ToxIC Projects and Registries

In addition to the ToxIC Core Registry, the specialized ToxIC Sub-Registries and projects below provide data specific to trending research interests in the field of medical toxicology.

ToxIC Core Registry

All cases entered into the Core Registry represent a patient that has been formally evaluated and treated by a medical toxicologist
as part of their medical care. Toxicological data is therefore gathered by trained medical toxicology physicians who are skilled in
the subtle signs of toxicity and poisoning, leading to a high quality case registry. 

FDA ACMT COVID-19 ToxIC (FACT)
Pharmacovigilance Project 

This project provides a mechanism for enhanced collection of
safety data related to drug therapies used in patients
treated for COVID-19.

Fentalog
Project

This project utilizes high volume geographically diverse ToxIC sites to evaluate risk factors and track regional trends in fentalog overdoses including fentanyl, fluorofentanyl, butyrylfentanyl, and carfentanil.

North American Snakebite Registry (NASBR)

The NASBR is a nationwide surveillance tool that prospectively
gathers deidentified information from medical toxicologists
providing bedside care for patients with envenomations.

ToxIC Novel Opioid and
Stimulant Exposures (NOSE)

This project brings enhanced reporting to ACMT members
and the Opioid Response Network (ORN) regarding
novel opioids and psychostimulants.

Pediatric Marijuana
and Opioid Registry (PEDMOP)

This project brings enhanced reporting to ACMT members
and the Opioid Response Network (ORN) regarding
novel opioids and psychostimulants.

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Marijuana Sub Registry

With the legalization/decriminalization of marijuana across the United States and the increased use of medical marijuana, we have seen an associated increase in both hospital visits and cases of unintentional exposure by children reported to regional poison centers. There is relatively little in the medical literature describing the risk factors and presentation characteristics of these children. Effective preventive measures are needed as more states consider legalizing the drug and front-line providers must be alerted to the typical signs, symptoms and outcomes of children with marijuana intoxication.

Opioid Sub-Registry

Pediatric repercussions of the opioid epidemic are many including increased unintentional exposure in young children, increased neonatal abstinence syndrome, and increased intentional abuse by adolescents. While there are an increasing number of published reports in the literature, the details surrounding exposure, clinical presentation, management and outcomes in the pediatric age group have not been adequately studied in a prospective manner. 

Registry’s Role

The purpose of ACMT’s Pediatric Marijuana and Opioid (PEDMOP) Sub-Registry is to gather detailed prospective information regarding demographics, circumstances surrounding exposure, method of exposure, symptom profile, management and clinical course of children who present with opioid or marijuana intoxication; and, are cared for by medical toxicologists. The ultimate goal is to use the information gathered to develop appropriate guidance on the management of these exposures and to inform targeted prevention efforts.

Principal Investigator Contact Information

Yaron Finkelstein, MD, FACMT
Hospital for Sick Children, Toronto, Ontario, Canada
Email: yaron.finkelstein@sickkids.ca

Natural Toxins Registry:
Plants and Mushrooms 

The purpose of this registry is to gather detailed information regarding ingestion amounts, method of confirmation, time to onset of symptoms, and clinical course of patients who ingest toxic plants and mushrooms.

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Background – Plants

Human exposures to plant toxins are relatively common.  In 2012, U.S. Poison Center’s received over 46,000 calls for exposures to plants. Despite this, research on the acute ingestion of these toxins in human populations is sparse, and is nearly exclusively case reports and small case series. 

The medical literature contains relatively little information on the clinical characteristics, demographics, and regionality of plant ingestions.  The purpose of ACMT’s Natural Toxins Registry – Plants is to gather detailed prospective information regarding ingestion amounts, method of confirmation, time to onset of symptoms, and clinical course of patients who ingest plants and are cared for by medical toxicologists.  The ultimate goal is to use the information gathered to develop appropriate guidance on the management of these exposures.

Background – Mushrooms

Human exposures to mushrooms are relatively common and may lead to significant morbidity and rarely mortality.  In 2012, U.S. Poison Center’s received over 6000 calls for human exposures to mushrooms. Despite this, research on the acute ingestion of these toxins in human populations is relatively sparse. 

The medical literature contains relatively little detailed information on the clinical characteristics, demographics, and regionality of mushroom ingestions.  The purpose of ACMT’s Natural Toxins Registry – Mushrooms is to gather detailed prospective information regarding ingestion amounts, method of confirmation, time to onset of symptoms, and clinical course of patients who ingest mushrooms and are cared for by medical toxicologists.  The ultimate goal is to use the information gathered to develop appropriate guidance on the management of these exposures.

Principal Investigator Contact Information

Robert G. Hendrickson, MD
Oregon Health and Science University, Portland, Oregon
Email: hendriro@ohsu.edu 

Extracorporeal Therapies
Registry

This registry gathers data on extracorporeal therapies used to treat
poisoned patients including hemodialysis, peritoneal dialysis, continuous renal replacement therapy, hemoperfusion, apheresis, and albumin dialysis.

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Background

Extracorporeal therapies (ECT), such as hemodialysis, are critically important tools in the treatment of poisoned patients. In the last two decades, major changes have occurred in the nature, utilization, and availability of different types of ECT – including, among others, changes in hemodialysis filter technology, the rise of utilization of continuous renal replacement therapies, the sharp increase in the usage of extracorporeal membrane oxygenation in adults within the last five years, and a number of newly emerging therapies such as the extracorporeal liver assist device. Existing literature regarding the use of extracorporeal therapies to treat poisoning likely does not take all of these changes into account. The rate at which therapies are modified or introduced may make it difficult to adequately study use in poisoned patients through single-institution avenues, especially given that the use of ECT for all but a few poisonings is relatively rare. In addition, very detailed case information about the use of dialysis for poisoning in a sizeable number of patients is nearly impossible to assemble from existing sources.

The purpose of the ToxIC Extracorporeal Therapies Registry is to gather detailed information about patients treated with any form of extracorporeal therapy which can facilitate extracorporeal removal of poisons including: hemodialysis; peritoneal dialysis; continuous renal replacement therapy; hemoperfusion; any form of apheresis; albumin dialysis; and novel forms of extracorporeal therapy. The main goals of this registry are to describe current utilization of ECT for poisoning from an epidemiological standpoint, and assist in determining how effective different forms of ECT are for the treatment of various poisonings.

Principal Investigator Contact Information

Joshua D. King, MD
Assistant Professor, Division of Nephrology and Division of Medical Toxicology
University of Virginia School of Medicine 
Email: joshking@virginia.edu

Lipid Emulsion Therapy
Registry

The purpose of this project is to evaluate the case characteristics
of patients who receive intravenous lipid emulsion therapy,
its potential benefits, and potential harms.

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Background

The purpose of this project is to evaluate the case characteristics of patients who receive intravenous lipid emulsion therapy. Previous literature to date has focused on animal studies or has been primarily limited to case reports or small case series. This prospectively collected data set will permit a much more detailed description of the use of lipid, its potential benefits, and potential harms. Recently, several cases of pancreatitis following lipid emulsion have been reported. One specific subset of this cohort we aim to study is the prevalence of pancreatitis following lipid emulsion therapy.

Principal Investigator Contact Information

Michael Levine, MD
University of Southern California
Email: mdlevine@usc.edu