoal for acute drug overdose: Efficacy of Ipecac-induced emesis.  Ann Emerg Med 1987;16:838-841. 
Hosted By Drexel University College Of Medicine

Advanced Topics in Liver Failure: May 12, 2015

  • Tjajadi, Matthew. "Extracorporeal Treatment For Acetaminophen Poisoning: Recommendations from the Extrip Workgroup." Journalof Emergency Medicine 47.6 (2014): 751-752.
  • Mpabanzi, Liliane, and Rajiv Jalan. "Neurological complications of acute liver failure: pathophysiological basis of current management and emerging therapies." Neurochemistry international 60.7 (2012): 736-742.
  •  Akdogan, M., et al. "The effect of total plasma exchange on fulminant hepatic failure." Journal of clinical apheresis 21.2 (2006): 96-99.
Hosted By Indiana University School Of Medicine

Toxins from the Oregon-Alaska-Guam Poison Center catchment area: March 10, 2015

  • Cardall BL, Brodie ED, Brodie ED, et al:  Secretion and regeneration of tetrodotoxin in the rough-skin newt (Tarich granulosa).  Toxicon 2004;44:933-938. 
  • Bachhuber MA, Saloner B, Cunningham CO, et al:  Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.
  • Krakauer J, Long Y, Kolbert A, et al:  Presence of L-Canavanine inHedysarum alpinum seeds and its potential role in the death of Chris McCandless.  Wild and Environ Med 2015;26:36-42. 
  • Johnston JJ, Savarie PJ, Primus TM, et al: Risk assessment of an acetaminophen baiting program for chemical control of Brown Tree Snakes in Guam: Evaluation of baits, snake residues, and potential primary and secondary hazards.  Environ Sci Technol 2002;36:3827-3833. 
  • Fagan RP, McLaughlin JB, Castrodale LJ, et al:  Endemic Foodborne Botulism among Alaska Native Persons – Alaska, 1947-2007. 
Hosted By The Oregon Poison Center 

Toxic Tots and Teens: January 13, 2015

  • Bond RG, Woodward RW, Ho M:  The growing impact of pediatric pharmaceutical poisoning.  J Pediatr 2012;160:265-70.
  • Tormoehlen LM, Mowry JB, Bodle JD, Rusyniak DE:  Increased adolescent opioid use and compilations reported to a poison control center following the 2000 JCAHO pain initiative.  Clin Toxicol.  2011;49:492-498.
  • Burghardt LC, Ayers JW, Brownstein JS, Bronstein AC, Burns Ewald M, Bourgeois FT: Adult prescription drug use and pediatric medication exposures and poisonings.  Pediatr 2013;132:18-27.  
Hosted By Drs. Michele Burns, Bradley Demeter and Rebecca Bruccoleri from the Harvard Medical Toxicology Fellowship

The Economics of Toxicology: November 11, 2014

  • Leikin JB, Vogel S, Samo D, Stevens P:  Reimbursement Profile of a
    Private Toxicology Practice.  Clin Toxicol 2006;44:261-265.
  • Curry SC, Brooks DE, Skolnik AB, Gerkin RD, Glenn S:  Effect of a
    Medical Toxicology Admitting Service on Length of Stay, Cost, and
    Mortality Among Inpatients Discharged with Poisoning-Related Diagnoses.  J
    Med Toxicol 2014;Aug 16 [Epub ahead of print].
  • Wiegand TJ, Crane PW, Kamali M, Reif M, Wratni R, et al:  Billing and
    Reimbursement for a Bedside Toxicology Service at a Tertiary Care Academic
    Center During Its First Fiscal Year.  J Med Toxicol 2014;Sept 25 [Epub
    ahead of print].
Hosted By Drs. Steven Walsh, William Boroughf and Robb Bassett from the Einstein Medical Toxicology Fellowship

Dabigatran: September 9, 2014

  • Connolly SJ, Ezekowitz MD, Yususf S, et al:  Dabigatran versus Warfarin in Atrial Fibrillation.  N Engl J Med 2009;361:1139-1151.
  • Eereberg ES, Kamphuisen PW, Sijpkens MK, et al: Reversal of Rivaroxaban and Dabigatran by Prothrombin Complex Concentrate:  A Randomized Placebo-Controlled, Crossover Study in Healthy Subjects.  Circulat 2011;124:1573-1679.
  • Cohen D:  Dabigatran:  how the drug company withheld important analyses.  BMJ 2014;349:g4670
Hosted By Drs. Kavita Babu, Peter Chai and the UMASS Toxicology Fellowship Program

Classics: July 8, 2014

  • Boehnert MT, Lovejoy FH:  Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants.  N Engl J Med 1985;313:474-9.
  • Pentel P, Peterson CD:  Asystole complicating physostigmine treatment of tricyclic antidepressant overdose.  Ann Emerg Med 1980;9:588-90.
  • Prescott LF, Balali-Mood M, Critchley JA, et al:  Diuresis or uninary alkalinisation for salicylate poisoning?  Br Med J (Clin Res Ed). 1982;285:1383-6.  
Hosted By Drs. Nancy Onisko, Jakub Furmaga, Kurt Kleinschmidt and the UT Southwestern Fellowship Program

Rhabdomyolysis: May 13, 2014

  • Weibrecht K, Dayno M, Darling C, Bird SB.  Liver aminotransferases are elevated with rhabdomyolysis in the absence of significant liver injury. J Med Toxicol. 2010 Sep;6(3):294-300.
  • McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013 Oct 28;173(19):1821-8.
  • Brown CV , Rhee P , Chan L , Evans K , Demetriades D , Velmahos GC .  Preventing renal failure in patients with rhabdomyolysis:do bicarbonate and mannitol make a difference?  J Trauma . 2004 ; 56 ( 6 ): 1191 - 1196.
  • Historical Background Paper: Waters EG, Beall D.  Crush Injuries with Impairment of Renal Function.  Br Med J. 1941 Mar 22;1(4185):427-32.
Hosted By Drs. Brandon Wills and the VCU Toxicology Fellowship Program

Cyanide: March 4, 2014

  • Baud FJ, Borron SW, Megarbane B, et al: Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning.  Crit Care Med 2002;30:2044-2050. 
  • Barillo DJ:  Diagnosis and treatment of  cyanide toxicity.  J Burn Care and Res 2009;30:148-152.
  • Geldner G, Koch EM, Gottwald-Hostalek U, et al:  Report on a study of fires with smoke gas development.  Der Anaesthesist 2013;8:609-618. 
  • Mintegi S, Clerigue N, Tipo V, et al:  Pediatric cyanide poisoning by fire smoke inhalation.  Ped Emerg Care;29:1234-1240. 
Hosted By Regions Hospital / Hennepin Regional Poison Center Medical Toxicology Fellowship Program

Click here for .pdf of presentation: January 7, 2014


  • Update: Pulmonary Hemorrhage/Hemosiderosis Among Infants-Cleveland, Ohio, 1993-96. MMWR 1997;46:33
  • Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment. Johanning et al. Int Arch Occup Environ Health 1996;68:207 
  • Update: Pulmonary Hemorrhage/Hemosiderosis Among Infants-Cleveland, Ohio, 1993-96. MMWR 2000;49:180 
  • Indoor mold, toxigenic fungi, and (Stachybotrys chartarum): Infectious disease perspective. Clin Microbiol Rev 2003;16:144  
Hosted By SUNY Upstate Medical University Syracuse, NY

Evaluation of the QT Interval for Medical Toxicologists: September 10, 2013

  • Chan A, Isbister GK, Kirkpatrick CMJ, et al:  Drug-induced QT prolongation and torsades de pointes: Evaluation of QT prolongation.  QJ Med 2007:100:609-615.
  • Sharma ND, Rosman HS, Padhi D, et al:  Torsades de pointes associated with intravenous haldoperidol in critically ill patients.  Am J Cardiol 1998;81:238-240. 
  • Isbister GK, Balit CR, Macleond D, et al:  Amisulpride overdose is frequently assoiated with QT prolongation and torsades de pointes.  J Clin Psychopharm 2010;30:391-395.
Hosted by University of Pittsburgh Medical Toxicology Fellowship Program

May 7, 2013

  • Bower JO, Mengle HAK:  The additive effect of calcium and digitalis:  A warning with a report of two deaths.  JAMA 1934;106:1151-1153.
  • Smith PK, Winkler AW, Hoff HE:  Calcium and digitalis synergism:  The toxicity of calcium salts injected intravenously into digitalized animals.  Arch Intern Med 1939: 322-329.
  • Hack JB, Woody JH, Lewis DE, et al:  The effect of calcium chloride in treating hyperkalemia due to acute digoxin toxicity in a porcine model.  J Toxicol Clin Toxicol 2004;42:337-342.
  • Levine M, Nikkan H, Pallin DJ:  The effects of intravenous calcium in patients with digoxin toxicity.  J Emerg Med 2011;40:41-46.

Hosted by OHSU/Oregon Poison Center Medical Toxicology Program

Radiation, Chelation, and Historical Toxicology: March 5, 2013

  • Llobet JM, Domingo JL:  Comparative effects of repeated parenteral administration of several chelators on the distribution and excretion of cobalt.  Res Comm Chem Pathol Pharm 1988;60:225-233.
  • Belongia EA, Hedbert CW, Gleich GJ, et al:  An investigation of the cause of the Eosinophilia-Myalgia Syndrome associated with tryptophan use.  N Engl J Med 1990;323:357-365.
  • Melo DR, Lipsztein JL, de Oliveria CAN, et al:  137Cs internal contamination involving a Brazilian accident, and theefficacy of prussian blue treatment. Health Phys 1994;66:245-252. 

Hosted by Emory Medical Toxicology Fellowship Program

Carbon Monoxide Poisoning: September 4, 2012

  • Annane D, Chadda K, Gajdos P, Jars-Guincestre MC, Chevret S, Raphael JC.Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials.Intensive Care Med. 2011 Mar;37(3):486-92. Epub 2010 Dec 2.
  • Weaver LK, Valentine KJ, Hopkins RO. Carbon monoxide poisoning: risk factors for cognitive sequelae and the role of hyperbaric oxygen.Am J Respir Crit Care Med. 2007 Sep 1;176(5):491-7. Epub 2007 May 11.
  • Thom SR, Bhopale VM, Fisher D, Zhang J, Gimotty P.Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci U S A. 200 Sep14;101(37):13660-5. Epub 2004 Sep 1. 

Hosted by the Indiana University School of Medicine

New or Novel Therapies for Cardiovascular Toxicity: July 10, 2012

  • Pinchon N, Dugard W, Clavel M, Extracorporeal albumin dialysis in three cases of acute CCB poisoning with life-threatening refractory cardiogenic shock. Ann Emerg Med 2012
  • Mottram A, Bryant S, Aks S: Dose dependent response to cyclodextrin infusion in a rat model of verapamil toxicity. West J Emerg Med 2012
  • Arici MAA et al: Effects of BQ-788 on amitriptyline induced cardiovasculare toxicity.Hum Exp Tox 2012.

Hosted by the Carolinas Medical Center Division of Medical Toxicology

Pediatric Sulfonylurea Exposure: May 1, 2012

  • Levine M, Ruha A-M, LoVecchio F, et al:  Hypoglycemia after accidental pediatric sulfonylurea ingestions.  Pediatr Emerg Care 2011;27:846-849.
  • McLaughlin SA, Crandall CS, McKinney PE:  Octreotide:  An antidote for sulfonylurea-induced hypoglycemia.  Ann Emerg Med 2000;36:133-138.
  • Lung DD, Olson KR:  Hypoglycemia in pediatric sulfonylurea poisoning:  An 8-year poison center retrospective study.  Pediatr 2011;127:e1558-e1564.

Hosted by the Harvard Medical Toxicology Fellowship / Children's Hospital Boston

What’s new with alpha-2?: January 10, 2012

Click here for OHSU's approach to journal club


  • Scheinin H, Aantaa R, Anttila M, et al: Reversal of the sedative and sympatholytic effects of dexmedetomidine with a specific alpha 2 adrenoceptor antagonist atipamezole. Anestheseology 1998;89:574-84.
  • Menon DV, Wang Z, Fadel PJ, et al: Central sympatholysis as a novel countermeasure for cocaine-induced sympathetic activation and vasoconstriction in humans. J Amer Coll Cardiol 2007;50:626-633.
  • Intramuscular dexmedetomidine sedation for pediatric MRI and CT. Amer J Radiol 2011;197:720-725.

Hosted by the OHSU / Oregon Poison Center Medical Toxicology Program

Thyroid: September 16, 2011

Click here for Toxikon's approach to journal club

  • Litovitz TL, White D: Leovthyroxine ingestions in children: An analysis of 78 cases: Am J Emerg Med 1985;3:297-300.
  • Lewander WJ, Lacouture PG, Silva JE, et al: Acute thyroxine ingestion in pediatric patients. Pediatr 1989;84:262-265.
  • Majlesi N, Greller HA, McGuigan MA, et al: Thyroid storm after pediatric levothyroxine ingestion. Pediatr 2010;126:e470-e473.

Hosted by the Chicago Toxikon Consortium