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More than 20 years that have elapsed since the inaugural American College of Medical Toxicology Spring Conference in 2002. During this time, the now ACMT Annual Scientific Meeting has grown in many ways, as demonstrated by the increase in attendance and abstract submissions, and diversification of educational offerings, and partners. Most importantly, the scientific rigor and presentation of new knowledge has continued to mature, and the conference is now firmly rooted in the annual educational schedule for medical toxicologists. In anticipation of the upcoming 2025 ASM, we reflect upon the evolution and growth of ACMT's research and educational agendas, and the Annual Scientific Meeting itself., (© 2024. American College of Medical Toxicology.)

The advancement of medical toxicology knowledge has traditionally relied on case reports and case series because of the ethical challenges involved in studying poisoned patients. The growing availability of several large databases and registries now allows researchers to describe and analyze patterns in poisoned patients who share a particular exposure, outcome, or condition. A large database or registry can be useful in generating hypotheses, supporting extramural funding applications, and planning more rigorous studies. Knowing how to access and interpret data in registries such as NPDS, NHAMCS, and HCUP is essential for all stakeholders engaged in medical toxicology research. This review describes the strengths and limitations of different toxicology-relevant registries and databases and how to leverage these powerful tools to advance the science in the field of medical toxicology., (© 2024. American College of Medical Toxicology.)

ACMT recognizes the pivotal role of high-quality research in advancing medical science. As such, the establishment of a formal research agenda for ACMT is a leap forward in communicating the priorities of the College, its members, and the patient populations we serve. This thoughtfully crafted agenda will serve as a strategic compass for ACMT, guiding our pursuit of scientific discovery, fostering innovation, and enhancing outcomes for patients and communities affected by poisonings and exposures., (© 2024. American College of Medical Toxicology.)

Background: Twitter-based chat groups (tweetchats) structured as virtual journal clubs have been demonstrated to provide value to learners. In order to promote topics in medical toxicology, we developed the #firesidetox tweetchat as a virtual journal club to discuss and disseminate topics in medical toxicology., Methods: A group of medical toxicologists from the American College of Medical Toxicology (ACMT) Public Affairs Committee and editorial board of the Journal of Medical Toxicology (JMT) developed a quarterly one hour tweetchat featuring JMT manuscripts. We gathered basic twittergraphics and used a healthcare hashtag aggregator to measure the number of impressions, participants, and tweets per tweetchat session. A qualitative analysis of important themes from #firesidetox was also completed., Results: During five tweetchats over 12 months, we attracted a mean of 23 participants generating a mean of 150 tweets per #firesidetox tweetchat. Tweets generated a mean of 329,200 impressions (unique user views): these impressions grew by 300% from the first through fifth #firesidetox. The majority of participants self-identified as medical toxicologists or physician learners. Although most were from the USA, participants also came from Australia, Poland, and Qatar. Most tweets centered on medical education and 7.9% tweets were learner-driven or questions asking for a medical toxicologist expert opinion., Conclusion: The #firesidetox attracted a diverse group of toxicologists, learners, and members of the public in a virtual journal club setting. The increasing number of impressions, participants, and tweets during #firesidetox demonstrates the tweetchat model to discuss pertinent toxicology topics is feasible and well received among its participants.

We compared high-fidelity medical simulation to short-answer written examination in the assessment of emergency medicine residents (EMR) on a month-long medical toxicology rotation. Knowledge-based assessment tools using cases of an aspirin overdose and a tricyclic antidepressant overdose were used to assess all consecutive rotating EMR (n=53). Assessment by simulation had similar accuracy and precision but higher satisfaction rates when compared to written examination. Incorporating simulation into the ABEM certifying examination warrants further study.

The article discusses the history and growth of the Journal of Medical Toxicology (JMT) as it celebrates its 20th year of publication. The author compares the decision to start the journal to Winnie the Pooh's decision to catch a Heffalump, with others expressing surprise that they hadn't thought of it sooner. The article also highlights the challenges faced by scientific journals, such as predatory journals and the decline in trust in science. The author emphasizes the importance of upholding the science of medical toxicology and the need for rigorous research and training in the field. [Extracted from the article]

Introduction: Medical toxicology is a small but growing specialty. To ensure that the specialty continues to grow and attract strong candidates, it is important to understand what influences physicians to pursue medical toxicology training. This would allow for targeted interventions to recruit strong candidates to the field. Methods: A cross-sectional survey was sent via email to current medical toxicology fellows and to medical toxicologists who completed fellowship in the last 5 years. ACMT listservs were utilized to target recipients. The survey was created through an iterative writing process among the study authors. Responses to the survey were recorded in REDCap. Descriptive statistics were obtained and analyzed. Results: A total of 126 participants responded to the survey request (46 fellows and 80 recent graduates). Most were primarily trained in emergency medicine. Interest in medical toxicology usually started during residency when exposure to the field was highest. Most respondents cite a mentor as a primary influence in pursuing medical toxicology training. Conclusions: Among current fellows and recent graduates of medical toxicology, having a mentor in the field of medical toxicology, having exposure to medical toxicology during residency, and participating in a clinical rotation in medical toxicology were common shared experiences that led to the decision to subspecialize in the field. These results may guide targeted intervention to continue to recruit strong candidates to medical toxicology. [ABSTRACT FROM AUTHOR]

Background: The sudden emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and scarcity of the accurate information especially in the initial phase of the struggle presented a series of challenges to health systems. Objective: To evaluate the changes in poisoning cases regarding distribution, types, and characteristics for better framing and planning of the role of our field in responding to pandemics. Methods: Study of telephone consultation calls and toxicology analysis records of poisoning cases referred to the Dammam Poison Control Center in Saudi Arabia during the first half of 2020. Their distribution according to frequencies, causes, and other characteristics was compared to the first half of 2019. Results: Analysis of telephone consultation calls revealed that the proportion of exposure to disinfectants and hand sanitizers during first half of 2020 increased to 20.4% (n = 496) and 3.4% (n = 83), respectively, compared to 9.8% (n = 215) and 0.4% (n = 10) for surface disinfectants and hand sanitizers, respectively, during the first half of 2019. In 2020, exposure to disinfectants and hand sanitizers dominated in preschool children (0-5 years). The total number of cases suspected for drugs/drugs of abuse overdose during the first 6 months of 2020 (n = 783) showed a significant decrease (P < 0.001) compared to the first 6 months of 2019 (n = 1086). Conclusion: The increased availability and use of disinfectants and sanitizers significantly increased the risk of poisoning, especially in preschool-aged children. Public health education for prevention of such home exposures is urgently needed to avoid unnecessary emergency medical system use in such critical time. [ABSTRACT FROM AUTHOR]

Intentional or unintentional caffeine abuse due to excessive intake of beverages or energy drinks containing caffeine is relatively frequent. However, death due to caffeine intoxication is rare and case reports of fatalities from caffeine toxicity are relatively infrequent. In this report, we describe an autopsy case involving a 31 year-old man who intentionally took a large amount of caffeine tablets in the form of a weight loss supplement as part of a suicide plan. Caffeine femoral blood concentration (170 mg/l) was within the toxic and potentially lethal ranges reported in the literature in similar cases. Postmortem biochemistry results suggested depressed glomerular filtration rate and pre-renal failure at the time of death but failed to reveal myoglobinuria, glycosuria, ketonuria or ketonemia. Based on the absence of pathological findings at autopsy and the high blood caffeine level, death was attributed to acute caffeine toxicity. The case emphasizes the usefulness of performing exhaustive toxicology and searching for all potentially relevant information in order to formulate appropriate hypotheses concerning the cause and manner of death. [ABSTRACT FROM AUTHOR]

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Objective. Caffeine is widely available in beverages and in different over-the-counter products, including tablets containing 100 mg caffeine. Because intentional fatal intoxications with caffeine occur, the maximum quantity of caffeine tablets that can be bought over the counter in a single purchase was restricted from 250 to 30 in Sweden in the year 2004. The objective of this article was to study the effect of this decision on the number of fatal caffeine intoxications. Method. In Sweden 95% of all cases undergoing forensic autopsy are screened for a number of drugs including caffeine. All cases during January 1993–September 2009 with a caffeine concentration above 80 μg/g blood were recorded. Results. During the study period toxicological investigations were performed in 83,580 forensic autopsies. Caffeine contributed to the fatal outcome in 20 cases (0.02%). Thirteen (65%) of these fatalities occurred before the introduction of the sales restriction. However, no fatal intoxications where caffeine contributed to the cause of death was recorded between May 2007 and September 2009. Conclusion. Overdoses of tablets containing caffeine can be fatal, suicides as well as accidents occur. Restricting the maximum quantity of caffeine tablets available over the counter seemed to be effective in preventing suicides because of caffeine although some time elapsed until the effect was noted. Further monitoring is required to ensure that the observed lower caffeine mortality is a sustained effect. [ABSTRACT FROM AUTHOR]

Background: Occupational lead poisoning is a health problem in Iran. It has not previously been studied in traditional tile makers. Objective: To determine the prevalence of lead poisoning and its complications in traditional tile workers in Mashhad, Northwest of Iran. Methods: We visited workers in two traditional tile factories and collected data by direct history taking and physical examination. Blood and urine lead concentrations were measured by heated graphite atomization technique. Results: Overall, 108 men with mean±SD age of 37±7.8 years were studied. The mean±SD length of daily lead exposure was 9.8±6 years. The mean±SD blood lead concentration was 520.5±323.2 μg/L. The main objective clinical findings were the presence of lead line (64.8%), peripheral neuropathy of the upper extremities (37%), depressed deep tendon reflexes in the upper extremities (25.7%), tremor (23.3%), peripheral neuropathy of the lower extremities (17%) and abdominal tenderness (15.1%). The subjective findings were mainly attributed to the central nervous system and included loss of memory (57%), moodiness (56.1%), agitation (47.7%), drowsiness (36.4%) and headache (29.9%). There was no statistically significant correlation between the blood lead concentration and glomerular filtration rate. However, there were significant correlations between the blood lead concentration and each of the urine lead concentration (p<0.001), diastolic blood pressure (p=0.04), serum triglyceride level (p=0.043), high density lipoprotein level (p=0.012), and basophilic stippling (p=0.048). Blood lead level, however, did not have any significant correlation with the presence of lead line. Conclusion: In traditional tile workers, lead toxicity is not uncommon and the toxic effects of lead were found more often on the teeth (bone), central and peripheral nervous system, hematological and lipid profiles than on the renal function. [ABSTRACT FROM AUTHOR]

Ethylene glycol classically produces an elevated anion gap metabolic acidosis. We report a series of patients with ethylene glycol toxicity with a component of non-anion gap metabolic acidosis without known associated confounding factors. A retrospective review of Poison Control Center records were searched more than 8 years (2000–2007) for ethylene glycol and antifreeze. Cases were reviewed and excluded for miscoding, information calls, animal exposures, or non-ingestion exposures. The bicarbonate gap, or delta ratio (DR), was calculated using the formula: DR = (AG − 12)/[24 – measured serum where anion gap (AG) = [Na+] − [Cl−] −  , all in mEq/l. Non-anion gap metabolic acidosis was considered present when the DR < 1. Of 254 cases, 175 were excluded. Of the remaining 79 cases, 14 had a component of non-anion gap metabolic acidosis at presentation. Their calculated anion gap was 14–28, and measured serum ranged from 2–20 mEq/l. A normal anion gap was present in two patients who presented with non-anion gap metabolic acidosis. The DR ranged from 0.28–0.95. Seven out of 14 patients with non-anion gap metabolic acidosis had elevated serum [Cl−]. In the other cases, no explanation for the non-anion gap metabolic acidosis could be determined. The absence of a significant anion gap elevation in the setting of metabolic acidosis after ethylene glycol ingestion without other confounding factors (such as ethanol, lithium carbonate or bromide) has not previously been recognized. Clinicians should be aware of the potential for non-anion gap metabolic acidosis in patients with ethylene glycol toxicity, and should not exclude the diagnosis in patients who present with a non-anion gap metabolic acidosis. Further study is needed to determine the mechanisms by which this occurs. [ABSTRACT FROM AUTHOR]

An author index for the September 2007 issue of "Clinical Toxicology" is presented.

The article presents studies on clinical toxicology. They include "Toxicity Mediated via Receptor Interactions. The Examples of Opioids," "Toxicity Mediated by Ion Channel Dysfunction. The Example of Calcium-Channel-Blocker Poisoning" and "Mechanisms and Clinical Effects of Interference With Enzyme Function Using Cholinesterases as an Example."

Professional societies, such as the American College of Medical Toxicology (ACMT) and the American Academy of Clinical Toxicology (AACT) have offered online toxicology resources to clinicians during this time. Prior to the pandemic, the Global Educational Toxicology Uniting Project (GETUP) was instituted to help improve connectivity and educational resources between clinicians in countries with and without toxicology services. [Extracted from the article]

This article presents two years of billing and collection data for a bedside toxicology consultation service. The collections rate was 34% or $26.19 per hour of consultative time. There was an inverse correlation between collection rates and patient acuity. [ABSTRACT FROM AUTHOR]

The article presents information on the American Academy of Clinical Toxicology Symposium which was held in the U.S. from September 8 to 14, 2005. The schedules of activities and its locations are presented. A list of studies conducted by several researchers are presented. Objectives of such studies are also listed.

Background: A significant number of patients seek medical evaluation for chronic subjective symptoms they presume to be associated with a single toxic trigger. This report describes our clinic experience with these patients. Case Series: Twenty patients (of a total of 261 patients) with a mean age of 41 years (median age 42 years; range: 4 to 65 years) were evaluated over an 8 month period. All describe a single past toxic exposure triggering their nonspecific (usually vaguely neurologic) symptoms. Zero of 20 (0%) describe other chemical sensitivities; 2/20 (10%) report ongoing exposure, 18/20 (90%) had a limited exposure dating 1 month to 6 yrs prior to toxicology clinic evaluation; 9/20 (45%) are currently employed; 6/20 (30%) sought alternative medical therapy prior to toxicologist evaluation; 6/20/(30%) have attempted litigation. Conclusion: Despite repeatedly normal toxicologic and medical evaluations, all data refuting an underlying toxic cause are not accepted by this series of patients, and their search for a diagnostic linkage persists. Specific toxin identification or treatment for these patients is unlikely to occur. [ABSTRACT FROM AUTHOR]

Presents abstracts of papers presented at the 2003 North American Congress of Clinical Toxicology Annual Meeting. "Foxy Methoxy: A New Drug of Abuse," by S. Smolinske, R. Rastogi, and S. Schenkel; "Serotonin Syndrome Following Initiation of Escitalopram Monotherapy For Depression," by T. Wiegand and D. Stuart; "Pediatric Overdose of Desmopressin Acetate," by T. Sigg, A. M. Burda, and S. Aks; Others.

Presents a schedule for the 2003 North American Congress of Clinical Toxicology Annual Meeting scheduled for September 3-9, 2003.

Context. Congenital lead poisoning is uncommon and there is no consensus on the management of the newborn. Case Details. A female infant was born to a lead-burdened woman identified by screening just prior to delivery. Maternal blood lead level (BLL) was 58 μg/dL. The infant's BLL on the second day of life was 72 μg/dL with a free erythrocyte protoporphyrin level of 175 μg/dL. The child was managed by an exchange transfusion followed by chelation. The BLL 6 h after exchange transfusion was 11.4 μg/dL. Follow-up 2 years later showed a BLL of 9 μg/dL and normal development. Discussion. We present the details of a case of congenital lead poisoning treated aggressively which appears to have resulted in a favorable outcome. [ABSTRACT FROM AUTHOR]