Current Awareness in Clinical Toxicology Editors: Damian Ballam Msc and Allister Vale MD

Current Awareness in Clinical Toxicology Editors: Damian Ballam MSc and Allister Vale MD

November 2015

CONTENTS General Toxicology 7 Metals 34 Management 17 Pesticides 36 Drugs 19 Chemical Warfare 39 Chemical Incidents & 28 Plants 39 Pollution Chemicals 29 Animals 40

CURRENT AWARENESS PAPERS OF THE MONTH

An outbreak of acute delirium from exposure to the synthetic cannabinoid AB-CHMINACA Tyndall JA, Gerona R, De Portu G, Trecki J, Elie M-C, Lucas J, Slish J, Rand K, Bazydlo L, Holder M, Ryan MF, Myers P, Iovine N, Plourde M, Weeks E, Hanley JR, Endres G, Germaine DST, Dobrowolski PJ, Schwartz M. Clin Toxicol 2015; online early: doi: 10.3109/15563650.2015.1100306: Background Synthetic cannabinoid containing products are a public health threat as reflected by a number of outbreaks of serious adverse health effects over the past 4 years. The designer drug epidemic is characterized by the rapid turnover of synthetic cannabinoid compounds on the market which creates a challenge in identifying the particular etiology of an outbreak, confirming exposure in cases, and providing current information to law enforcement. Results Between 28 May 2014 and 8 June 2014, 35 patients were evaluated and treated at the University of Florida Health Medical Center in Gainesville following reported exposure to a synthetic cannabinoid containing product obtained from a common source. Patients

Current Awareness in Clinical Toxicology is produced monthly for the American Academy of Clinical Toxicology by the Birmingham Unit of the UK National Poisons Information Service, with contributions from the Cardiff, Edinburgh, and Newcastle Units.

The NPIS is commissioned by Public Health England

demonstrated acute delirium (24) and seizures (14), and five required ventilator support and ICU-level care; none died. The presence of N-[(1S)-1-(aminocarbonyl)-2-methylpropyl]-1- (cyclohexylmethyl)-1H-indazole-3-carboxamide (AB-CHMINACA), or one of its predicted metabolites was confirmed in 15 of 21 cases. A rapid public health response and aggressive public messaging prevented further morbidity, identified the source, and led to law enforcement seizure of the implicated product. Discussion The significance of this outbreak lies as much in the rapid occurrence of unpredictable, life- threatening adverse health effects from a newly identified synthetic cannabinoid compound as it does in the multidisciplinary investigation and novel partnership between local public health, the laboratory, and the chemical industry, resulting in termination of the outbreak. Conclusion A coordinated response and collaboration between law enforcement, the local public health, emergency medical services and Health Center staff, were all key interventions in preventing a more substantial public health outbreak resulting from use of a novel synthetic cannabinoid compound. Real time collaborations between toxicology laboratories, suppliers of analytical standards and the public health system may be useful in the face of future novel chemical exposures. Full text available from: http://dx.doi.org/10.3109/15563650.2015.1100306

A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment Tait RJ, Caldicott D, Mountain D, Hill SL, Lenton S. Clin Toxicol 2015; online early: doi: 10.3109/15563650.2015.1110590: Context Synthetic cannabinoids (SCs) such as "Spice", "K2", etc. are widely available via the internet despite increasing legal restrictions. Currently, the prevalence of use is typically low in the general community (<1%) although it is higher among students and some niche groups subject to drug testing. Early evidence suggests that adverse outcomes associated with the use of SCs may be more prevalent and severe than those arising from cannabis consumption. Objectives To identify systematically the scientific reports of adverse events associated with the consumption of SCs in the medical literature and poison centre data. Method We searched online databases (Medline, PsycInfo, Embase, Google Scholar and Pubmed) and manually searched reference lists up to December 2014. To be eligible for inclusion, data had to be from hospital, emergency department, drug rehabilitation services or poison centre records of adverse events involving SCs and included both self-reported and/or analytically confirmed consumption. Results From 256 reports, we identified 106 eligible studies including 37 conference abstracts on about 4000 cases involving at least 26 deaths. Major complications include cardiovascular events (myocardial infarction, ischemic stroke and emboli), acute kidney injury (AKI), generalized tonic-clonic seizures, psychiatric presentations (including first episode psychosis, paranoia, self-harm/suicide ideation) and hyperemesis. However, most presentations were

not serious, typically involved young males with tachycardia (37–77%), agitation (16– 41%) and nausea (13–94%) requiring only symptomatic care with a length of stay of less than 8 hours. Conclusions SCs most frequently result in tachycardia, agitation and nausea. These symptoms typically resolve with symptomatic care, including intravenous fluids, benzodiazepines and antiemetics, and may not require inpatient care. Severe adverse events (stroke, seizure, myocardial infarction, rhabdomyolysis, AKI, psychosis and hyperemesis) and associated deaths manifest less commonly. Precise estimates of their incidence are difficult to calculate due to the lack of widely available, rapid laboratory confirmation, the variety of SC compounds and the unknown number of exposed individuals. Long-term consequences of SCs use are currently unknown. Full text available from: http://dx.doi.org/10.3109/15563650.2015.1110590

Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN) Dines AM, Wood DM, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R, Dargan PI. Clin Toxicol 2015; 53: 893-900. Context Despite the potential for recreational drugs and new psychoactive substances (NPSs) to cause significant morbidity and mortality, there is limited collection of systematic data on acute drug/NPS toxicity in Europe. Objective To report data on acute drug/NPS toxicity collected by a network of sentinel centres across Europe with a specialist clinical and research interest in the acute toxicity of recreational drugs and NPS to address this knowledge gap. Methods Sixteen sentinel centres in 10 European countries (Denmark, Estonia, France, Germany, Ireland, Norway, Poland, Spain, Switzerland and the UK) collected data on all acute drug toxicity presentations to their Emergency Rooms (ERs) for 12 months (October 2013– September 2014); information on the drug(s) involved in the presentations was on the basis of patient self-reporting. Results Data were collected on a total of 5529 presentations involving 8709 drugs (median (interquartile range [IQR]): 1 (1–2) drugs per presentation), a median of 0.3% of all ER attendances. Classical recreational drugs were most common (64.6%) followed by prescription drugs (26.5%) and NPS (5.6%). The 'top five' drugs recorded were heroin (1345 reports), cocaine (957), cannabis (904), GHB/GBL (711) and amphetamine (593). 69.5% of individuals went to hospital by ambulance (peak time between 19:00 and 02:00 at weekends); the median (IQR) age was 31 (24-39) years and 75.4% were male. Although serious clinical features were not seen in most presentations and 56.9% were medically discharged from the ER (median length of stay: 4.6 hours), a significant number (26.5%) was agitated, in 10.5% the GCS was 8 or less and 35 presented in cardiac arrest. There were 27 fatalities with opioids implicated in 13. Conclusion The Euro-DEN dataset provides a unique insight into the drugs involved in and clinical

pattern of toxicity/outcome of acute recreational drug toxicity presentations to hospitals around Europe. This is complimentary to other indicators of drug-related harm and helps to build a fuller picture of the public health implications of drug use in Europe. Full text available from: http://dx.doi.org/10.3109/15563650.2015.1088157

Abuse, misuse, and suicidal substance use by children on school property Vakkalanka JP, King JD, Holstege CP. Clin Toxicol 2015; 53: 901-7. Objective The purpose of this study was to characterize the epidemiological trends associated with substances used in intentional exposures among children while on school property reported to the U.S. National Poison Data System (NPDS). Materials and Methods NPDS was queried for intentional (abuse, misuse, suspected suicide, and unknown intentional) exposures reported to occur on school property between calendar years 2004 and 2013. Records were restricted to children 6–18 years of age. Demographic, exposure, and clinical characteristics were assessed. Results A total of 56,882 substances were intentionally used on school property by 50,379 children, of which 39.8% were females (n = 20,070), 57.7% were males (n = 29,084), and 2.4% were unknown gender (n = 1,225). The most frequent pharmaceutical exposures reported included sedatives (n = 4,096; 8.1%), analgesics (n = 4,022; 8.0%), and cough and cold preparations (n = 3,529; 7.0%). The majority of exposures were managed on site (n = 21,464; 42.6%), followed by care at a healthcare facility (n = 20,048; 39.7%). Serious outcomes (moderate or major effects and death) accounted for nine percent of all reported exposures. Compared to reference groups, female gender, teenagers 17–18 years, and pharmaceutical substances (Prevalence Ratios = 4.6, 9.4, and 9.9, respectively) were associated with suspected suicides when compared with other intentional exposures. Conclusions Along with other national data about behaviors in the adolescent and teenage population, additional trends in risky behavior may be gleaned by surveillance through poison centers. With over 5,000 annual reports to the poison centers about intentional exposures on school property, school personnel and parents/guardians must be vigilant about the range of pharmaceutical and non-pharmaceutical substances that are used for abuse, misuse, or suicide. Full text available from: http://dx.doi.org/10.3109/15563650.2015.1085998

Comprehensive microRNA profiling in acetaminophen toxicity identifies novel circulating biomarkers for human liver and kidney injury Vliegenthart ADB, Shaffer JM, Clarke JI, Peeters LEJ, Caporali A, Bateman DN, Wood DM, Dargan PI, Craig DG, Moore JK, Thompson AI, Henderson NC, Webb DJ, Sharkey J, Antoine DJ, Park BK, Bailey MA, Lader E, Simpson KJ, Dear JW. Sci Rep 2015; 5: 15501. Abstract and full text available from: http://dx.doi.org/10.1038/srep15501

A novel approach for estimating ingested dose associated with paracetamol overdose Zurlinden TJ, Heard K, Reisfeld B. Br J Clin Pharmacol 2015; online early: doi: 10.1111/bcp.12796:

Abstract and full text available from: http://dx.doi.org/10.1111/bcp.12796

Pharmacological treatment of cardiac glycoside poisoning Roberts DM, Galappatthy G, Dunuwille A, Chan BS. Br J Clin Pharmacol 2015; online early: doi: 10.1111/bcp.12814:

Abstract and full text available from: http://dx.doi.org/10.1111/bcp.12814

Toxic Christmas and New Year holiday plants...or are they? Krenzelok EP, Mrvos R. Asia Pac J Med Toxicol 2015; 4: 64-7. Abstract and full text available from: http://apjmt.mums.ac.ir/?_action=articleInfo&article=3539

Wilderness Medical Society practice guidelines for the treatment of pitviper envenomations in the United States and Canada Kanaan NC, Ray J, Stewart M, Russell KW, Fuller M, Bush SP, Caravati EM, Cardwell MD, Norris RL, Weinstein SA. Wilderness Environ Med 2015; online early: doi: 10.1016/j.wem.2015.05.007: Abstract and full text available from: http://www.wemjournal.org/article/S1080- 6032(15)00220-3/abstract

European viper envenomation recorded by French poison control centers: a clinical assessment and management study Jollivet V, Hamel JF, de Haro L, Labadie M, Sapori JM, Cordier L, Villa A, Nisse P, Puskarczyk E, Berthelon L, Harry P, Boels D. Toxicon 2015; 108: 97-103. Abstract and full text available from: http://dx.doi.org/10.1016/j.toxicon.2015.09.039

Favorable results after conservative management of 316 valproate intoxicated patients Shadnia S, Amiri H, Hassanian-Moghaddam H, Rezai M, Vasei Z, Ghodrati N, Zamani N. J Res Med Sci 2015; 20: 656-61. Abstract and full text available from: http://www.jmsjournal.net/article.asp?issn=1735- 1995;year=2015;volume=20;issue=7;spage=656;epage=661;aulast=Shadnia;type=0

Solvent-induced encephalopathy in the Netherlands and Finland Van der Laan G, Sainio M, van Valen E. Occup Med (Oxf) 2015; 65: 609-11.

Full text available from: http://dx.doi.org/10.1093/occmed/kqv169

Exploring the life-saving potential of naloxone: a systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users McAuley A, Aucott L, Matheson C. Int J Drug Policy 2015; online early: doi: 10.1016/j.drugpo.2015.09.011: Abstract and full text available from: http://dx.doi.org/10.1016/j.drugpo.2015.09.011

First-trimester pregnancy exposure to venlafaxine or duloxetine and risk of major congenital malformations: a systematic review Lassen D, Ennis ZN, Damkier P. Basic Clin Pharmacol Toxicol 2015; online early: doi: 10.1111/bcpt.12497:

Abstract and full text available from: http://dx.doi.org/10.1111/bcpt.12497

Use of tramadol in early pregnancy and congenital malformation risk Kallen B, Reis M. Reprod Toxicol 2015; 58: 246-51.

Abstract and full text available from: http://dx.doi.org/10.1016/j.reprotox.2015.10.007

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Carbamate insecticides Imidacloprid Annabi A, Dhouib IB, Lamine AJ, El Golli N, Gharbi N, El Carbosulfan Fazâa S, Lasram MM. El-Bini Dhouib I, Lasram MM, Annabi A, Gharbi N, El-Fazaa S. Recovery by N-acetylcysteine from subchronic exposure to A comparative study on toxicity induced by carbosulfan Imidacloprid-induced hypothalamic–pituitary–adrenal (HPA) and malathion in Wistar rat liver and spleen. axis tissues injury in male rats. Pestic Biochem Physiol 2015; 124: 21-8. Toxicol Mech Methods 2015; 25: 524-31.

Maneb Organochlorine pesticides Tinakoua A, Bouabid S, Faggiani E, De Deurwaerdère P, Lakhdar-Ghazal N, Benazzouz A. General The impact of combined administration of paraquat and Boada LD, Henríquez-Hernández LA, Zumbado M, Almeida- maneb on motor and non-motor functions in the rat. González M, Álvarez-León EE, Navarro P, Luzardo OP. Neuroscience 2015; online early: Organochlorine pesticides exposure and bladder cancer: doi: 10.1016/j.neuroscience.2015.10.021: evaluation from a gene-environment perspective in a hospital-based case-control study in the Canary Islands (Spain). Ziram J Agromed 2015; online early: Martin CA, Myers KM, Chen A, Martin NT, Barajas A, doi: 10.1080/1059924X.2015.1106374: Schweizer FE, Krantz DE. Ziram, a pesticide associated with increased risk for Mahmoud AFA, Ikenaka Y, Yohannes YB, Darwish WS, Parkinson's disease, differentially affects the presynaptic Eldaly EA, Morshdy AEMA, Nakayama SMM, Mizukawa H, function of aminergic and glutamatergic nerve terminals at Ishizuka M. the Drosophila neuromuscular junction. Distribution and health risk assessment of organochlorine Exp Neurol 2015; online early: pesticides (OCPs) residue in edible cattle tissues from doi: 10.1016/j.expneurol.2015.09.017: northeastern part of Egypt: High accumulation level of OCPs in tongue. Fipronil Chemosphere 2015; 144: 1365-71. Cochran RC, Yu L, Krieger RI, Ross JH. Postapplication fipronil exposure following use on pets. Ogbeide O, Tongo I, Ezemonye L.

Assessing the distribution and human health risk of doi: 10.1016/j.neuroscience.2015.10.021: organochlorine pesticide residues in sediments from selected rivers. Chemosphere 2015; 144: 1319-26. Phosphine Gottschalk BH, Anselm DD, Baranchuk A. Organophosphorus insecticides Phosphine poisoning is emerging as an important cause of brugada phenocopy. General Pacing Clin Electrophysiol 2015; online early: Faria M, Garcia-Reyero N, Padrós F, Babin PJ, Sebastián D, doi: 10.1111/pace.12777: Cachot J, Prats E, Arick M, II, Rial E, Knoll-Gellida A, Mathieu G, Le Bihanic F, Escalon BL, Zorzano A, Soares AMVM, Raldúa D. Pyrethroid insecticides Zebrafish models for human acute organophosphorus poisoning. General Sci Rep 2015; 5: 15591. Doe JE, Lander DR, Doerrer NG, Heard N, Hines RN, Lowit AB, Pastoor T, Phillips RD, Sargent D, Sherman JH, Young Liu H-X, Liu C-F, Yang W-H. Tanir J, Embry MR. Clinical study of continuous micropump infusion of Use of the RISK21 roadmap and matrix: human health risk atropine and pralidoxime chloride for treatment of severe assessment of the use of a pyrethroid in bed netting. acute organophosphorus insecticide poisoning. Crit Rev Toxicol 2015; onlin early: J Chin Med Assoc 2015; online early: doi: 10.3109/10408444.2015.1082974: doi: 10.1016/j.jcma.2015.08.006: Syed F, John PJ, Soni I. Yen T-H, Chen K-H, Hsu M-Y, Fan S-T, Huang Y-F, Chang Neurodevelopmental consequences of gestational and C-L, Wang Y-P, Cheng C-M. lactational exposure to pyrethroids in rats. Evaluating organophosphate poisoning in human serum with paper. Environ Toxicol 2015; online early: Talanta 2015; 144: 189-95. doi: 10.1002/tox.22178:

Chlorpyrifos Cypermethrin Tanvir EM, Afroz R, Chowdhury MAZ, Gan SH, Karim N, Ratelle M, Coté J, Bouchard M. Islam MN, Khalil MI. Time profiles and toxicokinetic parameters of key A model of chlorpyrifos distribution and its biochemical biomarkers of exposure to cypermethrin in orally exposed effects on the liver and kidneys of rats. volunteers compared with previously available kinetic data Hum Exp Toxicol 2015; online early: following permethrin exposure. doi: 10.1177/0960327115614384: J Appl Toxicol 2015; 35: 1586-93.

Diazinon Boussabbeh M, Ben Salem I, Hamdi M, Ben Fradj S, Abid- Cyphenothrin Essefi S, Bacha H. Driver JH, Ross JH, Holden LR, Selim S, Sharp JK, Carlson Diazinon, an organophosphate pesticide, induces oxidative D, Nouvel L. stress and genotoxicity in cells deriving from large Cyphenothrin flea and tick squeeze-on for dogs: intestine. evaluation of potential health risks based on the results of Environ Sci Pollut Res Int 2015; online early: observational biological monitoring. doi: 10.1007/s11356-015-5519-y: J Toxicol Environ Health A 2015; 78: 1105-21.

Dichlorvos Deltamethrin Xu M-Y, Wang P, Sun Y-J, Wang H-P, Liang Y-J, Zhu L, Xu M-Y, Wang P, Sun Y-J, Wang H-P, Liang Y-J, Zhu L, Wu Y-J. Wu Y-J. Redox status in liver of rats following subchronic exposure to the combination of low dose dichlorvos and deltamethrin. Redox status in liver of rats following subchronic exposure to the combination of low dose dichlorvos and deltamethrin. Pestic Biochem Physiol 2015; 124: 60-5. Pestic Biochem Physiol 2015; 124: 60-5. Malathion El-Bini Dhouib I, Lasram MM, Annabi A, Gharbi N, El-Fazaa S. Rodenticides A comparative study on toxicity induced by carbosulfan Curto-Barredo L, Segura S, Martín-Ezquerra G, Lloveras B, and malathion in Wistar rat liver and spleen. Gallardo F, Pujol RM. Pestic Biochem Physiol 2015; 124: 21-8. Anagen effluvium due to thallium poisoning derived from the intake of Chinese herbal medicine and rodenticide Paraquat and diquat containing thallium salts. Davarpanah MA, Hosseinzadeh F, Saeed S. J Dermatol 2015; 42: 1027-9. Treatment following intoxication with lethal dose of paraquat: a case report and review of literature. Iran Red Crescent Med J 2015; 17: e19373. Thallium Curto-Barredo L, Segura S, Martín-Ezquerra G, Lloveras B, Tinakoua A, Bouabid S, Faggiani E, De Deurwaerdère P, Gallardo F, Pujol RM. Lakhdar-Ghazal N, Benazzouz A. Anagen effluvium due to thallium poisoning derived from The impact of combined administration of paraquat and the intake of Chinese herbal medicine and rodenticide maneb on motor and non-motor functions in the rat. containing thallium salts. Neuroscience 2015; online early: J Dermatol 2015; 42: 1027-9.

CHEMICAL WARFARE, PLANTS BIOLOGICAL WARFARE AND General Krenzelok EP, Mrvos R. RIOT CONTROL AGENTS Toxic Christmas and New Year holiday plants...or are they? Biological warfare Asia Pac J Med Toxicol 2015; 4: 64-7. Anthrax D'Amelio E, Gentile B, Lista F, D'Amelio R. Areca spp. (Betel nut) Historical evolution of human anthrax from occupational Lee HH, Chen LY, Wang HL, Chen BH. disease to potentially global threat as bioweapon. Quantification of salivary arecoline, arecaidine and N- Environ Int 2015; 85: 133-46. methylnipecotic acid levels in volunteers by liquid chromatography-tandem mass spectrometry.

J Anal Toxicol 2015; 39: 714-9. Chemical warfare General Catha edulis (Khat) Faria M, Garcia-Reyero N, Padrós F, Babin PJ, Sebastián D, Kassim S, al'Absi M. Cachot J, Prats E, Arick M, II, Rial E, Knoll-Gellida A, Khat use is a neglected addictive behaviour. Mathieu G, Le Bihanic F, Escalon BL, Zorzano A, Soares Addiction 2015; online early: doi: 10.1111/add.13148: AMVM, Raldúa D. Zebrafish models for human acute organophosphorus Chresta martii poisoning. Franco ES, Mélo MEB, Militão GCG, Rocha RET, Silva Sci Rep 2015; 5: 15591. LTGA, Jatobá BJA, Silva PBN, Santana ALBD, Silva AAR,

Silva TG, Nascimento MS, Maia MBS. Khoshnevis MA, Panahi Y, Ghanei M, Borna H, Sahebkar A, Evaluation of the acute toxicity, cytotoxicity, and Aslani J. genotoxicity of Chresta martii (Asteraceae). A triage model for chemical warfare casualties. J Toxicol Environ Health A 2015; 78: 1083-93. Trauma Mon 2015; 20: e16211. Datura stramonium (Jimson weed) McElroy C, Day BJ. Özkaya AK, Güler E, Karabel N, Namli AR, Göksügür Y. Antioxidants as potential medical countermeasures for Datura stramonium poisoning in a child. chemical warfare agents and toxic industrial chemicals. Turk J Pediatr 2015; 57: 82-4. Biochem Pharmacol 2015; online early: doi: 10.1016/j.bcp.2015.10.003: Eupatorium cannabinum (Hemp Mustard gas agrimony) John H, Siegert M, Gandor F, Gawlik M, Kranawetvogl A, Judzentiene A, Garjonyte R, Budiene J. Karaghiosoff K, Thiermann H. Variability, toxicity, and antioxidant activity of Eupatorium Optimized verification method for detection of an albumin- cannabinum (hemp agrimony) essential oils. sulfur mustard adduct at Cys34 using a hybrid quadrupole Pharm Biol 2015; online early: time-of-flight tandem mass spectrometer after direct doi: 10.3109/13880209.2015.1078384: plasma proteolysis. Toxicol Lett 2015; online early: Mushrooms doi: 10.1016/j.toxlet.2015.09.027: Esposito P, La Prota E, Calatroni M, Bianzina S, Libetta C, Gregorini M, Rampino T, Dal Canton A. Layegh P, Maleki M, Mousavi SR, Yousefzadeh H, Renal involvement in mushroom poisoning: the case of Momenzadeh A, Golmohammadzadeh S, Balali-Mood M. Orellanus syndrome. Epidermal hydration and skin surface lipids in patients with Hemodial Int 2015; 19: E1-E5. long-term complications of sulfur mustard poisoning. J Res Med Sci 2015; 20: 640-5. Sohn CH. Type and treatment of toxic mushroom poisoning in Korea. Schmidt A, Steinritz D, Thiermann H, Meineke V, Abend M. J Korean Med Assoc 2015; 58: 818-24. Alteration of miRNA expression in early endothelial cells after exposure with sub-lethal sulfur mustard concentrations. Amanita mushrooms Toxicol Lett 2015; online early: Yilmaz I, Ermis F, Akata I, Kaya E. doi: 10.1016/j.toxlet.2015.10.002: A case study: what doses of Amanita phalloides and amatoxins are lethal to humans? Tahmasbpour E, Reza ES, Ghanei M, Panahi Y. Wilderness Environ Med 2015; online early: Role of oxidative stress in sulfur mustard-induced doi: 10.1016/j.wem.2015.08.002: pulmonary injury and antioxidant protection. Inhal Toxicol 2015; online early: Nerium oleander doi: 10.3109/08958378.2015.1092184: Roberts DM, Galappatthy G, Dunuwille A, Chan BS. Pharmacological treatment of cardiac glycoside poisoning. Nitrogen mustard Br J Clin Pharmacol 2015; online early: Malaviya R, Sunil VR, Venosa A, Verissimo VL, Cervelli JA, doi: 10.1111/bcp.12814: Vayas KN, Hall LR, Laskin JD, Laskin DL. Attenuation of nitrogen mustard-induced pulmonary injury Rhododendron spp and fibrosis by anti-tumor necrosis factor- antibody. These A, Bodi D, Uecker S, Reimers K, Ronczka S, Preiss- Toxicol Sci 2015; 148: 71-88. Weigert A, Lahrssen-Wiederholt M.

A case of human poisoning by grayanotoxins following Nielsen VG, Redford DT, Boyle PK. honey ingestion: elucidation of the toxin profile by mass Effect of iron and carbon monoxide on fibrinogenase-like spectrometry. degradation of plasmatic coagulation by venoms of six Food Addit Contam Part A Chem Anal Control Expo Risk Agkistrodon species. Assess 2015; 32: 1674-84. Basic Clin Pharmacol Toxicol 2015; online early: doi: 10.1111/bcpt.12504: Solanum torvum (Susumber berries) Glover RL, Connors NJ, Stefan C, Wong E, Hoffman RS, Ryan NM, Downes M, Isbister GK. Nelson LS, Milstein M, Smith SW, Swerdlow M. Clinical features of serum sickness after Australian snake Electromyographic and laboratory findings in acute antivenom. Solanum torvum poisoning. Toxicon 2015; online early: Clin Toxicol 2015; online early: doi: 10.1016/j.toxicon.2015.10.012: doi: 10.3109/15563650.2015.1110749: Williams DJ. Snake bite: a global failure to act costs thousands of lives ANIMALS each year. Fish/marine poisoning Br Med J 2015; 351: h5378 . Patocka J, Gupta RC, Wu Q-H, Kuca K. Toxic potential of palytoxin. Brown snake J Huazhong Univ Sci Technol Med Sci 2015; 35: 773-80. Weinstein SA, White J, Ou J, Haiart S, Galluccio S.

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INDEX

4-methylcyclohexanemethanol ...... 29 Cimetidine ...... 19 Acetaminophen ...... 26 Clenbuterol ...... 22 Acetylcysteine ...... 18 Clonazepam ...... 22 Air pollution ...... 28 Cobra ...... 40 Alcohol ...... 29 Cocaine...... 23 Aldehydes ...... 30 Codeine ...... 25 Alpha-(phenylselanyl) acetophenone ...... 29 Cosmetics ...... 31 Aluminium ...... 34 Cotton dusts ...... 31 Aluminium phosphide ...... 37 Crotalinae ...... 40 Amanita mushrooms ...... 39 Cypermethrin ...... 38 Amfetamines ...... 20 Cyphenothrin ...... 38 Anaesthetics ...... 20 Cytotoxic drugs ...... 23 Analytical toxicology ...... 7 Dabigatran ...... 21 Animals, general ...... 40 Dapsone ...... 21 Anthrax ...... 39 Datura stramonium ...... 39 Antiarrhythmic drugs ...... 21 Deltamethrin ...... 38 Antibiotics ...... 21 Denosumab ...... 24 Anticholinergic drugs ...... 21 Dermal toxicity ...... 9 Anticoagulants ...... 21 Designer drugs ...... 23 Anticonvulsants ...... 21 Developmental toxicology ...... 9 Antidepressants ...... 21 Diacetylmorphine...... 24 Antidotes ...... 18 Diazinon ...... 38 Antiemetics ...... 21 Dichlorvos ...... 38 Antihistamines ...... 21 Dietary supplements ...... 23 Antihypertensive drugs ...... 21 Digoxin ...... 23 Antineoplastic drugs ...... 21 Dioxin ...... 31 Antivenom ...... 18 Diphenhydramine ...... 21 Antiviral drugs ...... 22 Diphenidol...... 21 Areca spp ...... 39 Diquat ...... 38 Arsenic ...... 34 Doxycycline ...... 21 Asphalt ...... 30 Driving under the influence ...... 10 Atorvastatin ...... 27 Dronabinol ...... 19 Atropine ...... 18 Drugs, general ...... 19 Benzodiazepines ...... 22 E-cigarettes ...... 31 Benzyl alcohol ...... 19 Ecstasy ...... 20 Beta 2 agonists ...... 22 Endocrine disrupting chemicals ...... 31 Beta-arbutin ...... 30 Epidemiology...... 10 Betel nut ...... 39 Ethanol ...... 29 Biological warfare...... 39 Ethnic remedies ...... 23 Biomarkers ...... 8 Ethylene glycol ...... 31 Bisphenol A ...... 30 Eupatorium cannabinum ...... 39 Bisphosphonates ...... 22 Exhaust fumes ...... 29 Botulism ...... 40 Extracorporeal treatments ...... 19 Bromate ...... 30 Fentanyl...... 25 Brown snake ...... 40 Fipronil ...... 37 Bupivacaine ...... 20 Fish/marine poisoning ...... 40 Bupropion ...... 21 Flame retardants ...... 31 Cadmium ...... 35 Fluorouracil ...... 21 Caffeine...... 22 Folic acid ...... 19 Calciferol ...... 28 Forensic toxicology ...... 11 Cannabis ...... 22 Formaldehyde ...... 31 Carbamate insecticides ...... 37 Fragrance compounds ...... 32 Carbon monoxide ...... 30 Gabapentin ...... 19 Carcinogenicity ...... 8 Gasoline ...... 32 Cardiotoxicity ...... 9 Gemcitabine ...... 21 Catha edulis...... 39 Genotoxicity ...... 11 Chelating agents ...... 18 Glimepiride ...... 24 Chemical incidents ...... 29 Glyphosate ...... 37 Chemical warfare, general ...... 39 Granulocyte colony-stimulating factor ...... 19 Chemicals, general ...... 29 Hazardous waste ...... 29 Chlorpyrifos ...... 38 Hemp agrimony ...... 39 Cholinesterase inhibitors ...... 22 Hepatotoxicity ...... 11 Chresta martii ...... 39 Herbal medicines ...... 23 Chromium ...... 35 Herbicides ...... 37 Ciguatera ...... 40 Heroin ...... 24

Honey ...... 32 Paraphenylenediamine ...... 32 Hydrocarbons ...... 32 Paraquat ...... 38 Hydroxyethyl starch ...... 19 Perchlorate ...... 32 Hypoglycaemic drugs ...... 24 Perfluorinated compounds ...... 32 Hypoglycaemics ...... 24 Pesticides and cancer...... 37 Ibogaine ...... 24 Pesticides, general ...... 36 Imidacloprid ...... 37 Petrol...... 32 Indium ...... 35 Phosphine ...... 38 Inhalation toxicity ...... 12 Phthalate esters ...... 33 Iodine ...... 32 Pit vipers ...... 40 Isobutylparaben ...... 32 Plants, general ...... 39 Isocyanates ...... 32 Pollution ...... 29 Jet fuel ...... 33 Polybrominated diphenyl ethers ...... 33 Jimson weed ...... 39 Polychlorinated biphenyls ...... 33 Ketamine ...... 24 Polycyclic aromatic hydrocarbons ...... 33 Khat ...... 24, 39 Polymorphisms ...... 16 Kinetics ...... 12 Pralidoxime ...... 18 Latex ...... 32 Propafenone ...... 21 Lead...... 35 Propofol ...... 26 Lidocaine ...... 21 Psychiatric aspects ...... 16 Lipid emulsion therapy ...... 18 Pyrethroid insecticides, general ...... 38 Lithium ...... 24, 36 Radiation ...... 33 Malathion ...... 38 Reprotoxicity ...... 16 Management, general ...... 17 Rhododendron spp ...... 39 Maneb ...... 37 Risk assessment ...... 17 Marijuana ...... 22 Rivaroxaban ...... 21 MDMA ...... 20 Rodenticides ...... 38 Medication errors ...... 12 Scopolamine ...... 21 Melatonin ...... 19 Scorpions ...... 40 Mephedrone ...... 23 Sedatives ...... 26 Mercury ...... 36 Selenium ...... 36 Metals, general ...... 34 Sildenafil ...... 27 Metformin ...... 24 Smoke ...... 33 Methadone ...... 25 Snake bites ...... 40 Methanol ...... 32 Sodium bicarbonate ...... 27 Methotrexate ...... 22 Sodium chloride...... 33 Methyl methacrylate ...... 32 Solanum torvum ...... 40 Methylene blue ...... 18 Solvents ...... 34 Methylthioninium chloride ...... 18 Spiders ...... 40 Methyphenidate ...... 24 SSRIs and SNRIs ...... 27 Metolachlor ...... 37 Statins ...... 27 Microorganisms ...... 40 Styrene ...... 34 Monoclonal antibodies ...... 24 Substance abuse ...... 27 Montelukast ...... 19 Suicide ...... 17 Mushrooms ...... 39 Sulphur dioxide ...... 34 Mustard gas ...... 39 Susumber berries ...... 40 Naloxone ...... 19 Synthetic cannabinoids ...... 23 Nanoparticles ...... 32 Thallium...... 36, 38 Neonicotinoid insecticides ...... 37 Thiamine pyrophosphate ...... 19 Nephrotoxicity ...... 12 Tobacco ...... 34 Nerium oleander ...... 39 Toxicology, general ...... 7 Neurotoxicity ...... 12 Tramadol ...... 26 Nicotine ...... 24 Tricyclic antidepressants ...... 28 Nitrogen dioxide ...... 32 True vipers...... 40 Nitrogen mustard ...... 23, 39 Uranium ...... 36 Nitrous oxide ...... 32 Valproate ...... 21 Occupational toxicology ...... 13 Vemurafenib ...... 22 Octylphenol ...... 32 Viperinae ...... 40 Ocular toxicity ...... 14 Vitamins...... 28 Opioid maintenance therapy ...... 19 Volatile organic compounds ...... 34 Opioids ...... 25 Warfarin ...... 21 Opium ...... 25 Water ...... 34 Organochlorine pesticides, general ...... 37 Water pollution ...... 29 Organophosphorus insecticides, general ...... 38 Wheat flour ...... 34 Oxycodone ...... 26 Wood dusts ...... 34 Paediatric toxicology ...... 14 Ziram ...... 37 Parabens ...... 32 Zolpidem ...... 27 Paracetamol ...... 26

The NPIS is commissioned by Public Health England