Alvin C Bronstein

University of Colorado, Denver, Colorado, United States

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Publications (54)268.41 Total impact

  • Sahaphume Srisuma · Alvin C Bronstein · Christopher O Hoyte ·
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    ABSTRACT: Hallucinogenic designer drugs, especially NBOMe and the 2C substitute phenylethylamine series, have been increasing ubiquitous in past years. The purpose of this study is to characterize and compare clinical features of NBOMe and 2C exposures in humans. This is a retrospective cohort study of all single agent exposures to NBOMe and 2C substitute phenylethlamine reported to the National Poison Data System (NPDS) from 1st September 2012 to 30th September 2014. Over the study period, there were a total 341 cases including 148 NBOMe exposures and 193 2C exposures. The majority cases involved men (73.9%); median age was 18 years (Interquartile-range, 16-21). Similar clinical effects were reported in both groups including tachycardia (45.2%), agitation/irritable (44.3%), hallucination/delusion (32.0%), confusion (19.1%) and hypertension (18.5%). There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe exposures (40.5%, 8.8% and 50.0%respectively) than those of 2C exposures (25.4%, 3.1%, and 32.6% respectively). There were 2.3% death; no difference between two groups. The higher rate of symptoms in NBOMe is consistent with the higher 5HT2A agonistic effects of NBOMe described in both molecular and animal studies. Common clinical effects of NBOMe and 2C exposures were tachycardia, agitation/irritable, hallucination/delusion, confusion, and hypertension. There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe.
    Clinical toxicology 06/2015; DOI:10.3109/15563650.2015.1054502 · 3.12 Impact Factor
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    ABSTRACT: Deaths from drug overdose have become the leading cause of injury death in the United States, where the poison center system is available to provide real-time advice and collect data about a variety of poisonings. In 2012, emergency medical providers were confronted with new poisonings, such as bath salts (substituted cathinones) and Spice (synthetic cannabinoid drugs), as well as continued trends in established poisonings such as from prescription opioids. This article addresses current trends in opioid poisonings; new substances implicated in poisoning cases, including unit-dose laundry detergents, bath salts, Spice, and energy drinks; and the role of poison centers in public health emergencies such as the Fukushima radiation incident. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
    Annals of Emergency Medicine 12/2014; 65(4). DOI:10.1016/j.annemergmed.2014.11.001 · 4.68 Impact Factor
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    K Heard · B H Rumack · J L Green · B Bucher-Bartelson · S Heard · A C Bronstein · R C Dart ·

  • R K Law · S Sheikh · A Bronstein · R Thomas · H A Spiller · J G Schier ·
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    ABSTRACT: Background. The Centers for Disease Control and Prevention (CDC) and the American Association of Poison Control Centers conduct national surveillance on data collected by US poison centers to identify incidents of potential public health significance (IPHS). The overarching goals of this collaboration are to improve CDC's national surveillance capacity for public health threats, identify early markers of public health incidents and enhance situational awareness. The National Poison Data System (NPDS) is used as a surveillance system to automatically identify data anomalies.
    Clinical Toxicology 09/2014; 52(9):1-6. DOI:10.3109/15563650.2014.953171 · 3.67 Impact Factor
  • S. Sheikh · M. Punja · R. Schultz · D. Sollee · M. Halliday · S. Kieszak · R. Law · C. Siptak · A. C. Bronstein · J. G. Schier ·

    Clinical Toxicology 08/2014; 52(7):691-692. · 3.67 Impact Factor
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    K Heard · B H Rumack · J L Green · B Bucher-Bartelson · S Heard · A C Bronstein · R C Dart ·
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    ABSTRACT: Introduction: Acetylcysteine prevents hepatic injury when administered soon after acetaminophen overdose. The most commonly used treatment protocols are a 72-hour oral and a 21-hour intravenous (IV) protocol. Between 1984 and 1994, 409 patients were enrolled in a study to describe the outcomes of patients who were treated using a 48-hour IV protocol. In 1991, an interim analysis reported the first 223 patients. The objective of this manuscript is to report the rates of hepatotoxicity and adverse events occurring during a 48-hour IV acetylcysteine protocol in the entire 409 patient cohort. Methods: This was a multicenter, single-arm, open-label clinical trial enrolling patients who presented with a toxic serum acetaminophen concentration within 24 h of acute acetaminophen ingestion. Patients were treated with 140 mg/kg loading dose followed by 70 mg/kg every 4 h for 12 doses. Serum aminotransferase activities were measured every 8 h during the protocol, and adverse events were recorded. The primary outcome was the percentage of subjects who developed hepatotoxicity defined as a peak serum aminotransferase greater than 1000 IU/L. Results: Four hundred and nine patients were enrolled, and 309 met inclusion for the outcome analysis. The overall percentage of patients developing hepatotoxicity was 18.1%, and 3.4% of patients treated within 10 h developed hepatotoxicity. One acetaminophen-related death occurred in a patient treated at 22 h. Adverse events occurred in 28.9% of enrolled subjects; the most common adverse events were nausea, vomiting, and flushing, and no events were rated as serious by the investigator. Conclusions: Acetaminophen-overdosed patients treated with IV acetylcysteine administered as 140 mg/kg loading dose followed by 70 mg/kg every 4 h for 12 doses had a low rate of hepatotoxicity and few adverse events. This protocol delivers a higher dose of acetylcysteine which may be useful in selected cases involving very large overdoses.
    Clinical Toxicology 04/2014; 52(5). DOI:10.3109/15563650.2014.902955 · 3.67 Impact Factor
  • Shireen Banerji · Alvin C. Bronstein ·

    Clinical Toxicology 04/2014; 52(4):319-319. · 3.67 Impact Factor
  • Laura Settimi · Alvin C. Bronstein · Franca Davanzo · Anna Celentano · Fabrizio Sesana ·

    Clinical Toxicology 04/2014; 52(4):336-336. · 3.67 Impact Factor

  • Clinical Toxicology 04/2014; 52(4):402-402. · 3.67 Impact Factor

  • Clinical Toxicology 02/2014; 52(3). DOI:10.3109/15563650.2014.888446 · 3.67 Impact Factor
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    ABSTRACT: We compare state trends in unintentional pediatric marijuana exposures, as measured by call volume to US poison centers, by state marijuana legislation status. A retrospective review of the American Association of Poison Control Centers National Poison Data System was performed from January 1, 2005, to December 31, 2011. States were classified as nonlegal if they have not passed legislation, transitional if they enacted legislation between 2005 and 2011, and decriminalized if laws passed before 2005. Our hypotheses were that decriminalized and transitional states would experience a significant increase in call volume, with more symptomatic exposures and more health care admissions than nonlegal states. There were 985 unintentional marijuana exposures reported from 2005 through 2011 in children aged 9 years and younger: 496 in nonlegal states, 93 in transitional states, and 396 in decriminalized states. There was a slight male predominance, and the median age ranged from 1.5 to 2.0 years. Clinical effects varied, with neurologic effects the most frequent. More exposures in decriminalized states required health care evaluation and had moderate to major clinical effects and critical care admissions compared with exposures from nonlegal states. The call rate in nonlegal states to poison centers did not change from 2005 to 2011. The call rate in decriminalized states increased by 30.3% calls per year, and transitional states had a trend toward an increase of 11.5% per year. Although the number of pediatric exposures to marijuana reported to the National Poison Data System was low, the rate of exposure increased from 2005 to 2011 in states that had passed marijuana legislation.
    Annals of emergency medicine 02/2014; 63(6). DOI:10.1016/j.annemergmed.2014.01.017 · 4.68 Impact Factor
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    ABSTRACT: Young men in Colorado presented with altered mental status and seizures after ingestion of a synthetic cannabinoid known as black mamba. Medical toxicologists and public health and law enforcement officials identified 263 cases of exposure to this novel substance.To the Editor: Although early reports of exposure to synthetic cannabinoids described a benign course,(1) with little need for emergency care, on August 24, 2013, patients began to present to Denver emergency departments with severe symptoms after exposure to a novel synthetic cannabinoid known locally as black mamba. The Colorado Department of Public Health and Environment (CDPHE) was notified on September 3. Medical toxicologists and CDPHE epidemiologists developed a case definition and began prospective monitoring with assistance from the Centers for Disease Control and Prevention. Records from poison control centers, care providers in nonhospital settings, and law enforcement were reviewed. ...
    New England Journal of Medicine 01/2014; 370(4):389-90. DOI:10.1056/NEJMc1313655 · 55.87 Impact Factor
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    ABSTRACT: Poisonings from lamp oil ingestion continue to occur worldwide among the pediatric population despite preventive measures such as restricted sale of colored and scented lamp oils. This suggests that optimal prevention practices for unintentional pediatric exposures to lamp oil have yet to be identified and/or properly implemented. Objective. To characterize demographic, health data, and potential risk factors associated with reported exposures to lamp oil by callers to poison centers (PCs) in the US and discuss their public health implications. Study design. This was a two part study in which the first part included characterizing all exposures to a lamp oil product reported to the National Poison Data System (NPDS) with regard to demographics, exposure, health, and outcome data from 1/1/2000 to 12/31/2010. Regional penetrance was calculated using NPDS data by grouping states into four regions and dividing the number of exposure calls by pediatric population per region (from the 2000 US census). Temporal analyses were performed on NPDS data by comparing number of exposures by season and around the July 4th holiday. Poisson regression was used to model the count of exposures for these analyses. In the second part of this project, in order to identify risk factors we conducted a telephone-based survey to the parents of children from five PCs in five different states. The 10 most recent lamp oil product exposure calls for each poison center were systematically selected for inclusion. Calls in which a parent or guardian witnessed a pediatric lamp oil product ingestion were eligible for inclusion. Data on demographics, exposure information, behavioral traits, and health were collected. A descriptive analysis was performed and Fisher's exact test was used to evaluate associations between variables. All analyses were conducted using SAS v9.3. Results. Among NPDS data, 2 years was the most common patient age reported and states in the Midwestern region had the highest numbers of exposure calls compared to other regions. Exposure calls differed by season (p < 0.0001) and were higher around the July 4th holiday compared to the rest of the days in July (2.09 vs. 1.89 calls/day, p < 0.002). Most exposures occurred inside a house, were managed on-site and also had a "no effect" medical outcome. Of the 50 PC-administered surveys to parents or guardians, 39 (78%) met inclusion criteria for analysis. The majority of ingestions occurred in children that were 2 years of age, that were not alone, involved tiki torch fuel products located on a table or shelf, and occurred inside the home. The amount of lamp oil ingested did not appear to be associated with either the smell (p = 0.19) or the color of the oil (p = 1.00) in this small sample. Approximately half were asymptomatic (n = 18; 46%), and of those that reported symptoms, cough was the most common (n = 20, 95%) complaint. Conclusions. Lamp oil product exposures are most common among young children (around 2 years of age) while at home, not alone and likely as a result of the product being in a child-accessible location. Increasing parental awareness about potential health risks to children from these products and teaching safe storage and handling practices may help prevent both exposures and associated illness. These activities may be of greater benefit in Midwestern states and during summer months (including the period around the July 4th holiday).
    Clinical Toxicology 09/2013; 51(9). DOI:10.3109/15563650.2013.839028 · 3.67 Impact Factor
  • Adam C. Pomerleau · Royal K. Law · Alvin C. Bronstein · Arthur S. Chang ·

    Clinical Toxicology 08/2013; 51(7):711-712. · 3.67 Impact Factor

  • Clinical Toxicology 08/2013; 51(7):606-607. · 3.67 Impact Factor
  • Daniel A. Spyker · Shireen Banerji · Alvin C. Bronstein ·

    Clinical Toxicology 08/2013; 51(7):626-627. · 3.67 Impact Factor
  • Sarah M. Bruhn · Martin Ebbecke · Alvin C. Bronstein · Daniel A. Spyker ·

    Clinical Toxicology 08/2013; 51(7):630-630. · 3.67 Impact Factor
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    ABSTRACT: Context. Small studies have associated energy drinks-beverages that typically contain high concentrations of caffeine and other stimulants-with serious adverse health events. Objective. To assess the incidence and outcomes of toxic exposures to caffeine-containing energy drinks, including caffeinated alcoholic energy drinks, and to evaluate the effect of regulatory actions and educational initiatives on the rates of energy drink exposures. Methods. We analyzed all unique cases of energy drink exposures reported to the US National Poison Data System (NPDS) between October 1, 2010 and September 30, 2011. We analyzed only exposures to caffeine-containing energy drinks consumed as a single product ingestion and categorized them as caffeine-containing non-alcoholic, alcoholic, or "unknown" for those with unknown formulations. Non-alcoholic energy drinks were further classified as those containing caffeine from a single source and those containing multiple stimulant additives, such as guarana or yerba mate. The data were analyzed for the demographics and outcomes of exposures (unknown data were not included in the denominator for percentages). The rates of change of energy drink-related calls to poison centers were analyzed before and after major regulatory events. Results. Of 2.3 million calls to the NPDS, 4854 (0.2%) were energy drink-related. The 3192 (65.8%) cases involving energy drinks with unknown additives were excluded. Of 1480 non-alcoholic energy drink cases, 50.7% were children < 6 years old; 76.7% were unintentional; and 60.8% were males. The incidence of moderate to major adverse effects of energy drink-related toxicity was 15.2% and 39.3% for non-alcoholic and alcoholic energy drinks, respectively. Major adverse effects consisted of three cases of seizure, two of non-ventricular dysrhythmia, one ventricular dysrhythmia, and one tachypnea. Of the 182 caffeinated alcoholic energy drink cases, 68.2% were < 20 years old; 76.7% were referred to a health care facility. Educational and legislative initiatives to enhance understanding of the health consequences of energy drink consumption were significantly associated with a decreased rate of energy drink-related cases (p = 0.036). Conclusions. About half the cases of energy drink-related toxicity involved unintentional exposures by children < 6 years old. Educational campaigns and legal restrictions on the sale of energy drinks were associated with decreasing calls to poison centers for energy drink toxicity and are encouraged.
    Clinical Toxicology 08/2013; 51(7):566-74. DOI:10.3109/15563650.2013.820310 · 3.67 Impact Factor
  • C. M. Deutsch · A. C. Bronstein · G. Lewis ·

    Clinical Toxicology 08/2013; 51(7):584-584. · 3.67 Impact Factor

  • Clinical Toxicology 08/2013; 51(7):701-701. · 3.67 Impact Factor

Publication Stats

1k Citations
268.41 Total Impact Points


  • 2011-2014
    • University of Colorado
      • • Department of Medicine
      • • Department of Emergency Medicine
      Denver, Colorado, United States
  • 2012
    • University of Colorado at Boulder
      Boulder, Colorado, United States
    • Denver Health and Hospital Authority
      Denver, Colorado, United States
  • 2007
    • University of California, San Francisco
      San Francisco, California, United States