Fall 2016 Vol. 14 No. 4


Ciguatera is one of the more common causes of fish-related foodborne illness in the United States. It is caused by toxins that accumulate in the flesh of large predatory fish found in tropical oceans. The name ciguatera is derived from the Spanish name cigua for the sea snail Turbo pica found in the Caribbean Spanish Antilles.....

Summer 2016 Vol. 14 No. 3


A 39 year-old man was found slumped over at his home computer by his wife, who noted him to be diaphoretic and clammy with a weak pulse. She had last seen him normal 2 hours prior, at which point she had gone to bed. ......

Fall 2015 Vol. 13 No. 4

Salvia Divinorum

Salvia divinorum is a rare member of the mint family (Labiatae), endemic to a small region of Oaxaca, Mexico. Shamans of the Mazatec Indians of Oaxaca have used the plant for centuries for religious purposes as well as in medicinal practices to treat diarrhea, headache, rheumatism, anemia, and a semi-magical disease known as panzón de Borrego.....

Winter 2016 Vol. 14 No. 1

Amnesic Shellfish Poisoning

Amnesic shellfish Poisoning (ASP) is a potentially deadly illness caused by the toxin domoic acid. Domoic acid is produced by the diatom pseudo-nitzschia, an algae species, and shellfish that eat this algae bioaccumulate domoic acid......

Spring 2016 Vol. 14 No. 2

Fentanyl-tainted Street Norco

On March 25, 2016 the Sacramento County Division of Public Health released a drug overdose health alert entitled Fentanyl-Contaminated Street Norco. This report was in response to 12 cases of poisoning from “street” Norco thought to contain fentanyl over the previous 48 hours.......

Winter 2015 Vol. 13 No. 1

Acute Cyanide Poisoning

Acute cyanide exposure is an uncommon exposure the majority of which are unintentional but often results in cardiovascular embarrassment when it occurs.....

Spring 2015 Vol. 13 No. 2

NBOMe Drugs

Over the last decade, there has been an explosion of novel psychoactive substances. Among these, are the “2C” compounds; the name referring to the chemical structure consisting of two carbon atoms between the phenyl and amine moieties.....

Summer 2015 Vol. 13 No. 3

MALA: Metformin-Associated Lactic Acidosis

Metformin is a first-line agent for type 2 diabetes mellitus often used as monotherapy or in combination with oral diabetic medications. MALA (metformin-associated lactic acidosis) is a rare but well reported event that occurs with both therapeutic use and overdose states.......

Spring 2014 Vol. 12 No. 2


There has been a dramatic increase in the observed number of reports on the use of Krokodil (also known as Crocodile, Krok, or Croc) in the last few years. Krokodil use was first reported in Siberia in 2002 and has mostly been described in European countries.....

Summer 2014 Vol. 12 No. 3

Levamisole-contaminated Cocaine

In 2003 the Drug Enforcement Agency first detected levamisole in cocaine bricks. In 2008 officials in Alberta, Canada identified a cluster of unexplained cases of agranulocytosis related to cocaine contaminated with levamisole.....

Fall 2014 Vol. 12 No. 4

Scombroid Fish Poisoning

Scombroid poisoning, or histamine fish poisoning, is a type of food poisoning that is similar to symptoms of seafood allergies. The term “scombroid” derives from the type of fish (i.e. Scombridae) first implicated, such as tuna and mackere.....

Summer 2013 Vol. 11 No. 2

Inhalant Abuse

Inhalant abuse describes the practice of inhaling vapors for the purpose of intoxication. Inhalant abuse is a growing practice, particularly among adolescents.....

Fall 2013 Vol. 11 No. 3

Atypical Antipsychotics

The use of antipsychotics began in the 1950’s after it was realized that chlorpromazine, an antihistamine, had a potent calming effect on mentation.....

Winter 2014 Vol. 12 No. 1


Gamma-hydroxybutyric acid (GHB) and its precursors, gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are popular drugs of abuse and primarily cause CNS depression. There are numerous common names for GBH such as “Liquid ecstasy”.....

Fall 2012 Vol. 10 No. 3

Strychnine Poisoning

Strychnine is an odorless, colorless crystalline powder that is found in both naturally occurring alkaloid forms as well as commercially produced salts.  It has been used as a rodenticide since the 1500’s as well as for various antiquated medical treatments.....

Winter 2012 Vol. 10 No. 4

Diethylene Glycol Poisoning

Diethylene glycol (DEG) is a clear, colorless, odorless liquid with a sweet taste, and is an excellent solvent for water-insoluble chemicals and drugs. DEG is used as a component of multiple different products including antifreeze preparations.....

Spring 2013 Vol. 11 No. 1

Synthetic Cannabinoids

Synthetic cannabinoid (SC) compounds were originally developed to study the pharmacology of cannabinoid receptors. However in recent years, they have emerged as drugs of abuse. Synthetic cannabinoids first emerged in Europe in 2005.....

Winter 2011 Vol. 9 No. 4

“Bath Salts”
Synthetic Cathinones

The use of synthetic cathinones has risen dramatically in the last several years. These drugs are analogs of the naturally occurring stimulant cathinone which is found in Khat (Catha edulis)....

Spring 2012 Vol. 10 No. 1

Adrenergic Antagonists

ß-adrenergic antagonists (beta-blockers) (BBs) are commonly used for treatment of hypertension, coronary artery disease, and tachydysrhythmias. The number of exposures reported nationally to poison centers has doubled in the past decade....

Summer 2012 Vol. 10 No. 2

Jellyfish Envenomation

Jellyfish (Scyphozoa) are delicate soft-bodied animals in the phylum Cnidaria. While they are found in virtually coastal water zones worldwide, jellyfish populations fluctuate greatly is association with ocean climate and perhaps other factors related to human interactions with the oceans...

Spring 2011 Vol. 9 No. 1


Mercury remains a common heavy metal exposure as it can be found in both the home and industrial setting. The toxicology of mercury (Hg) is complex due to the presences of different states, different routes of exposure, and distinctly different pathological effects ....

Summer 2011 Vol. 9 No. 2

Neurotoxic Seafood Poisoning

Thousands of cases of seafood poisoning with neurologic symptoms present to health care providers annually. Neurotoxic seafood poisoning most often occurs following consumption of fish and shellfish....

Fall 2011 Vol. 9 No. 3

Arsenic Poisoning

Arsenic is a naturally occurring and ubiquitous metalloid that can result in poisoning from a variety of sources including environmental and occupational exposures as well as more nefarious intent including homicide and suicide....

Summer 2010 Vol. 8 No. 2

Lindane and Organochlorine Poisoning

Organochlorine compounds were introduced in the 1940’s as potent insecticides and pesticides. They offered the advantages of low cost of manufacture, nonvolatile properties, persistent environmental effects, and less toxicity compared to previous pesticides ...

Fall 2010 Vol. 8 No. 3

Drug and Medication-Related Hyperthermia

The differential diagnosis of the hyperthermic patient in the emergency department is broad. ...

Winter 2010 Vol. 8 No. 4

Bacterial Food Poisoning

Millions of cases of food poisoning are reported to poison centers, public health departments, and other health agencies every year. Food poisoning represents a crossover between infectious diseases and toxin-mediated illnesss ...

Spring 2009 Vol. 7 No. 2

Hydrocarbon Toxicity and Abuse

Hydrocarbons (HC) are organic compounds containing primarily hydrogen and carbon atoms, although they may contain other molecules such as halogens or alcohols. Generally speaking there are two types ...

Summer 2009 Vol. 7 No. 3


Methemoglobin is an altered form of hemoglobin in which the ferrous state, Fe2+, loses an electron and is oxidized to the ferric, Fe3+, state ...

Spring 2010 Vol. 8 No. 1

Hydrofluoric Acid and Fluorides

Hydrofluoric acid (HF) is a corrosive agent with unique chemical properties that set it apart from other caustic agents ...

Fall 2008 Vol. 6 No. 3

Methamphetamine Poisoning

Methamphetamine, closely related to amphetamine, is a fat-soluble sympathomimetic agent that in users can produce symptoms as mild as restlessnes...

Winter 2008 Vol. 6 No. 4

Anticholinergic Plants

Most plants with anticholinergic properties are from the family Solanaceae, and can be identified from their characteristic flowers...

Spring 2009 Vol. 7 No. 1

Novel Antidotes In Calcium Channel Antagonist Toxicity: Chicken Soup for the Toxic Heart

As the U.S. population ages, increasing prescriptions for cardiovascular drugs are being written. Not only does this make these potentially lethal drugs more available for intentional overdose, but can also ...

Winter 2007 Vol. 5 No. 4

The Use of Rattlesnake (Crotaline) Antivenom

Research on inducing immunity through the use of vaccines in the early 20th century led to the first rattlesnake antivenoms. There are currently two antivenom products marketed for the treatment of rattlesnake envenomations in North America...

Spring 2008 Vol. 6 No. 1

Cyanide Poisoning

Swedish chemist Carl Wilhelm Scheele first isolated cyanide in 1782. He reportedly died due to cyanide poisoning in 1786. Since that time cyanide has earned its reputation as a powerful and deadly poison...

Summer 2008 Vol. 6 No. 2

Organic Phosphorus and Carbamate

Organic phosphorus (OP) and carbamate compounds are some of the most widely utilized pesticides in the world. Globally, these agents may kill more people each year than acute poisoning by any other chemical...

Fall 2007 Vol. 5 No. 5

Thallium Poisoning

Thallium is a well-known poison cited in numerous works of fictional literature, but is also a popular real-life agent of murder with worldwide homicidal usage documented since the 1800s ...

Summer 2007 Vol. 5 No. 2

Arsenic Poisoning

Arsenic is a naturally occurring element that is an odorless, tasteless, silver-grey, brittle, semi-metallic solid. When bound to sulfur, oxygen, and chlorine it forms inorganic compounds; when bound to molecules containing carbon it form....

Spring 2007 Vol. 5 No. 1

The Use of Sodium Bicarbonate in Medical Toxicology

Sodium bicarbonate administration is a suggested treatment modality for a variety of toxicologic and nontoxicologic conditions such as poisonings by tricyclic antidepressants, toxic alcohols, and salicylates, and other conditions such as hyperkalemia...
July 2006 Vol. 4 No. 2
Diagnosis and Treatment of Colchicine Poisoning

Colchicine is a widely prescribed and effective medication for the treatment of gouty arthritis. Plants such as autumn crocus or meadow saffron (Colchicum autumnale) and glory lily (gloriosa superba) contain colchicine alkaloids.
  September 2006 Vol. 4 No. 3
Latrodectism - Diagnosis and Treatment

Of over 20,000 species of spiders in the United States, only about 50 species have fangs that can penetrate human skin and only 2 species are commonly implicated in human illness...
  December 2006 Vol. 4 No. 4
The Use of Calcium in Toxicalogy

Calcium is a cation necessary for the normal functioning of a variety of enzymes and organ systems, including muscle and nerve tissue...
April 2005 Vol. 3 No. 3
Poisoning-related Hypotension

Hypotension is a frequently encountered problem in patients with poisoning or drug overdose. Toxicological causes of hypotension are...
  April 2005 Vol. 3 No. 4
Diagnosis and Treatment of Acute Isoniazid Poisoning

Isoniazid (INH, isonicotinic hydrazide) is a synthetic derivative of nicotinamide (vitamin B3). It has been used for over 50 years in...
  April 2006 Vol. 4 No. 1
Using Activated Charcoal In Medical Toxicology

Activated charcoal is the single most widely used method of gastrointestinal (GI) decontamination for the treatment of...
Dec 2004 Vol. 2 No. 4
Management of Sulfonylurea Overdose

There are multiple oral agents available for the treatment of diabetes. These include several pharmacological classes: the sulfonylureas, biguanides, a-glucosidase inhibitors, thiolidinediones, and ...


April 2005 Vol. 3 No. 1
Calcium channel blocker Toxicity

Calcium channel blockers (CCB) are used extensively for treatment of hypertension, angina pectoris, tachyarrhythmias and migraine prophylaxis. Reports of serious CCB...


April 2005 Vol. 3 No. 2
Nicotine Poisoning

Nicotine is a water-soluble alkaloid found primarily in plants of the Nicotiana species, although it is also found in lower quantities in...

April 2004 Vol. 2 No. 1
Drug-Induced QT Prolongation

The “long QT syndrome” is characterized by a long QT interval on electrocardiogram and symptoms such as syncope or even cardiac arrest due to the development of...


May 2004 Vol. 2 No. 2
Loxoscelophobia:  The Alleged Brown Recluse Spider Bite

Loxosceles reclusa, or the brown recluse spider is one of the most feared and at the same time misunderstood arthropods in...


Nov 2004 Vol. 2 No. 3

Physostigmine is a reversible acetylcholinesterase inhibitor capable of temporarily reversing the effects of antimuscarinic agents. It was first derived from a plant in Africa...

Jun 2003 Vol. 1 No. 4
Whole Bowel Irrigation

The rationale behind GI decontamination is to prevent absorption of ingested toxins by either eliminating the toxin from the GI tract or binding the toxin within the GI tract.


Sept 2003 Vol. 1 No. 5
Carbon Monoxide Poisoning

Carbon monoxide (CO) poisoning remains an important cause of illness and death. A colorless, odorless gas produced by the combustion of any organic material, it has been implicated in approximately 5,000 deaths per year in the United States.


Nov 2003 * No. 6
Lithium Toxicity

The medical use of lithium has evolved considerably since it was first used for gout and rheumatism in the 1800’s. It was also used as a salt substitute in patients with hypertension, and was at one point present in the soft drink...

Feb 2002 Vol. 1 No. 1
Ethylene Glycol (Antifreeze) Ingestion

Ethylene glycol (C2H6O2, CAS # 107-21-1) is a significant cause of poisoning morbidity and mortality in California. Ethylene glycol (EG) per se causes an altered mental status similar to ethyl alcohol. More importantly,  


Jun 2002 Vol. 1 No. 2
The Anthrax Outbreak of 2001,
Lessons Learned in California

It has been more than six months since the last case of human anthrax attributed to the release of B. anthracis spore contaminated letters in the eastern United States. Although 


Feb 2003 Vol. 1 No. 3
Diagnosis and Treatment of
Pediatric Iron Ingestion

Iron is essential for normal tissue and organ function. In toxic doses, iron salts (ferrous sulfate, fumarate or gluconate) cause corrosive gastrointestinal effects followed by hypotension, metabolic acidosis, and multisystem failure. 


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