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Neurotoxicology
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Sean D. McCann, Trevonne M. Thompson
Care of the patient with neurotoxicity should be approached from the framework used in the general care of the poisoned patient. Medical toxicology is rooted in a principle originally articulated by the 16th-century Swiss physician Paracelsus: “All things are poison, and nothing is without poison; the dosage alone makes it, so a thing is not a poison.” Substances considered benign or therapeutic may become toxic at high doses as is seen with water intoxication, which can present with severe hyponatremia, seizures, and hemolysis. At toxic doses, substances may have pharmacologic, pharmacodynamic, and pharmacokinetic properties that are different from those seen at physiologic or therapeutic concentrations. Thus, we refer to their toxicologic, toxicodynamic, and toxicokinetic properties in order to distinguish from the effects observed under normal or therapeutic conditions. Several aspects of care unique to the poisoned patient should be considered in the assessment and treatment of these individuals.
Toxicology
Published in Aruna Bakhru, Nutrition and Integrative Medicine, 2018
There are several subdisciplines of toxicology, which focus on particular aspects of toxicology. These include: ToxicogenomicsChemical toxicologyClinical toxicologyEcotoxicologyEnvironmental toxicologyForensic toxicologyMedical toxicologyOccupational toxicologyRegulatory toxicology
Toxicologic Malingering
Published in Alan R. Hirsch, Neurological Malingering, 2018
A second pillar of medical toxicology is toxidrome recognition: the spectrum of symptom complexes relatable to a specific toxic exposure (Mofenson and Greensher, 1970; Nice, Leikin, Maturen, Madsen, Zell, and Hryhorczuk, 1988). For example, organophosphate insecticide exposure usually presents with a cholinergic response (salivation, lacrimation, urination, defecation, wheezing, and pinpoint pupils). Most gases are mucosal irritants—thus, eye/throat irritation, along with coughing or wheezing, are prominent symptoms. Ammonia and chlorine gases are common examples of mucosal irritant gases with otherwise few symptoms. Very few gases/toxicants will cause neurological-based problems without mucosal irritation (cyanide, carbon monoxide, and lead are the primary examples). Factors to consider associating with a toxic etiology are listed below:
Dexmedetomidine in the treatment of toxicologic conditions: a systematic review and review of the toxicology investigators consortium database
Published in Clinical Toxicology, 2022
Kevin Baumgartner, Michelle Doering and, Michael E. Mullins
It is clear that additional high-quality clinical research on the use of dexmedetomidine to treat toxicologic conditions is necessary. Future investigators should report high-quality data on dexmedetomidine dosing and duration, temporal correlation between dexmedetomidine initiation and symptom control, and detailed descriptions of the use of other sedatives, including dose and duration. Future studies should focus on clearly defined homogeneous toxicologic conditions and control, as much as possible, for the use of other sedatives and antidotal therapies. Ultimately, rigorous prospective research in clearly delineated patient populations using a well-defined dexmedetomidine dosing protocol and standardized adjunctive medications will be required. Randomized controlled trials would be ideal but are frequently impractical in medical toxicology.
Predictors of severe outcome following opioid intoxication in children
Published in Clinical Toxicology, 2022
Neta Cohen, Mathew Mathew, Adrienne Davis, Jeffrey Brent, Paul Wax, Suzanne Schuh, Stephen B. Freedman, Blake Froberg, Evan Schwarz, Joshua Canning, Laura Tortora, Christopher Hoyte, Andrew L. Koons, Michele M. Burns, Joshua McFalls, Timothy J. Wiegand, Robert G. Hendrickson, Bryan Judge, Lawrence S. Quang, Michael Hodgman, James A. Chenoweth, Douglas A. Algren, Jennifer Carey, E. Martin Caravati, Peter Akpunonu, Ann-Jeannette Geib, Steven A. Seifert, Ziad Kazzi, Rittirak Othong, Spencer C. Greene, Christopher Holstege, Marit S. Tweet, David Vearrier, Anthony F. Pizon, Sharan L. Campleman, Shao Li, Kim Aldy, Yaron Finkelstein
The pediatric opioid sub registry was established as a dedicated part of the ToxIC case registry in 2017. The ToxIC case registry was established in 2010 by the American College of Medical Toxicology [21]. ToxIC prospectively compiles data from 35 participating sites, comprised of 50 medical centers across the US, which represent approximately 60% of all medical toxicology training programs in the country, as well as international sites in Canada, Israel, and Thailand [22]. All prospectively identified patients consulted on and managed by participating medical toxicologists are entered in real-time into the ToxIC registry. If the case involved a pediatric opioid exposure, additional detailed data were collected, and the patient was entered into the dedicated pediatric opioid exposure sub-registry. Thus, our patient cohort was derived from the opioid exposure sub-registry with complimentary data from the ToxIC registry. The latter collects patient-level clinical and demographic data, including circumstances of exposure, substances involved, signs and symptoms on presentation, management, disposition, and outcome.
Failure of chelator-provoked urine testing results to predict heavy metal toxicity in a prospective cohort of patients referred for medical toxicology evaluation
Published in Clinical Toxicology, 2022
Stephanie T. Weiss, Sharan Campleman, Paul Wax, William McGill, Jeffrey Brent
Medical toxicology is a highly specialized discipline, and the formal outpatient evaluation of patients with potentially consequential toxicologic exposure is relatively uncommon. This is evidenced by the fact that the participating site clinics reported seeing a total of only 2946 non addiction clinic patients over a time period of 7.5 years. Although medical toxicology clinics do occasionally encounter patients who present with the results of PUT, these patients are seen relatively infrequently by mainstream medical practitioners, including medical toxicologists. The ToxIC case registry, aggregating the prospective experience of medical toxicologists from dozens of different sites, allowed for the accumulation of a relatively large number of cases of patients who have been evaluated and had their diagnoses ascertained by a board-certified medical toxicologist.