The Poison Lab

Listen here (https://www.wpr.org/shows/larry-meiller-show) to hear Ryan Live on AIR for the Larry Meiller show, Thursday July 17th 11:45AM-12:30 PM CST.

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The Poison Lab: Outbreak – Markham Aconite Poisoning

On August 29, 2022, twelve diners at...

In this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Amy Zosel, a medical toxicologist, emergency physician, and educator. Together, they use real poisoning cases to practice identifying toxins and flexing their toxic differential The conversation dives into intriguing and challenging toxicology cases, with a focus on educating listeners about real-world poisoning scenarios, myth-busting internet misinformation, and providing practical clinical insights.

Mini episode with Dr. Robert Bassett on Remembering Poisonous Mushrooms

Dr. Zosel and Ryan discuss:

14:15 Case 1

33:04 Case 2

37:00 Case 3

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If you are looking for links to Dr. Basset's initiatives check back later...

In this special collaboration with NephMadness, we're diving into the world of nephrotoxins with an expert panel from Virginia Commonwealth University. NephMadness is an educational competition modeled after March Madness, and this year, one of the featured regions focuses on plant-based nephrotoxins. Together, with our expert panel we break down the competing nephrotoxin teams: Tubular Toxins vs. Oxalate Offenders.

Joining us are Dr. Anna Vinnokova (Nephrologist), Dr. Rachel Khan PharmD (Neph pharmacist), Dr. Ethan Downes (Nephrology fellow), and the legendary nephrotoxicologist, Dr. Josh King (Board certified Nephrologist and Toxicologist). We ALMOST named this episode "Getting Downe with...

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode 

Finally, the journal club to rule ALL journal clubs.

In this episode of The Poison Lab, we tackle one of the biggest topics in emergency medicine and toxicology: Should naloxone be given during opioid-associated cardiac arrest? With three fantastic studies published in 2024, we’re diving into the data and hearing directly from the authors themselves.

Join host Ryan Feldman as he interviews Dr. Eric Quinn, Dr. Joshua Lupton, and Dr. David Dillon, some of the minds behind the latest research exploring the role of naloxone in out-of-hospital cardiac arrest (OHCA). With perspectives ranging from clinical ou...

In this special holiday bonus episode, Ryan takes a look back at some of the most captivating episodes of The Poison Lab from 2022. Get ready for an ultimate test of your toxicology differential diagnosis skills as we compile all the "Stump the Toxicologist" segments into one streamlined, binge-worthy episode. Explore eight unique poisoning cases, be sure to check the show notes for a description of each case. time stamp of where it begins, and links to the original episodes, where you can dive deeper into the discussions and unravel the mysteries behind these intriguing cases!

Case Teasers...

Join host Ryan Feldman in an insightful episode of "The Poison Lab" as he sits down with Dr. John Downs, Director of the Virginia Poison Center, and one of the leading experts on per- and polyfluoroalkyl substances (PFAS), commonly known as "forever chemicals." Known for their persistence in the environment and human body, PFAS have raised significant public health concerns over the past few decades. Dr. Downs shares his journey through occupational medicine, toxicology, and public health, which uniquely positioned him to provide expertise on PFAS exposure, health risks, and ongoing regulatory efforts. Together, they delve into the origins...

Ryan on others shows

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In this exciting live episode from the 2024 North American Congress of Clinical Toxicology (NACCT) in Denver, Ryan dives into 12 of the most impactful research abstracts presented at the conference directly with the authors themselves. Covering a wide range of toxicology topics—from the NACSTOP2 trial on acetaminophen overdose, ECG intervals, cannabis toxicity in young children, and more—each guest breaks down their study’s findings and clinical relevance. If you missed the conference or want a deeper understanding of the year's most important toxicology research, this episode is for you. Check the show notes for links to the published abstra...

In this episode the poison lab hosts scientific discourse . Three listeners (Dr. Michael Mullins, Dr. Donna Seger, and Dr. Leon Gussow) write in their critiques surrounding specific recommendations and language used with the AHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity guidelines. Lead author of the guidelines Dr. Eric Lavonas then responds to and addresses their points with counterpoints or appraisals. Tune in and draw your own conclusions!

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Have a burning question you have always wanted to ask a toxicologist? What are tips for managing an anticholinergic overdose? What is the deadliest poison? Why are they called lead pencils if there is no lead?! Send your questions in to toxtalk1@gmail.com to take part in a future episode! (If you would like to be anonymous simply state it in the email)

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In this episode Ryan is joined by two expert guests to help read listener guesses for the cause of this poisoning murder and shed light on the toxin involved in the case, which puzzled medicolegal investigators. Ryan is joined by Dr. Dan McCabe, MD (emergency medicine physician, medical toxicologist, medical director of Iowa poison center) and Dr. Crissy Lawson PharmD (emergency medicine pharmacist). 

In this bonus episode Ryan highlights some of the great episodes done in 2023 and compiles ALL of the stump the toxicologist segments from 2023 into one easy to consume episode. Test your toxicology differential skills with more than six poisoning cases. Check out the actual episodes for more information in the show notes on each of the poisonings. 

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Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode 

A quick update to share some other shows Ryan has been on in the last few weeks! Check the show notes for links to each episode!

Ryan on "The Larry Meiller Show" discussing delta cannabanoids

Ryan on EMS2020 talking prehospital overdose

In this episode Ryan interviews Dr. Alex Krotulski PhD from the Center for Forensic Science Research and Education. Together take a look at trends in novel opioids, benzodiazepines, stimulants, hallucinogens, synthetic cannabinoids, and "hemp products" that are showing up in your patients, drug products, and fatal overdoses. The conversation takes places around the Center for Forensic Science Research and Education quarterly report on Novel Psychoactive Substances found in patients and drug products.

The episode starts with a discussion of the novel benzodiazepines market, highlighting bromazolam and how long it may remain in the market. Then t...

Dr. Ann Arens, MD an emergency medicine physician and medical toxicologist with Oschner Medical center in New Orleans, LA joins the show to educate us on some HOT toxins, solve toxic cases, and opine on the philosophical and existential reasons drugs even exist. Tune in for a fantastic discussion with Dr. Arens and to hear the answer to our mystery case. 

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Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 29

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In this episode Ryan is joined by a guest panel (Dr. Grant Comstock MD, Dr. Joshua Trebach MD, Dr. Emily Kiernan DO, and Dr Frank Paloucek PharmD, DABAT) to review nine of the most interesting or clinically impactful research abstracts that were presented at the 2023 North American Congress of Clinical Toxicology (NACCT) in Montreal Canada. If you didn't get a chance to read all 363 research abstracts from some of Toxicology's best and brightest this year, tune in for a high yield review as well as clinical a break down of the studies and their relevance from the expert panel.  

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In this episode, Ryan dives into cutting-edge research on the treatment of acetaminophen (APAP) overdose, featuring interviews with authors of several key abstracts from the North American Congress of Clinical Toxicology (NACCT) in Montreal Canada (Abstracts and posters available in the show notes). We get first looks insights into research evaluating the impact of fomepizole high risk acetaminophen overdose, as well as who gets fomepizole for acetaminophen overdose and dies. Then we evaluate the effectiveness of standard N-acetylcysteine (NAC) treatment in high risk patients and high dose NAC in high...

In this episode Ryan does a high yield "just the facts" break down of the recently released "2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Tune in to learn about the most recent treatment recommendations made by AHA via a panel of toxicology experts. This was released alongside a full interview with the lead author Dr. Eric Lavonas MD. Be sure to check out the full interview to hear it straight from the...

In this episode, Ryan sits down with Dr. Eric Lavonas MD, a seasoned EM resuscitation guideline writer, emergency medicine physician, medical toxicologist, and lead author of the latest update to the American Heart Association's guidelines for the management of cardiac arrest and life-threatening toxicity due to poisoning. They have an in-depth discussion as they explore the key aspects of the 2023 AHA treatment recommendations and the rationale behind each decision point. A great review to discover how to effectively apply these guidelines in real-world scenarios and find out what knowledge gaps exist in the realm of toxin resuscitation. Be sure...

In this enlightening episode, Ryan engages in a deep conversation with Dr. Paul Hutson, PharmD, a renowned researcher in the field of psilocybin and director of the Transdisciplinary Center for Research in Psychoactive Substances at the University of Wisconsin Madison. Dr. Hutson shares his extensive knowledge and insights into the promising role of psilocybin in the treatment of depression and substance use disorder.  

Throughout the discussion, they delve into the research that supports the use of psilocybin in medical therapy, shedding light on the rigorous processes involved in conducting such studies. Dr. Hutson elucidates the efficacy and s...

New Art and New Tox Trinkets. If you want to share your tox joy in the real world, find some trinkets here: https://www.etsy.com/shop/thepoisonlab

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Mini episode- High-yield over view of Management of Acetaminophen Poisoning in the US and Canada Consensus Statement 

In this Ryan sits down with Dr. Richard Dart MD, PhD. He is the lead author of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informed on the most recent treatment recommendations.  They dive in to the definitions established by the guideline and notable treatment recommendations, dissecting the ratinonale for ea...

This episode is a a high yield "just the facts" break down of the recently released "Management of Acetaminophen Poisoning in the US and Canada Consensus Statement" from the American Academy of Clinical Toxicology, American College of Medical Toxicology, Americans Poisons Centers, and the Canadian Association of Poison Centers. Listen to be informed on the most recent treatment recommendations. This was released alongside a full interview with the consensus statement corresponding author Dr. Richard Dart MD, PhD. Be sure to check out the full interview to hear it straight from the source! (link in show notes).

Link...

Dr. Frank Paloucek, PharmD, DABAT (@itsalltox) joins the show. He was one of the very first emergency medicine pharmacists and one of the original board-certified clinical toxicologists (DABAT). He is now a proudly retired professor emeritus at The Univeristy of Illinois at Chicago. In his tenure there he spent nearly 20 years as the program director for their clinical pharmacy residency, was an integral part of the Toxikon Consortium toxicology fellowship, and coauthored the text book "Poisoning and Toxicology Handbook (Poisoning and Toxicology Handbook (Leiken & Paloucek's)) 4th Edition. Frank and Ryan kick off the show hearing about Frank's fledgling years...

In this episode Ryan explores the concept of brain death and the implications of drug overdoses causing false positive diagnosis of brain death. He is joined by an author of the ACMT Position statement on brain death in overdose (Dr. Andrew Stolbach MD) as well as authors of two case reports (neuro critical care physician Dr. Ranier Reyes and emergency physician Dr. Doug Stranges) involving bupropion where patients had absent brain stem reflexes after overdose but made a full neurologic recovery. We delve into the criteria used to determine brain death and the challenges faced by families and healthcare...

Dr. Adam Blumenberg, MD (@ABlumenbergMD) Join's the show. He is an emergency medicine physician, medical toxicologist, and Assistant Professor at Columbia University Medical Center in New York City. He hosts his own toxicology youtube series (www.ToxicHistory.com) and has developed multiple free medical education software programs in toxicology (www.toxicrunner.net) and medical simulation (www.medsimstudio.com). Most impressively, he has produced his own free base lidocaine crystals on a stove top, if you ask nicely he might just loan you one. He joins the show to sleuth the cause of fatal poisoning cases and tackle internet questions...

Ready for a high-octane dose of knowledge? 🔥🧠 Ryan's got you covered with this electrifying mini-episode on managing a bupropion overdose! 💊💥  Beware - there are plenty of pitfalls you'll want to avoid. Check out the full episode and other mini-episodes for even more tips and tricks! 🎧👀

What Do Bath Salts, Face-Eating Zombies, and Antidepressants Have in Common?

In this episode of The Poison Lab, Ryan is joined by Dr. Filip, Dr. Olives, and Dr. Reyes to discuss a unique and heartbreaking poisoning scenario involving an antidepressant now recognized as the #1 cause of major life-threatening effects in antidepressant overdoses in the U.S. Check out the mini-episodes for more details!

Key Highlights

This Antidepressant:

Rohr 2004- Gap junction blockade can cause a wide QRS Vink 2004 Connexin 43 is the most important protein for connexon formation and cardiac signal transmissionCallier 2012- Bupropion does not block sodium channels, and does exhibit similar effects on the cardiac action potential as known gap junction  Burnham 2014 Bupropion has an IC50 for connexin 43 >50 uMol, larger than other drugs such as fluoextine and lamotrigineShaikh Quereshi 2014 Bupropion interferes with connexin43 production and localization in chicken cardiac myoctes at concentration >50 uMol

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Seizure Risk: Patients can seize 8–24 hours post-ingestion. Neurologic symptoms and tachycardia often precede seizures.Delayed Symptoms: Co-ingestions may mask tachycardia, and symptoms can be significantly delayed.Key Management Advice:Do not discharge patients without consulting a toxicologist or poison center about observation times.Do not dismiss tachycardia and anxiety as situational in cases of bupropion overdose.

Key Studies

All published abstracts can be found here 

Abstracts

Category 1: Amlodipine Vasoplegia

Category 2: Xylazine

Category 3: Case Reports with...

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 19

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Dr. Emily Kiernan, DO (@em2kiernan) an emergency medicine physician and medical toxicologist with Emory university school of medicine joins the show to solve toxic cases, opine on recent healthcare related poisoning, and dive head first into the bongwater on this episode. (Remember friends, don't drink the bong water).

Phenibut is an emerging and unfamiliar drug taking hold in the US that is readily available online and legal to obtain. It acts as a GABA-B agonist and carries risks of dependency and withdrawal. In this episode Ryan interviews phenibut users as well as experts involved in phenibut treatment. They explore the history, current trends, toxicity, and management of phenibut, a novel GABA-B agonist. He is joined by guest Dr. Matthew Stanton PharmD and Dr. Benjamin Weston MD who listen in to an audio documentary by that includes clips from Dr. Janessa Graves PhD and Dr. Erica Liebelt MD...

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 16

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