Journal of toxicology. Clinical toxicology (J Toxicol Clin Toxicol )


Reflecting the professional concerns and astute scientific judgment of the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT), the Journal of Toxicology - Clinical Toxicology serves as an international voice on the unique specialty of medical toxicology - presenting timely, peer-reviewed scientific research and clinical articles on all facets of acute and chronic poisoning and its management. The rapid proliferation of new drugs, toxin, antitoxins, and environmental hazards and the renewed threat of chemical warfare are pressing issues in emergency medicine. Certification in the subspecialty of Clinical Toxicology is now offered by the American Boards of Emergency Medicine (ABEM), Preventative Medicine (ABPM), and Pediatrics (ABP), reflecting the need for expertise in Acute toxicologic care, including hemodialysis hemoperfusion hepatic support systems liquid ventilatory perfusion Environmental exposures Civil Defense Occupational toxicology Substance abuse Analytic toxicology In addition, the journal furnishes opportunities for new insights and explications as well as consolidates consensus views on contemporary issues, offering state-of-the-art, evidence-based position papers on topics related to gastrointestinal decontamination and elimination techniques and guidelines ipecac, lavage and charcoal gastric lavage single and multiple dose activated charcoal cathartics whole bowel irrigation alkaline diuresis hemoperfusion hemodialysis and much more! about the sponsors... The American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) are organizations of clinical toxicologists primarily affiliated with teaching hospitals, schools of pharmacy and public health, and regional centers for poison information and treatment. Their professional activities include emergency and critical care; family practice; internal medicine; pediatrics; occupational, environmental, preventive, and public health; epidemiology; forensic and clinical chemistry; substance abuse; pharmacy; and research pharmacology and toxicology. Discontinued in 2005 - now Clinical Toxicology.

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    Journal of toxicology. Clinical toxicology, Clinical toxicology
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Emergency departments of hospitals frequently admit patients that are intoxicated by drugs or that attempted to suicide. Intoxication due to substance use may differ according to geographical regions and culture. Intoxication due to orpiment, used for hair removal, has been common in the Eastern Asian countries, particularly in Iran and India. The substance has also been used for suicidal purposes because it is inexpensive and easily available and has high toxicity. Herein we report a case who presented with oral consumption of orpiment, including arsenic, for suicidal purpose.
    Journal of toxicology. Clinical toxicology 11/2013; 2013(3):5.
  • Journal of toxicology. Clinical toxicology 01/2013;
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    ABSTRACT: The Australian Small-scaled Snake, Oxyuranus microlepidotus , recently rediscovered, is the world's most venomous snake, with a murine LD50 of 0.01 mg/kg. Recently developed immunological techniques, combined with a whole animal model, have enabled us to measure accurately the mass of venom actually injected by a striking snake. The venom of this species contains at least six identified protein fractions, and one or more of these possesses potent neurotoxic action. An initial assessment of the molecular weights of each of these is reported. This study describes field biting experiments applicable to potential human snake-bite, and presents data concerning the injected venom:LD50 ratio which is an index of potential human lethality. This snake delivers an average mass of 17.3 mg in a strike, and the injected mass:LD50 ratio is 1730, the highest recorded for any snake. Comparative results for five other Elapidae whose venom contains potent neurotoxins are also presented. An average mass of 0.6 mg of venom is split on the skin surface during a strike, and 40% of this can be recovered within three hours after a simulated bite. As with other Elapidae studied to date, an adequate mass of venom remains on the skin for an accurate species diagnosis to be made in the case of human snake-bite.
    Journal of toxicology. Clinical toxicology 09/2008; 21(3):373-85.
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    ABSTRACT: The utility of the toxicology laboratory in emergency medicine is directly related to both establishing communication between the toxicology laboratory and the clinical staff, and to providing reliable toxicology data while the diagnostic process is still in progress. When 604 patients, on whom a "complete toxicology screen" was requested, were evaluated using qualitative probes involving chemical spot tests, immunoassay, TLC and/or selected GC/HPLC methods, the resulting data were demonstrated to be of value. The ability of the clinician to accurately predict which, if any, of a large number of intoxicants were present in a given patient, was found to be minimal and as a result these combined tests were found to be essential in facilitating a proper diagnosis. Additionally, it was found that using only chemical spot tests, immunoassay and TLC in a combined qualitative approach detected 94-98% of all the substances eventually found within the population when it was further studied using more sophisticated instrumental methods. The integrated approach involving the initial establishment of a dialogue between the clinician and the toxicologist, use of simple qualitative analytical probes, confirmation of positive findings and prompt reporting of toxicology data is a viable way in which meaningful toxicology support can be provided while the diagnostic process is still underway.
    Journal of toxicology. Clinical toxicology 09/2008; 22(6):503-28.
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    ABSTRACT: As man takes increasing advantage of the waters of the world for recreational, commercial and scientific purposes, the hazards of human contact with inhabitants must be appreciated. Many invertebrate and vertebrate animal species have developed natural defense mechanisms, some of which involve envenomation, with a few species posing the threat of serious injury or death. This paper discusses the more common and more serious marine envenomations encountered worldwide, including toxicology of the associated venoms and a discussion of current treatment recommendations.
    Journal of toxicology. Clinical toxicology 09/2008; 21(4-5):527-55.
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    ABSTRACT: Objective: To define the pharmacokinetics of continuous infusion pralidoxime in organophosphate-poisoned children. Study Design: Open-label study in 11 children and adolescents poisoned with organophosphates or carbamates. Serial blood samples were obtained during continuous pralidoxime infusion and after the drug was stopped. Results: Patients were treated for 12-43 hours. Steady-state concentrations were (mean ± SD) 22.2 ± 12.3 mg/L. Volume of distribution ranged from 1.7 to 13.8 L/kg and was significantly higher in the more severely poisoned subjects. Elimination half-life was 3.6 ± 0.8 hours, and clearance was 0.88 ± 0.55 L/h/kg. After initiation of continuous infusion pralidoxime, only 1 patient required any additional atropine to control recurrent muscarinic symptoms. All patients exhibited complete clinical recovery. Conclusions: The pharmacokinetics of pralidoxime in poisoned children following continuous intravenous infusion are widely variable and differ from those previously reported in both healthy and poisoned adults. A loading dose of 25-50 mg/kg is recommended followed by a continuous infusion of 10-20 mg/kg/h. A loading dose of 50 mg/kg may be appropriate in more severely poisoned patients.
    Journal of toxicology. Clinical toxicology 09/2008; 36(6).
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    ABSTRACT: Black widow spiders (Latrodectus species) are found worldwide. Envenomation of humans usually occurs as the result of chance intrusion into the spider's domain by the human. The venom is regarded as one of the most potent biologic toxins. The venom acts by destabilization of cell membranes and degranulation of nerve terminals resulting in the release of neurotransmitters. The clinical picture is characterized by painful muscle spasm and hypertension. The very young, the elderly or enfeebled, and those with cardiovascular disease are at greatest risk. While not always necessary, the most effective treatment is specific antiserum. Muscle relaxants, analgesics and intravenous calcium are useful adjuvant treatment.
    Journal of toxicology. Clinical toxicology 09/2008; 21(4-5):473-85.
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    ABSTRACT: In rats and humans chronically exposed to large amounts of PCB (polychlorinated biphenyls) and PCDF (polychlorinated dibenzofurans), the urinary excretion of uroporphyrin and coproporphyrin are altered. However, porphyrin excretion in humans after acute transient low level exposure has not been evaluated. Following such an exposure in which bystanders and firefighters were in contact with smoke from a PCB transformer fire, we surveyed 90 self-referred individuals by questionnaire and by determining single 24 hour urinary excretion of uroporphyrin and coproporphyrin 2-4 weeks after the fire. Questionnaire variables that assessed exposure were not associated with the magnitude of either uroporphyrin or coproporphyrin excretion. Uroporphyrin excretion was slightly elevated in nine subjects (range 66-106 micrograms/24 hours, normal less than 60), which is much less than in clinical cases of porphyria cutanea tarda. Uroporphyrin excretion was inversely correlated with coproporphyrin excretion (r = -0.3844, p = 0.0002). For 5 subjects (3 with elevated initial uroporphyrin excretion) retested at 3-4 weeks after the fire, all 5 showed increases in uroporphyrin and decreases in coproporphyrin excretion when compared to initial determinations. These two reciprocal relationships would be the expected result from inhibition of uroporphyrinogen decarboxylase, a known experimental effect of PCB and PCDF in mice. Overall, urinary porphyrin excretions were not altered or sensitive measures of exposure.
    Journal of toxicology. Clinical toxicology 09/2008; 24(6):533-44.
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    ABSTRACT: Activated charcoal in 70% sorbitol enjoys wide use in the management of acute poisonings but the effects of the activated charcoal-sorbitol mixture in healthy individuals have not been characterized. We were concerned about the possibility of sorbitol causing changes in the routinely monitored serum chemistry and hematological parameters, either directly due to the absorbed polyol or due to the diarrhea induced by it, thus complicating the diagnosis and management in an overdose setting. We assessed the action of a single dose of 30g of activated charcoal in 150 ml of 70% sorbitol and its effects on serum osmolality, electrolytes, metabolic profile (SMAC), magnesium, hepatic enzymes, and complete blood count in healthy adult individuals. The only significant change in the laboratory parameters tested was the consistent rise in serum sodium and phosphorus concentrations four hours after drinking the charcoal-sorbitol mixture. However, a similarly consistent rise in the concentrations at the same hours on another day without ingestion of the charcoal-sorbitol mixture suggested the rise was due to circadian rhythm or other factors unrelated to the cathartic. The lack of effect on routinely monitored laboratory parameters, relative palatability and the rapid onset (40-225 minutes), and long duration (7 to 127 hours) of purgation, make charcoal-sorbitol an attractive combination for use as a gastrointestinal decontaminant. Possible effects of multiple dose regimens and the effects in pediatric and geriatric populations need further study.
    Journal of toxicology. Clinical toxicology 09/2008; 22(6):529-36.
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    ABSTRACT: We describe a case of a 43-yr-old female with severe multiorgan injury after accidental poisoning with Colchicum autumnale, which was mistaken for wild garlic (Allium ursinum). Both plants grow on damp meadows and can be confused in the spring when both plants have leaves but no blossoms. The autumn crocus contains colchicine, which inhibits cellular division. Treatment consisted of supportive care, antibiotic therapy, and granulocyte-directed growth factor. The patient was discharged from the hospital after three weeks. Three years after recovery from the acute poisoning, the patient continued to complain of muscle weakness and intermittent episodes of hair loss.
    Journal of toxicology. Clinical toxicology 02/2004; 42(1):85-8.
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    ABSTRACT: Organochlorine insecticides are highly toxic compounds that are responsible for a number of severe intoxications worldwide with several deaths. Despite their widespread use in agriculture during the 1940s to 1960s and the well-known signs and symptoms of intoxication, the clinical picture in case of poisoning varies. We report two cases of acute intentional endosulfan intoxication with cerebral edema and cardiac failure. Both cases developed life-threatening signs like epileptic state, respiratory insufficiency and hemodynamic instability soon after ingestion. The survivor developed severe myocardial insufficiency and pulmonary edema documented by echocardiography and x-ray of the chest. The deceased patient developed severe cerebral edema and multiorgan failure ten days after ingestion of Thiodan 35. The peak serum concentration of endosulfan in the survivor was 0.12 mg/L approximately 23 hours after ingestion, whereas the peak blood concentration in the fatal case was 0.86 mg/L approximately 25 hours post-ingestion. Post-mortem endosulfan levels in different organs were determined. Endosulfan is a highly toxic organochlorine insecticide that produces well-known neurological symptoms of tonic-clonic convulsions, headache, dizziness and ataxia but also can cause gastrointestinal symptoms and metabolic disturbances. Life-threatening cerebral edema and hemodynamic instability may occur. Treatment is symptomatic and supportive.
    Journal of toxicology. Clinical toxicology 02/2004; 42(6):927-32.
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    ABSTRACT: We report a case of forearm compartment syndrome caused by extravasation of mannitol in an intoxicated patient. The pathophysiology and management of a forearm compartment syndrome from extravasation of mannitol are discussed in this case.
    Journal of toxicology. Clinical toxicology 02/2004; 42(5):649-52.
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    ABSTRACT: 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. 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. 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.
    Journal of toxicology. Clinical toxicology 02/2004; 42(5):643-8.
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    ABSTRACT: Gastric lavage should not be employed routinely, if ever, in the management of poisoned patients. In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished with time. The results of clinical outcome studies in overdose patients are weighed heavily on the side of showing a lack of beneficial effect. Serious risks of the procedure include hypoxia, dysrhythmias, laryngospasm, perforation of the GI tract or pharynx, fluid and electrolyte abnormalities, and aspiration pneumonitis. Contraindications include loss of protective airway reflexes (unless the patient is first intubated tracheally), ingestion of a strong acid or alkali, ingestion of a hydrocarbon with a high aspiration potential, or risk of GI hemorrhage due to an underlying medical or surgical condition. A review of the 1997 Gastric Lavage Position Statement revealed no new evidence that would require a revision of the conclusions of the Statement.
    Journal of toxicology. Clinical toxicology 02/2004; 42(7):933-43.
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    ABSTRACT: When Poisons Information, or Poisons Control Centers (PCC) give directive advice in response to general public calls it is usually assumed that the advice will be followed, but it is difficult to measure the actual compliance of callers to a PCC. Epidemiological data regarding the incidence of poisoning incidents (Toxicovigilance) often utilizes reports of calls to a PCC. Retrospective review of advice given to all callers to the New Zealand National Poisons Centre (NZNPC) from a defined area for the calendar year 2001. Callers to the NZNPC telephone hotlines who were advised to attend or not to attend the hospital Emergency Department (ED) were subsequently matched with actual ED visits. The compliance rate for those advised to attend the ED was 76.1%, whereas those advised not to attend had a compliance rate of 98.7%. The overall compliance rate was 94.1%. Of the patients presenting to the ED with a potential poisoning, only 10.2% were referred by the PCC. The callers referred by PCC and direct ED visitors appeared to differ in some respects. Compliance with PCC telephone advice is similar to the compliance rates in many other health interventions. Comparisons between populations calling a PCC and those self-presenting to an ED show that PCC data may not reflect the true burden of poisoning to health care systems.
    Journal of toxicology. Clinical toxicology 02/2004; 42(5):603-10.