Toxicology Trivia


poisonIt’s day two of toxicology at Bellevue and the New York City Poison Control Center (212-POISONS, how great is that?). Great lectures, high-yield learning, and lots of hold music and hang-ups while trying to do callbacks and follow-ups. So it goes.

Thought I’d throw in some interesting factoids from the past several days that were news to me (and should be practiced with consultation with your own toxicologist only!):

  • Sudden sniffing death syndrome is, ahem, sudden death after huffing an inhalant, thought to be due to a catecholamine surge from a huffer who is startled or just got caught. Apparently if they’re not dead, they’re incredibly tachycardic (perhaps pulseless VT), and the treatment is actually beta blockers to try to stop the catecholamine surge. Certainly counter-intuitive.
  • Crystal meth has a 24-hour half-life. Most of the other amphetamines are much shorter-acting.
  • Dapsone is one of the few agents that can cause recurrent methemoglobinemia; one of the treatments is actually cimetidine, since it inhibits the P450 system and prevents dapsone’s toxic metabolite from being produced as quickly.
  • When you give hydroxycobalamin for cyanide poisoning, the body ends up taking the cyanide group and making cyanocobalamin, part of the B12 vitamin family. Take that, cyanide.
  • 2-3% of all suicidal ingestions “without Tylenol,” where the patient tells you “exactly what they took” will actually turn up having a positive acetaminophen level, which would explain why the toxicologists are always asking for the level even when the suspicion for co-ingestion is low.
  • Activated charcoal, if given before the 4-hour mark, can prevent patients from meeting the treatment criteria (150 µg/dL at 4 hours) for acetaminophen overdose.
  • And if you hadn’t heard this yet, I’m sad to report that California Poison Control lost its budget and may close soon. According to the linked press release, it prevents over 150,000 ED visits in the state.

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  1. #1 by goog - October 21st, 2009 at 23:00

  2. #2 by Leon Gussow - October 22nd, 2009 at 09:52

    Note also that since both dapsone and one of its metabolites undergo enterohepatic circulation, giving multidose activated charcoal (loading dose then 25 gm q 2 h in an adult) will enhance elimination.

  3. #3 by Hot News Today - November 9th, 2009 at 12:19

    Leon Gussow :
    Note also that since both dapsone and one of its metabolites undergo enterohepatic circulation, giving multidose activated charcoal (loading dose then 25 gm q 2 h in an adult) will enhance elimination.

    Wow, excellent article full of important information and also completed by Leon Gussow.
    Feels like I’ve found remarkable site, thanks to Google who dropped me to great place such as this site. Bookmark immediately.

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