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

April 2014

CURRENT AWARENESS PAPERS OF THE MONTH

Significance of the imidazoline receptors in toxicology Lowry JA, Brown JT. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.898770: Introduction The alpha-2 adrenergic (AA-2) receptor agonists and imidazolines are common exposures in the American Association of Control Centers (AAPCC) National Poison Data System (NPDS). Although the interaction between the AA-2 receptor and imidazoline receptors has been extensively studied, it largely remains unknown to health-care professionals. This review describes these interactions and mechanisms by which agonists affect physiologic responses binding to these receptors. Methods Papers published in English from 1960 to 2013 were retrieved from PubMed. A total of 323 original articles were identified and 173 were included. Background The associated with clonidine (e.g., bradycardia, miosis, and hypotension) is largely assumed to be secondary to the functional overlap of the AA-2 receptors and the mu receptors. However, the effects at the AA-2 receptor could not fully account for these symptoms. Subsequently, clonidine was found to produce its pharmacologic effect in the central (CNS) by interaction not only with the AA-2 receptor but also on selective imidazoline receptors. Imidazoline receptors Since their discovery, three distinct classes of imidazoline receptors, also known as imidazoline binding sites or imidazoline/guanidinium receptive sites, have been characterized. Imidazoline-1 (I-1) receptors are involved in the hypotensive activity of clonidine and related compounds supporting the idea that the I-1 receptors are upstream from the AA-2 receptor and work in tandem for its effect on blood pressure. Additionally, stimulation of N-type Calcium-2 channels, G-protein inwardly rectifying potassium channel, adenosine receptors, phosphatidyl-choline-specific phospholipase C, and nicotinic receptors have been implicated to be involved. Previous studies have shown that I-1 receptors may also be involved in other physiologic responses beyond cardiac function. Imidazoline-2 (I-2)

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

The NPIS is commissioned by Public Health England

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receptors interact with A and monoamine oxidase B leading to research that has focused on the effect of I-2 receptors and depression and the suggestion of a possible antidepressant action of the imidazolines. I-2 receptor ligands may have substantial antinociceptive activity and work synergistically with opioids in acute pain. Imidazoline-3 (I- 3) receptors are located on the pancreatic -cells and modulate glucose homeostasis. Imidazoline ligands Four endogenous compounds have been found to bind and include clonidine-displacing substance, agmatine, harmane, and imidazole acetic acid. Significant interest in developing new agents with higher selectivity and affinity for I-1 receptors has resulted. Toxicology Alpha-2 adrenoceptor and imidazoline receptor agonists such as clonidine and tetrahydrozoline are common ingestions reported to poison control centers. The most common toxic effects of clonidine are similar to those of the over-the-counter imidazolines and include CNS depression, bradycardia, hypotension, respiratory depression, miosis, hypothermia, and hypertension (early and transient). Based on their structure and subsequent studies, imidazoline receptors seem to be the primary binding site for these chemicals. Case reports typically illustrate rapid onset of action with serious side effects following ingestion of relatively small amounts. These agents have been reportedly used in drug-assisted sexual assaults. Conclusion Much of the toxicity associated with drugs such as clonidine, guanfacine, and tetrahydrozoline are due to their binding to imidazoline receptors. Knowledge of the imidazoline receptors may lead to new therapeutic agents and inform management of patients with imidazoline overdose. Full text available from: http://dx.doi.org/10.3109/15563650.2014.898770

Neurotoxicity of European viperids in Italy: Pavia Poison Control Centre case series 2001–2011 Lonati D, Giampreti A, Rossetto O, Petrolini VM, Vecchio S, Buscaglia E, Mazzoleni M, Chiara F, Aloise M, Gentilli A, Montecucco C, Coccini T, Locatelli CA. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.904046: Context Some clinical aspects about neurotoxicity after by European viper species remain to be elucidated. Objective This observational case series aims to analyze neurological manifestations due to viper envenomation in Italy in order to describe the characteristic of neurotoxicity and to evaluate the clinical response to the antidotic treatment, the outcome, and the influence of individual variability in determining the appearance of neurotoxic effects. Materials and methods. All cases of referred to Pavia Poison Centre (PPC) presenting peripheral neurotoxic effects from 2001 to 2011 were included. Cases were assessed for time from bite to PPC evaluation, Grade Severity Score (GSS), onset/duration of clinical manifestations, severity/time course of local, non-neurological and neurological effects, and antidotic treatment. Results Twenty-four were included (age, 3-75 years) and represented on average of 2.2 cases/year

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(about 5% of total envenomed patients). The mean interval time of PPC evaluation from snakebite was 10.80 ± 19.93 hours. GSS at ED-admission was 0 (1 case), 1 (10 cases), and 2 (13 cases). All patients showed local signs: 41.6%, minor; 58.4%, extensive swelling and necrosis. The main systemic non-neurological effects were as follows: vomiting (86.7%), diarrhea (66.7%), abdominal discomfort (53.3%), and hypotension (20%). Neurotoxic effects were accommodation troubles and diplopia (100%), ptosis (91.7%), ophtalmoplegia (58.3%), dysphagia (20.8%), drowsiness (16.6%), cranial muscle weakness (12.5%), and dyspnea (4.2%). Neurotoxicity was the unique systemic manifestation in 9 cases; in 4 cases, they were associated with only mild local swelling. In 10 patients the onset of neurotoxic effects followed the resolution of systemic non-neurological effects. Antidote was intravenously administered in 19 (79.2%) patients. The mean duration of manifestations in untreated versus treated groups was 53.5 ± 62.91 versus 41.75 ± 21.18 hours (p = 0.68, local effects) and 9.77 ± 3.29 versus 8.25 ± 12.23 hours (p = 0.1, systemic non- neurological effects) and 43.4 ± 14.69 versus 26.58 ± 20.62 hours (p = 0.03, neurotoxic effects). Conclusions Neurotoxicity may appear late (11 hours after the bite in 58.3% of cases), in contrast with the data reported in medical literature. Neurotoxic effects have been reversible in all cases and may be the unique systemic manifestation of envenomation. Neurotoxic effects are shorter in treated group. The antidotic treatment of patients considered as GSS 2 only for neurotoxic effects (with mild local effects) may not be necessary. Variable factors such as different amount of injected, concentration of PLA2 component, and individual susceptibility may explain the less percentage of patients presenting neurotoxic effects. Full text available from: http://dx.doi.org/10.3109/15563650.2014.904046

Does diisocyanate exposure result in neurotoxicity? Hughes MA, Carson M, Collins MA, Jolly AT, Molenaar DM, Steffens W, Swaen GMH. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.898769: Context Diisocyanates have been associated with respiratory and dermal sensitization. Limited number of case reports, and a few case studies, media, and other references suggest potential neurotoxic effects from exposures to toluene diisocyanate (TDI), 1,6 hexamethylene diisocyanate (HDI), and methylene diisocyanate (MDI). However, a systematic review of the literature evaluating the causal association on humans does not exist to support this alleged association. Objective To perform systematic review examining the body of epidemiologic evidence and provide assessment of causal association based on principles of the Sir Austin Bradford Hill criteria or considerations for causal analysis. Methods A comprehensive search of public databases for published abstracts, case reports, cross- sectional surveys, and cohort studies using key search terms was conducted. Additional searches included regulatory reviews, EU IUCLID and EU Risk Assessment databases, and unpublished reports in the International Isocyanate Institute database. An expert panel consisting of physicians, toxicologists, and an epidemiologist critically reviewed accepted papers, providing examination of epidemiologic evidence of each report. Finally, the Hill criteria for causation were applied to the summative analysis of identified reports to

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estimate probability of causal association. Results Twelve papers reporting exposed populations with a variety of neurological symptoms or findings suitable for analysis were identified, including eleven case or case series reports, and one cross-sectional study. Three papers reported on the same population. Each of the papers was limited by paucity of diisocyanate exposure estimates, the presence of confounding exposures to known or suspected neurotoxicants, a lack of objective biological measures of exposure or neurotoxic effects, and lack of relative strength of association measures. Additionally, reported health symptoms and syndromes lacked consistency or specificity. No plausible mechanism of toxicity was found. Application of a predictive mathematical model for determining probability of causal association for neurotoxicity was calculated to be 21%. Conclusion There is insufficient evidence for a causal association of neurotoxic effects and diisocyanate exposure based on lack of evidence in all categories of the Hill criteria for causality except for temporal association of reported symptoms and alleged exposure. Future reports should attempt to address more rigorous exposure assessment and control for confounding exposures. Full text available from: http://dx.doi.org/10.3109/15563650.2014.898769

Four-hour acetaminophen concentration estimation after ingested dose based on pharmacokinetic models Villeneuve E, Gosselin S, Whyte I. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.902956: Introduction The United Kingdom has recently changed the indications for N-acetylcysteine treatment for acetaminophen intoxication. Any ingestion over 75 mg/kg is now referred to the hospital. A model based on pharmacokinetic parameters was developed to predict 4-h acetaminophen concentration for this and other ingested doses. Methodology EMBASE and Medline were searched to obtain values for volume of distribution, absorption, and elimination constants and bioavailability for acetaminophen. Four-hour concentrations were calculated for ingestion doses currently recommended for hospital referral in different countries. Calculated plasma concentrations at 4 h for several doses were plotted against the Rumack-Matthew and the United Kingdom treatment lines. Results Six articles were used for the calculations (4 adult and 2 pediatric). In order to achieve a 4-h acetaminophen concentration of 100 mg/L, doses (mg/kg ± 99.9CI) of 180.5 ± 43.2 for adults and 396.1 ± 115.5 for children were calculated. Discussion A dose of 75 mg/kg would likely yield a 4-h acetaminophen concentrations well below 100 mg/L. Medical toxicologists and poison information specialists are left without evidence- based guidance for which patients or which ingestion history would now warrant referral to hospital for acetaminophen concentration measurement. Larger toxicokinetic studies in acetaminophen overdose are needed to define ingestion dose for referral to hospital. Full text available from: http://dx.doi.org/10.3109/15563650.2014.902956

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Effect of the UK's revised paracetamol management guidelines on admissions, adverse reactions, and costs of treatment Bateman DN, Carroll R, Pettie J, Yamamoto T, Elamin MEMO, Peart L, Dow M, Coyle J, Cranfield KR, Hook C, Sandilands EA, Veiriaiah A, Webb DJ, Gray A, Dargan PI, Wood DM, Thomas SHL, Dear JW, Eddleston M. Br J Clin Pharmacol 2014; online early: doi: 10.1111/bcp.12362: Abstract and full text available from: http://dx.doi.org/10.1111/bcp.12362

Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: a retrospective intensive care unit-based study in a tertiary care teaching hospital Ahmed SM, Das B, Nadeem A, Samal RK. Indian J Anaesth 2014; 58: 11-7. Abstract and full text available from: http://dx.doi.org/10.4103/0019-5049.126780

Non-renal effects and the risk assessment of environmental cadmium exposure Åkesson A, Barregard L, Bergdahl IA, Nordberg GF, Nordberg M, Skerfving S. Environ Health Perspect 2014; online early: doi: 10.1289/ehp.1307110: Abstract and full text available from: http://dx.doi.org/10.1289/ehp.1307110

Intermittent hemodialysis is superior to continuous veno- venous hemodialysis/hemodiafiltration to eliminate and formate during treatment for methanol poisoning Zakharov S, Pelclova D, Navratil T, Belacek J, Kurcova I, Komzak O, Salek T, Latta J, Turek R, Bocek R, Kucera C, Hubacek JA, Fenclova Z, Petrik V, Cermak M, Erik HK. Int 2014; online early: doi: 10.1038/ki.2014.60: Abstract and full text available from: http://dx.doi.org/10.1038/ki.2014.60

The fetal safety of levetiracetam: a systematic review Chaudhry SA, Jong G, Koren G. Reprod Toxicol 2014; 46: 40-5. Abstract and full text available from: http://dx.doi.org/10.1016/j.reprotox.2014.02.004

The impacts of acute carbon monoxide poisoning on the brain: longitudinal clinical and 99mTc ethyl cysteinate brain SPECT characterization of patients with persistent and delayed neurological sequelae Tsai C-F, Yip P-K, Chen S-Y, Lin J-C, Yeh Z-T, Kung L-Y, Wang C-Y, Fan Y- M. Clin Neurol Neurosurg 2014; 119: 21-7. Abstract and full text available from: http://dx.doi.org/10.1016/j.clineuro.2014.01.005

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TOXICOLOGY Rumpler MJ. Quantitative analysis of 11-nor-9-carboxy-tetrahydro- General cannbinol (THC-COOH) in by LC-MS/MS following a Jones C. simple filtration. Television: pick your poison. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 957C: Nat Chem 2014; 6: 269. 77-83. van Ravenzwaay B, Montoya GA, Fabian E, Herold M, Sun W, Qu S, Du Z. Krennrich G, Looser R, Mellert W, Peter NE, Strauss V, Hollow fiber liquid-phase microextraction combined with ultra- Walk T, Kamp H. high performance liquid chromatography-tandem mass The sensitivity of metabolomics versus classical regulatory spectrometry for the simultaneous determination of naloxone, toxicology from a NOAEL perspective. buprenorphine and norbuprenorphine in human plasma. Toxicol Lett 2014; 227: 20-8. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 951-952: 157-63. Analytical toxicology Arvanitoyannis IS, Kotsanopoulos KV, Papadopoulou A. Biomarkers Rapid detection of chemical hazards (, dioxins, and Alshaarawy O, Zhu M, Ducatman AM, Conway B, Andrew ME. PCBs) in . Urinary polycyclic aromatic hydrocarbon biomarkers and Crit Rev Food Sci Nutr 2014; 54: 1473-528. diabetes mellitus.

Occup Environ Med 2014; online early: Beck O, Rausberg L, Al-Saffar Y, Villen T, Karlsson L, Hansson T, Helander A. doi: 10.1136/oemed-2013-101987: Detectability of new psychoactive substances, 'legal highs', in CEDIA, EMIT, and KIMS immunochemical screening Antoine DJ, Harrill AH, Watkins PB, Park BK. assays for drugs of abuse. Safety biomarkers for drug-induced liver injury-current Drug Test Anal 2014; online early: status and future perspectives. doi: 10.1002/dta.1641: Toxicol Res (Camb) 2014; 3: 75-85.

Di Rago M, Saar E, Rodda LN, Turfus S, Kotsos A, Baker MG, Simpson CD, Stover B, Sheppard L, Checkoway Gerostamoulos D, Drummer OH. H, Racette BA, Seixas NS. Fast targeted analysis of 132 acidic and neutral drugs and Blood manganese as an exposure biomarker: state of the poisons in whole blood using LC-MS/MS. evidence. Forensic Sci Int 2014; online early: J Occup Environ Hyg 2014; 11: 210-7. doi: 10.1016/j.forsciint.2014.03.021: Boscolo-Berto R, Favretto D, Cecchetto G, Vincenti M, Ellefsen KN, Anizan S, Castaneto MS, Desrosiers NA, Kronstrand R, Ferrara SD, Viel G. Martin TM, Klette KL, Huestis MA. Sensitivity and specificity of EtG in hair as a marker of Validation of the only commercially available immunoassay chronic excessive drinking. Pooled analysis of raw data for synthetic cathinones in urine: randox drugs of abuse V and meta-analysis of diagnostic accuracy studies. biochip array technology. Ther Drug Monit 2014; online early: Drug Test Anal 2014; online early: doi: 10.1097/FTD.0000000000000063: doi: 10.1002/dta.1633:

Lin Y, Chen J, Yan L, Guo L, Wu B, Li C, Feng J, Liu Q, Xie J. Carnevale A, Aleksa K, Goodyer CG, Koren G. Determination of nerve agent metabolites in human urine Investigating the use of hair to assess polybrominated by isotope-dilution gas chromatography-tandem mass diphenyl ether exposure retrospectively. spectrometry after solid phase supported derivatization. Ther Drug Monit 2014; 36: 244-51. Anal Bioanal Chem 2014; online early: doi: 10.1007/s00216-014-7695-x: Côté J, Bonvalot Y, Carrier G, Lapointe C, Fuhr U, Tomalik- Scharte D, Wachall B, Bouchard M. Minakata K, Yamagishi I, Nozawa H, Hasegawa K, Wurita A novel toxicokinetic modeling of cypermethrin and per- A, Gonmori K, Suzuki M, Watanabe K, Suzuki O. methrin and their metabolites in humans for dose MALDI-TOF mass spectrometric determination of four reconstruction from biomarker data. pyrrolidino cathinones in human blood. PLoS ONE 2014; 9: e88517. Forensic Toxicol 2014; 32: 169-75. Gjerde H, Langel K, Favretto D, Verstraete AG. O'Brien PJ. Detection of 4 benzodiazepines in oral fluid as biomarker High-content analysis in toxicology: screening substances for presence in blood. for human toxicity potential, elucidating subcellular Ther Drug Monit 2014; 36: 252-6. mechanisms, and in vivo use as translational safety biomarkers. Hong H, Tong W. Basic Clin Pharmacol Toxicol 2014; online early: doi: 10.1111/bcpt.12227: Emerging efforts for discovering new biomarkers of liver disease and hepatotoxicity.

Remane D, Montenarh D, Meyer MR, Maurer HH. Biomark Med 2014; 8: 143-6. Application of a UHPLC MS/MS-based multianalyte approach for screening and validated quantification of Lenihan DJ. drugs in human blood plasma often requested in the Cardiac biomarkers, cardiotoxicity, and active collaboration: context of brain death diagnosis. is this the final frontier or the wave we should catch? Ther Drug Monit 2014; 36: 257-60. J Am Coll Cardiol 2014; 63: 817-8.

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Biomarkers Sun Y, Bochmann F, Nold A, Mattenklott M. Mcgill MR, Li F, Sharpe MR, Williams CD, Curry SC, Ma X, Diesel exhaust exposure and the risk of lung cancer–A Jaeschke H. review of the epidemiological evidence. Circulating acylcarnitines as biomarkers of mitochondrial Int J Environ Res Public Health 2014; 11: 1312-40. dysfunction after acetaminophen overdose in mice and humans. Taeger D, Hagemeyer O, Merget R, Brüning T, Pallapies D. Is there a lung cancer risk in US coal miners? Arch Toxicol 2014; 88: 39110.1007/s00204-013-1118-1-401. Occup Environ Med 2014; online early:

doi: 10.1136/oemed-2014-102146: O'Brien PJ.

High-content analysis in toxicology: screening substances for Vlaanderen J, Straif K, Ruder A, Blair A, Hansen J, Lynge human toxicity potential, elucidating subcellular mechanisms, E, Charbotel B, Loomis D, Kauppinen T, Kyyronen P, and in vivo use as translational safety biomarkers. Pukkala E, Weiderpass E, Guha N. Basic Clin Pharmacol Toxicol 2014; online early: Tetrachloroethylene exposure and bladder cancer risk: a doi: 10.1111/bcpt.12227: meta-analysis of dry-cleaning-worker studies.

Environ Health Perspect 2014; online early: Pigatto PD, Ronchi A, Guzzi G. doi: 10.1289/ehp.1307055: NSE as a biomarker of mercury exposure. Clin Toxicol 2014; online early: Zablotska LB, Lane RSD, Frost SE, Thompson PA. doi: 10.3109/15563650.2014.897353: Leukemia, lymphoma and multiple myeloma mortality (1950–1999) and incidence (1969–1999) in the Eldorado Specht IO, Toft G, Hougaard KS, Lindh CH, Lenters V, uranium workers cohort. Jonsson BA, Heederik D, Giwercman A, Bonde JP. Environ Res 2014; 130: 43-50. Associations between serum phthalates and biomarkers of reproductive function in 589 adult men. Environ Int 2014; 66C: 146-56. Cardiotoxicity Akdemir HU, Güngörer B, Çaliskan F, Çolak S, Güzel M. Wang Y, Chen T, Tong W. Atrial fibrillation related to carbon monoxide poisoning in a female patient. miRNAs and their application in drug-induced liver injury. Am J Emerg Med 2014; online early: Biomark Med 2014; 8: 161-72. doi: 10.1016/j.ajem.2014.02.050:

Body packers Balasubramanian D, Subramanian S, Thangaraju P, Kucukmetin NT, Gucyetmez B, Poyraz T, Yildirim S, Boztas Shanmugam K. G, Tozun N. Right bundle branch block: an uncommon cardiotoxic Foreign material in the : cocaine packets. manifestation of hair dye poisoning-a case report. Case Rep Gastroenterol 2014; 8: 56-60. J Clin Diagn Res 2014; 8: 174-6.

Carcinogenicity Brune K. Adams SV, Quraishi SM, Shafer MM, Passarelli MN, Freney Diclofenac: increase of myocardial infarctions at low doses? EP, Chlebowski RT, Luo J, Meliker JR, Mu L, Neuhouser Pharmacoepidemiol Drug Saf 2014; 23: 326-8.

ML, Newcomb PA. Dyrud M, Gupta R, Khan R. Dietary cadmium exposure and risk of breast, endometrial, Acute myocardial depression with inverted (reverse) and ovarian cancer in the women's health initiative. takotsubo physiology following bupivacaine/lidocaine Environ Health Perspect 2014; online early: injection for axillary nerve block. doi: 10.1289/ehp.1307054: Chest 2014; 145: 62A.

Beane Freeman LE, Blair A, Lubin JH, Stewart PA, Hayes Gac P, Sobieszczanska M. RB, Hoover RN, Hauptmann M. Effects of cigarette smoke on Holter ECG recordings in Response to Tarone and McLaughlin: re: Mortality from solid patients with arterial hypertension. Part 2: parameters of tumors in the updated NCI formaldehyde worker cohort. heart rate turbulence. Am J Ind Med 2014; 57: 488-9. Environ Toxicol Pharmacol 2014; 37: 600-7.

Carreón T, Hein MJ, Hanley KW, Viet SM, Ruder AM. Ibrahim NY, Saad ES. Coronary artery disease and cancer mortality in a cohort of Cardiac toxicity in breast cancer patients. workers exposed to vinyl chloride, carbon disulfide, rotating Gulf J Oncolog 2014; 1: 49-55. shift work, and o-toluidine at a chemical manufacturing plant. Koo K, Kim SB, Kim K, Oh J. Am J Ind Med 2014; 57: 398-411. An optical multi-sensing system for detection of cardio- vascular toxicity. Naimi AI, Cole SR, Hudgens MG, Richardson DB. Biotechnol Lett 2014; online early: doi: 10.1007/s10529- Estimating the effect of cumulative occupational asbestos 014-1453-1: exposure on time to lung cancer mortality: using structural nested failure-time models to account for healthy-worker Lenihan DJ. survivor bias. Cardiac biomarkers, cardiotoxicity, and active collaboration: Epidemiology 2014; 25: 246-54. is this the final frontier or the wave we should catch? J Am Coll Cardiol 2014; 63: 817-8. Nielsen LS, Baelum J, Rasmussen J, Dahl S, Olsen KE, Albin M, Hansen NC, Sherson D. Nisahan B, Selvaratnam G, Kumanan T. Occupational asbestos exposure and lung cancer – A Myocardial injury following multiple bee stings. systematic review of the literature. Trop Doct 2014; online early: Arch Environ Occup Health 2014; 69: 191-206. doi: 10.1177/0049475514525606:

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Cardiotoxicity Matar H, Larner J, Kansagra S, Atkinson KL, Skamarauskas Patel NP, Jain R, Ratre BK, Patel U. JT, Amlot R, Chilcott RP. Design and characterisation of a novel in vitro skin diffusion Endosulfan poisoning induced myocarditis: rare manifestation cell system for assessing mass casualty decontamination of a commonly used in India: a case report. systems. Res J Pharm Biol Chem Sci 2014; 5: 693-7. Toxicol Vitro 2014; 28: 492-501.

Schaffer SW, Shimada K, Jong CJ, Ito T, Azuma J, St.Louis T, Ehrlich E, Bunn T, Kanotra S, Fussman C, Takahashi K. Rosenman KD. Effect of taurine and potential interactions with caffeine on Proportion of dermatitis attributed to work exposures in cardiovascular function. the working population, United States, 2011 behavioral Amino Acids 2014; online early: doi: 10.1007/s00726-014- risk factor surveillance system. 1708-0: Am J Ind Med 2014; online early: doi: 10.1002/ajim.22311:

Slomski A. Timmerman JG, Heederik D, Spee T, Smit LAM. Testosterone therapy boosts MI risk. Skin symptoms in the construction industry: occurrence JAMA 2014; 311: 1191. and determinants. Am J Ind Med 2014; online early: doi: 10.1002/ajim.22314: Smith J. The cardiotoxicity of cancer-related drug therapies. Yorio JT, Mays SR, Ciurea AM, Cohen PR, Wang W-L, Hwu US Pharm 2014; 39: HS2-HS10. W-J, Gonzalez N, Richard JL, Kim KB. Case of vemurafenib-induced Sweet's syndrome. Weichenthal S, Villeneuve PJ, Burnett RT, van Donkelaar J Dermatol 2014; online early: A, Martin RV, Jones RR, DellaValle CT, Sandler DP, Ward doi: 10.1111/1346-8138.12430: MH, Hoppin JA. Long-term exposure to fine particulate matter: association Developmental toxicology with nonaccidental and cardiovascular mortality in the Bloom MS, Surdu S, Neamtiu IA, Gurzau ES. agricultural health study cohort. Maternal arsenic exposure and birth outcomes: a Environ Health Perspect 2014; online early: comprehensive review of the epidemiologic literature doi: 10.1289/ehp.1307277: focused on drinking water. Int J Hyg Environ Health 2014; online early: Dermal toxicity doi: 10.1016/j.ijheh.2014.03.004: Aalto-Korte K, Pesonen M, Kuuliala O, Suuronen K. Occupational allergic contact dermatitis caused by coconut Chaudhry SA, Jong G, Koren G. fatty acids diethanolamide. The fetal safety of levetiracetam: a systematic review. Contact Derm 2014; 70: 169-74. Reprod Toxicol 2014; 46: 40-45.

Abbott JT, Zgherea Y, Gierer S. Choi AL, Mogensen UB, Bjerve KS, Debes F, Weihe P, A case of recurrent severe poison ivy contact dermatitis, Grandjean P, Budtz-Jørgensen E. treated successfully with seasonal cyclosporine. Negative confounding by essential fatty acids in methyl- J Allergy Clin Immunol 2014; 133: AB197. mercury neurotoxicity associations. Neurotoxicol Teratol 2014; 42: 85-92. Anjum N, Polak ME, Ardern-Jones M, Cooper HL. Presence of the HLA-A*3101 allele in a familial case of Dalbey WE, McKee RH, Goyak KO, Charlap JH, Parker C, drug reaction with eosinophilia and systemic symptoms, White R. secondary to carbamazepine. Subchronic and developmental toxicity of aromatic extracts. Clin Exp Dermatol 2014; 39: 307-9. Int J Toxicol 2014; 33: 136S-55S.

Gehring U, Tamburic L, Sbihi H, Davies HW, Brauer M. Cahill JL, Toholka RW, Nixon RL. Impact of noise and air pollution on pregnancy outcomes. Methylisothiazolinone in baby wipes: a rising star among Epidemiology 2014; online early: causes of contact dermatitis. doi: 10.1097/EDE.0000000000000073: Med J Aust 2014; 200: 208.

Gianicolo EA, Mangia C, Cervino M, Bruni A, Andreassi MG, Kocak O, Gul U. Latini G. Patch test results of the dental personnel with contact Congenital anomalies among live births in a high dermatitis. environmental risk area–A case-control study in Brindisi Cutan Ocul Toxicol 2014; online early: (southern Italy). doi: 10.3109/15569527.2013.866132: Environ Res 2014; 128: 9-14.

Lin Y-F, Yang C-H, Sindy H, Lin J-Y, Rosaline, Hui C-Y, Tsai Grandjean P, Landrigan PJ. Y-C, Wu T-S, Huang C-T, Kao K-C, Hu H-C, Chiu C-H, Hung Neurobehavioural effects of developmental toxicity. S-I, Chung W-H. Lancet Neurol 2014; 13: 330-8. Severe cutaneous adverse reactions related to systemic antibiotics. Grzywacz K, Brochu P, Beaunoyer M, Lallier M, Alvarez F. Clin Infect Dis 2014; online early: #doi: 10.1093/cid/ciu126: Neonatal peliosis with maternal ingestion of pesticides. J Pediatr Gastroenterol Nutr 2014; 58: e14-e17. López-Villaescusa MT, Pérez-García LJ, Rodríguez-Vázquez M, Martínez-Martínez ML. Johnson CC, Wegienka GR. Skin toxicity due to telaprevir: a new drug we should be Cigarette exposure in very early life leads to persistent familiar with. respiratory effects. Actas Dermosifiliogr 2014; 105: 317-9. Am J Respir Crit Care Med 2014; 189: 380-1.

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Developmental toxicology Epidemiology Machaalani R, Ghazavi E, Hinton T, Waters KA, Hennessy A. Beelen R, Stafoggia M, Raaschou-Nielsen O, Andersen ZJ, Cigarette smoking during pregnancy regulates the Xun WW, Katsouyanni K, Dimakopoulou K, Brunekreef B, expression of specific nicotinic acetylcholine receptor Weinmayr G, Hoffmann B, Wolf K, Samoli E, Houthuijs D, (nAChR) subunits in the human placenta. Nieuwenhuijsen M, Oudin A, Forsberg B, Olsson D, Toxicol Appl Pharmacol 2014; online early: Salomaa V, Lanki T, Yli-Tuomi T, Oftedal B, Aamodt G, Nafstad P, de Faire U, Pedersen NL, Östenson CG, doi: 10.1016/j.taap.2014.02.015: Fratiglioni L, Penell J, Korek M, Pyko A.

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Risk assessment Davis JM, Searles VB, Severtson SG, Dart RC, Bucher- Åkesson A, Barregard L, Bergdahl IA, Nordberg GF, Bartelson B. Nordberg M, Skerfving S. Seasonal variation in suicidal behavior with prescription Non-renal effects and the risk assessment of environmental opioid medication. cadmium exposure. J Affect Disord 2014; 158: 30-6. Environ Health Perspect 2014; online early: doi: 10.1289/ehp.1307110: Felton D, Ganetsky M, Berg AH. Osmolal gap without anion gap in a 43-year-old man. Bierkens J, Geerts L. Clin Chem 2014; 60: 446-8. Environmental hazard and risk characterisation of petroleum substances: a guided "walking tour" of petroleum Juebner M, Fietzke M, Beike J, Rothschild MA, Bender K. hydrocarbons. Assisted suicide by fentanyl intoxication due to excessive Environ Int 2014; 66C: 182-93. transdermal application. Int J Legal Med 2014; online early: doi: 10.1007/s00414- Chevillotte G, Ficheux AS, Morisset T, Roudot AC. 014-0982-4: Exposure method development for risk assessment to cosmetic products using a standard composition. Torimitsu S, Yajima D, Abe H, Kubo Y, Nagasawa S, Iwase H. Food Chem Toxicol 2014; online early: Homicide-suicide by oral administration of cyclobarbital. doi: 10.1016/j.fct.2014.03.010: Forensic Toxicol 2014; 32: 180-5.

Huang M, Chen X, Shao D, Zhao Y, Wang W, Wong MH. Risk assessment of arsenic and other metals via Tasers atmospheric particles, and effects of atmospheric exposure Ho JD, Dawes DM, Chang RJ, Nelson RS, Miner JR. and other demographic factors on their accumulations in Physiologic effects of a new-generation conducted human scalp hair in urban area of Guangzhou, China. electrical weapon on human volunteers. Ecotoxicol Environ Saf 2014; 102: 84-92. J Emerg Med 2014; 46: 428-35.

Kimber I, Basketter DA. Categorisation of protein respiratory allergens: the case of MANAGEMENT subtilisin. General Regul Toxicol Pharmacol 2014; 68: 488-92. Bateman DN, Carroll R, Pettie J, Yamamoto T, Elamin MEMO, Peart L, Dow M, Coyle J, Cranfield KR, Hook C, Pottenger LH, Andrews LS, Bachman AN, Boogaard PJ, Sandilands EA, Veiriaiah A, Webb DJ, Gray A, Dargan PI, Cadet J, Embry MR, Farmer PB, Himmelstein MW, Jarabek Wood DM, Thomas SHL, Dear JW, Eddleston M. AM, Martin EA, Mauthe RJ, Persaud R, Preston RJ, Effect of the UK's revised Schoeny R, Skare J, Swenberg JA, Williams GM, Zeiger E, management guidelines on admissions, adverse reactions, Zhang F, Kim JH. and costs of treatment. An organizational approach for the assessment of DNA Br J Clin Pharmacol 2014; online early: adduct data in risk assessment: case studies for aflatoxin doi: 10.1111/bcp.12362: B1, tamoxifen and vinyl chloride. Crit Rev Toxicol 2014; 44: 348-91. Felker D, Lynn A, Wang S, Johnson DE. Evidence for a potential protective effect of carnitine- Steiling W, Bascompta M, Carthew P, Catalano G, Corea N, pantothenic acid co-treatment on valproic acid-induced D'Haese A, Jackson P, Kromidas L, Meurice P, Rothe H, hepatotoxicity. Singal M. Expert Rev Clin Pharmacol 2014; 7: 211-8. Principle considerations for the risk assessment of sprayed consumer products. Khan AV, Ahmed QU, Khan MW, Khan AA. Toxicol Lett 2014; online early: Herbal cure for poisons and poisonous bites from Western doi: 10.1016/j.toxlet.2014.03.005: Uttar Pradesh, India.

Asian Pac J Trop Dis 2014; 4: S116-S120. Suicide Arai S, Matsui H, Ohki R, Miyazawa Y, Koike H, Hashita T, Kumar N, Shirali AC. Katsuyama Y, Sekine Y, Nomura M, Shibata Y, Hatori M, What is the best therapy for toxicity in the setting of Ito K, Yamamoto K, Ohmori S, Suzuki K. methotrexate-associated acute kidney injury: high-flux Suicide attempt with an overdose of sunitinib. hemodialysis or carboxypeptidase G2? Br J Clin Pharmacol 2014; online early: Semin Dial 2014; online early: doi: 10.1111/sdi.12220: doi: 10.1111/bcp.12381:

Mann S. Arun P, Sahni S. Management of calcium channel blocker overdose. Methylphenidate and suicidal ideation: report of two cases. Indian J Psychiatry 2014; 56: 79-81. Emerg Nurse 2014; 21: 36-9.

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Pandurang KS, Singh J, Bijesh S, Singh HP. MANAEMENT Effectiveness of anti venom for red scorpion General envenomation. Spear SE. Indian Pediatr 2014; 51: 131-3. Reducing readmissions to detoxification: an inter- organizational network perspective. Rusmili MR, Yee TT, Mustafa MR, Othman I, Hodgson WC. Drug Alcohol Depend 2014; 137: 76-82. In-vitro neurotoxicity of two Malaysian krait species

(Bungarus candidus and Bungarus fasciatus) venoms: van Helden DF, Thomas PA, Dosen PJ, Imtiaz MS, Laver neutralization by monovalent and polyvalent antivenoms DR, Isbister GK. from Thailand. Pharmacological approaches that slow lymphatic flow as a snakebite first aid. Toxins (Basel) 2014; 6: 1036-48. PLoS Negl Trop Dis 2014; 8: e2722. DigiFab Antidotes Dimeski G, Jones B, Pillans P, Page C, Brown NN. Dumestre D, Nickerson D. Digoxin overdose – An accurate method for determining Use of cyanide antidotes in burn patients with suspected free digoxin concentrations on general chemistry analysers inhalation injuries in North America: a cross-sectional post DigiFab treatment. survey. Clin Chem Lab Med 2014; online early: J Burn Care Res 2014; 35: e112-e117. doi: 10.1515/cclm-2013-1043:

Rietjens SJ, de Lange DW, Meulenbelt J. Ethylene glycol or methanol intoxication: which antidote Flumazenil should be used, fomepizole or ethanol? Moore PW, Donovan JW, Burkhart KK, Waskin JA, Hieger Neth J Med 2014; 72: 73-9. MA, Adkins AR, Wert Y, Haggerty DA, Rasimas JJ. Safety and efficacy of flumazenil for reversal of iatrogenic Acetylcysteine benzodiazepine-associated delirium toxicity during treatment Frankowska M, Jastrzebska J, Nowak E, Bialko M, of alcohol withdrawal, a retrospective review at one center. Przegalinski E, Filip M. J Med Toxicol 2014; online early: doi: 10.1007/s13181-014- The effects of N-acetylcysteine on cocaine reward and 0391-6: seeking behaviors in a rat model of depression. Behav Brain Res 2014; online early: Nelson LS. doi: 10.1016/j.bbr.2014.02.044: Alcohol withdrawal and flumazenil: not for the faint of heart.

J Med Toxicol 2014; online early: doi: 10.1007/s13181- Heard K, Rumack BH, Green JL, Bucher-Bartelson B, Heard 014-0392-5: S, Bronstein AC, Dart RC. A single-arm clinical trial of a 48-hour intravenous N- acetylcysteine protocol for treatment of acetaminophen Hyperbaric oxygen therapy poisoning. Dassan M, Paul V, Chadha S, Aggarwal N, Kupfer Y, Clin Toxicol 2014; online early: Tessler S. doi: 10.3109/15563650.2014.902955: Acute pulmonary edema due to hyperbaric oxygen therapy.

Chest 2014; 145: 74A. Kasperczyk S, Dobrakowski M, Kasperczyk A, Machnik G,

Birkner E. Effect of N-acetylcysteine administration on the expression Lipid emulsion therapy and activities of antioxidant enzymes and the Bazerbachi F, Rank K, Chan A. malondialdehyde level in the blood of lead-exposed workers. Intravenous lipid rescue and ropivacaine systemic toxicity. Environ Toxicol Pharmacol 2014; 37: 638-47. J Anesth 2014; 28: 139.

Vargha R, Mostafa G, Burda G, Hermon M, Trittenwein G, Gole J. Schwarz ES, Arroyo-Plasencia AM, Mullins ME. Treatment with N-acetylcystein and total Plasma exchange Other Complications Following Lipid Emulsion Therapy : Re: for extracorporeal liver support in children with paracetamol Levine M, Skolnik AB, Ruha AM, et al. (2013) Complications intoxication. following antidotal use of intravenous lipid emulsion Klin Padiatr 2014; online early: therapy. J Med Toxicol Dec 13. [Epub ahead of print]. doi: 10.1055/s-0034-1367051: J Med Toxicol 2014; online early: doi: 10.1007/s13181- 014-0397-0: Activated charcoal Cumpston K, Stromberg P, Wills BK, Rose SR. Schwarz ES, Arroyo-Plasencia AM, Mullins ME. Activated charcoal does not reduce duration of phenytoin Other complications following lipid emulsion therapy. toxicity in hospitalized patients. J Med Toxicol 2014; online early: doi: 10.1007/s13181- Am J Ther 2014; online early: 014-0397-0: doi: 10.1097/MJT.0000000000000058:

Methylthioninium chloride (Methylene Antivenom Gutiérrez JM, Lomonte B, Sanz L, Calvete JJ, Pla D. blue) Immunological profile of antivenoms: preclinical analysis Sungar WG. of the efficacy of a polyspecific antivenom through used in the treatment of refractory shock antivenomics and neutralization assays. resulting from drug poisoning: Fisher J, Taori G, Braitberg J Proteomics 2014; online early: G, et al. Clin Toxicol 2013;52:63-5. doi: 10.1016/j.jprot.2014.02.021: J Emerg Med 2014; 46: 600.

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Oximes Opioid maintenance therapy Sit RK, Fokin VV, Amitai G, Sharpless KB, Taylor P, Radic Z. Matthew-Simmons F, Ritter A. Imidazole aldoximes effective in assisting butyryl- 'Miracle cure' or 'liquid handcuffs': reporting on naltrexone cholinesterase catalysis of organophosphate detoxification. and methadone in the Australian print media. J Med Chem 2014; 57: 1378-89. Drug Alcohol Rev 2014; online early: doi: 10.1111/dar.12134: Potassium ketoxime Sun J-H, Sun P-P, Zheng W, Han S, Ying Y, Liu H-Y, Zhang Buprenorphine C, Zhao B-Q, Zuo G-M, Lu H, Zhong Y-X. Polomeni P, Schwan R. Skin decontamination efficacy of potassium ketoxime on Management of opioid addiction with buprenorphine: rabbits exposed to sulfur mustard. French history and current management. Cutan Ocul Toxicol 2014; online early: Int J Gen Med 2014; 7: 143-8. doi: 10.3109/15569527.2014.880454: Methadone Bhatt-Mehta V, Ng CM, Schumacher RE. Pralidoxime Effectiveness of a clinical pathway with methadone treatment Banerjee I, Tripathi SK, Roy AS. protocol for treatment of neonatal abstinence syndrome Efficacy of pralidoxime in organophosphorus poisoning: following in utero drug exposure to substances of abuse. revisiting the controversy in Indian setting. Pediatr Crit Care Med 2014; 15: 162-9. J Postgrad Med 2014; 60: 27-30. Byford S, Barrett B, Metrebian N, Groshkova T, Cary M, Dronabinol Charles V, Lintzeris N, Strang J. Milman G, Bergamaschi MM, Lee D, Mendu DR, Barnes AJ, Effectiveness of methadone treatment for heroin addiction: Vandrey R, Huestis MA. authors' reply. Br J Psychiatry 2014; 204: 241-2. Plasma cannabinoid concentrations during dronabinol pharmacotherapy for cannabis dependence. Newman R. Ther Drug Monit 2014; 36: 218-24. Effectiveness of methadone treatment for heroin addiction.

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Magnesium isoglycyrrhizinate Quercetin Xiao ZW, Zhang W, Ma L, Qiu ZW. Hou Y, Zeng Y, Li S, Qi L, Xu W, Wang H, Zhao X, Sun C. Therapeutic effect of magnesium isoglycyrrhizinate in rats Effect of quercetin against dichlorvos induced nephrotoxicity on lung injury induced by paraquat poisoning. in rats. Eur Rev Med Pharmacol Sci 2014; 18: 311-20. Exp Toxicol Pathol 2014; 66: 211-8.

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Sucralfate McCormack SA, Best BM. Toh JW, Morris D, Chen Z, Chen C. Obstetric pharmacokinetic dosing studies are urgently Near fatal 5-FU gut toxicity post surgery – Remarkable needed. effect of high-dose sucralfate. Front Pediatr 2014; 2: 9. J Chemother 2014; online early: doi: 10.1179/1973947814Y.0000000178: Morton D, Houle CD, Tomlinson L. Perspectives on drug-induced vascular injury. Toxicol Pathol 2014; online early: DRUGS doi: 10.1177/0192623314524490: General Al Rahbi HA, Al-Sabri RM, Chitme HR. Müller F, Dormann H, Pfistermeister B, Sonst A, Patapovas Interventions by pharmacists in out-patient pharmaceutical A, Vogler R, Hartmann N, Plank-Kiegele B, Kirchner M, care. Bürkle T, Maas R. Saudi Pharm J 2014; 22: 101-6. Application of the Pareto principle to identify and address drug-therapy safety issues. Antoine DJ, Harrill AH, Watkins PB, Park BK. Eur J Clin Pharmacol 2014; online early 10.1007/s00228- Safety biomarkers for drug-induced liver injury-current 014-1665-2: status and future perspectives. Toxicol Res (Camb) 2014; 3: 75-85. Noguera-Morel L, Hernández-Martín Á, Torrelo A. Cutaneous drug reactions in the pediatric population. Cannon RD, Wagner M, Jacoby JL. Pediatr Clin North Am 2014; 61: 403-26. Troponin leak associated with drug-induced methemoglobinemia. O'Donnell JT, Marks DH, Danese P, O'Donnell JJ, III. Am J Emerg Med 2014; online early: Drug-induced liver disease: Primer for the primary care doi: 10.1016/j.ajem.2014.03.015: physician.

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DRUGS Lisdexamfetamine General Hutson PH, Pennick M, Secker R. Preclinical pharmacokinetics, pharmacology and toxicology Vignali C, Stramesi C, Morini L, San BP, Groppi A. of lisdexamfetamine: a novel d-amphetamine pro-drug. Workplace drug testing in Italy: findings about second- Neuropharmacology 2014; online early: stage testing. Drug Test Anal 2014; online early: doi: 10.1016/j.neuropharm.2014.02.014: doi: 10.1002/dta.1640: Anaesthetics von Lueder TG, Atar D. Dyrud M, Gupta R, Khan R. Comorbidities and polypharmacy. Acute myocardial depression with inverted (reverse) Heart Fail Clin 2014; 10: 367-72. takotsubo physiology following bupivacaine/lidocaine injection

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Alpha 2 agonists Lowry JA, Brown JT. Halothane Significance of the imidazoline receptors in toxicology. Endo S, Yano A, Fukami T, Nakajima M, Yokoi T. Clin Toxicol 2014; online early: Involvement of miRNAs in the early phase of halothane- doi: 10.3109/15563650.2014.898770: induced liver injury. Toxicology 2014; online early: Amfetamines and MDMA (ecstasy) doi: 10.1016/j.tox.2014.02.011: Barbosa DJ, Serrat R, Mirra S, Quevedo M, Goméz de Barreda E, Avila J, Ferreira LM, Branco PS, Fernandes E, Lidocaine Bastos MD, Capela JP, Soriano E, Carvalho F. Kargl S, Hornath F, Rossegg U, Biebl A, Pumberger W, The mixture of "ecstasy" and its metabolites impairs Schmitt K, Furtner D. mitochondrial fusion/fission equilibrium and trafficking in Status epilepticus, cardiac resuscitation, and posterior hippocampal neurons, at in vivo relevant concentrations. reversible encephalopathy syndrome after ingestion of Toxicol Sci 2014; online early: viscous lidocaine: a plea for more childproof packaging of doi: 10.1093/toxsci/kfu042: pharmaceuticals.

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Jayasumana C, Gunatilake S, Senanayake P. Chowdhury FR, Bari MS, Alam MJ, Rahman MM, Glyphosate, hard water and nephrotoxic metals: are they Bhattacharjee B, Qayyum JA, Mridha MS. the culprits behind the epidemic of chronic kidney disease Organophosphate poisoning presenting with muscular of unknown etiology in Sri Lanka? weakness and abdominal pain – A case report. Int J Environ Res Public Health 2014; 11: 2125-47. BMC Res Notes 2014; 7: 140.

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Organophosphate insecticides Côté J, Bonvalot Y, Carrier G, Lapointe C, Fuhr U, Tomalik- Scharte D, Wachall B, Bouchard M. General A novel toxicokinetic modeling of cypermethrin and Kang C, Park IS, Kim DH, Kim SC, Jeong JH, Lee SH, Lee permethrin and their metabolites in humans for dose SB, Jung SM, Kang T-S, Lee K-W. reconstruction from biomarker data. Red cell distribution width as a predictor of mortality in PLoS ONE 2014; 9: e88517. organophosphate insecticide poisoning. Am J Emerg Med 2014; online early: doi: 10.1016/j.ajem.2014.02.048: Prallethrin Senthilkumaran S, Menezes RG, Balamurugan N, Liu S-H, Lin J-L, Shen H-L, Chang C-C, Huang W-H, Weng Thirumalaikolundusubramanian P. C-H, Hsu C-W, Wang I-K, Liang C-C, Yen T-H. Prallethrin poisoning that taxes the brain. Acute large-dose exposure to organophosphates in J Anaesthesiol Clin Pharmacol 2014; 30: 116-7. patients with and without diabetes mellitus: analysis of mortality rate and new-onset diabetes mellitus. Environ Health 2014; 13: 11. Rodenticides Gómez-Canela C, Barata C, Lacorte S. Sit RK, Fokin VV, Amitai G, Sharpless KB, Taylor P, Radic Z. Occurrence, elimination, and risk of anticoagulant Imidazole aldoximes effective in assisting butyryl- rodenticides and drugs during wastewater treatment. cholinesterase catalysis of organophosphate detoxification. Environ Sci Pollut Res Int 2014; online early: J Med Chem 2014; 57: 1378-89. doi: 10.1007/s11356-014-2714-1: Azinphos methyl Güngördü A, Uçkun M. CHEMICAL WARFARE, Comparative assessment of in vitro and in vivo toxicity of azinphos methyl and its commercial formulation. BIOLOGICAL WARFARE AND Environ Toxicol 2014; online early: RIOT CONTROL AGENTS doi: 10.1002/tox.21982: Biological warfare Dichlorvos Anthrax Hou Y, Zeng Y, Li S, Qi L, Xu W, Wang H, Zhao X, Sun C. Esmer O, Karadag R, Bilgili SG, Gultepe B, Bayramlar H, Effect of quercetin against dichlorvos induced nephrotoxicity Karadag AS. in rats. Three eyelid localized cutaneous anthrax cases. Exp Toxicol Pathol 2014; 66: 211-8. Cutan Ocul Toxicol 2014; online early: doi: 10.3109/15569527.2013.875557: Paraquat and diquat Jones BC, Huang X, Mailman RB, Lu L, Williams RW. The perplexing paradox of paraquat: the case for host-based Ricin susceptibility and postulated neurodegenerative effects. Ma X, Tang J, Li C, Liu Q, Chen J, Li H, Guo L, Xie J. J Biochem Mol Toxicol 2014; online early: Identification and quantification of ricin in biomedical doi: 10.1002/jbt.21552: samples by magnetic immunocapture enrichment and liquid chromatography electrospray ionization tandem Silva R, Sousa E, Carmo H, Palmeira A, Barbosa DJ, mass spectrometry. Gameiro M, Pinto M, de Lourdes Bastos M, Remião F. Anal Bioanal Chem 2014; online early: Induction and activation of p-glycoprotein by doi: 10.1007/s00216-014-7710-2: dihydroxylated xanthones protect against the cytotoxicity of the p-glycoprotein substrate paraquat. Arch Toxicol 2014; 88: 937-51. Chemical warfare Agent orange Xiao ZW, Zhang W, Ma L, Qiu ZW. Lurker PA, Berman F, Clapp RW, Stellman JM. Therapeutic effect of magnesium isoglycyrrhizinate in rats Post-Vietnam military herbicide exposures in UC-123 agent on lung injury induced by paraquat poisoning. orange spray aircraft. Eur Rev Med Pharmacol Sci 2014; 18: 311-20. Environ Res 2014; 130: 34-42.

Pyrethroid insecticides Mustard gas General Dachir S, Cohen M, Sahar R, Graham J, Eisenkraft A, Yoshinaga J, Imai K, Shiraishi H, Nozawa S, Yoshiike M, Horwitz V, Kadar T. Mieno MN, Andersson AM, Iwamoto T. Beneficial effects of activated macrophages on sulfur Pyrethroid insecticide exposure and reproductive hormone mustard-induced cutaneous burns, an in vivo experience. levels in healthy Japanese male subjects. Andrology 2014; online early: Cutan Ocul Toxicol 2014; online early: doi: 10.1111/j.2047-2927.2014.00202.x: doi: 10.3109/15569527.2013.877023:

Cypermethrin Sun J-H, Sun P-P, Zheng W, Han S, Ying Y, Liu H-Y, Zhang Cao DQ, Chen N, Zhu CX, Zhao Y, Liu L, Yang J, An L. C, Zhao B-Q, Zuo G-M, Lu H, Zhong Y-X. -cypermethrin-induced acute neurotoxicity in the cerebral Skin decontamination efficacy of potassium ketoxime on cortex of mice. rabbits exposed to sulfur mustard. Drug Chem Toxicol 2014; online early: Cutan Ocul Toxicol 2014; online early: doi: 10.3109/01480545.2014.900072: doi: 10.3109/15569527.2014.880454:

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Nitrogen mustard Cassia occidentalis (Cassia) Jain AK, Tewari-Singh N, Inturi S, Orlicky DJ, White CW, Panigrahi G, Tiwari S, Ansari KM, Chaturvedi RK, Khanna Agarwal R. VK, Chaudhari BP, Vashistha VM, Raisuddin S, Das M. Myeloperoxidase deficiency attenuates mustard- Association between children death and consumption of induced skin injuries. Cassia occidentalis seeds: clinical and experimental Toxicology 2014; online early: investigations. Food Chem Toxicol 2014; online early: doi: 10.1016/j.tox.2014.02.013: doi: 10.1016/j.fct.2014.03.005:

Nerve agents Datura stramonium (Jimson weed) Lin Y, Chen J, Yan L, Guo L, Wu B, Li C, Feng J, Liu Q, Xie J. Melvin K, Hourani D. Determination of nerve agent metabolites in human urine Datura stramonium toxicity mistakenly diagnosed as "bath by isotope-dilution gas chromatography-tandem mass salt" intoxication: a case report. spectrometry after solid phase supported derivatization. W V Med J 2014; 110: 22-5. Anal Bioanal Chem 2014; online early: doi: 10.1007/s00216-014-7695-x: Ipomoea carnea (Pink morning glory) Misik J, Pavlikova R, Cabal J, Kuca K. Fatima N, Rahman MM, Khan MA, Fu J. Acute toxicity of some nerve agents and pesticides in rats. A review on Ipomoea carnea: pharmacology, toxicology and phytochemistry. Drug Chem Toxicol 2014; online early: J Complement Integr Med 2014; online early: doi: 10.3109/01480545.2014.900070: doi: 10.1515/jcim-2013-0046:

Rezk PE, Zdenka P, Sabnekar P, Kajih T, Mata DG, Wrobel C, Cerasoli DM, Chilukuri N. Luffa echinata (Bristly luffa) An in vitro and in vivo evaluation of the efficacy of Giri S, Lokesh CR, Sahu S, Gupta N. recombinant human liver prolidase as a catalytic bioscavenger Luffa echinata: healer plant or potential killer. of chemical warfare nerve agents. J Postgrad Med 2014; 60: 72-4. Drug Chem Toxicol 2014; online early: doi: 10.3109/01480545.2014.900071: Mitragyna speciosa (Kratom) Singh D, Müller CP, Vicknasingam BK. Schmidt C, Breyer F, Blum M-M, Thiermann H, Worek F, Kratom (Mitragyna speciosa) dependence, withdrawal John H. symptoms and craving in regular users. V-type nerve agents phosphonylate ubiquitin at biologically Drug Alcohol Depend 2014; online early: relevant lysine residues and induce intramolecular doi: 10.1016/j.drugalcdep.2014.03.017: cyclization by an isopeptide bond. Anal Bioanal Chem 2014; online early: Mushrooms and other fungi doi: 10.1007/s00216-014-7706-y: Graeme KA.

Mycetism: a review of the recent literature. Sit RK, Fokin VV, Amitai G, Sharpless KB, Taylor P, Radic Z. J Med Toxicol 2014; online early: doi: 10.1007/s13181-013- Imidazole aldoximes effective in assisting butyryl- 0355-2: cholinesterase catalysis of organophosphate detoxification. J Med Chem 2014; 57: 1378-89. Mycotoxins Ashiq S, Hussain M, Ahmad B. Cyclosarin Natural occurrence of mycotoxins in medicinal plants: a Reiter G, Muller S, Koller M, Thiermann H, Worek F. review. In vitro toxicokinetic studies of cyclosarin: molecular Fungal Genet Biol 2014; online early: mechanisms of elimination. doi: 10.1016/j.fgb.2014.02.005: Toxicol Lett 2014; 227: 1-11. Narcissus tazetta (Daffodil) PLANTS Hussein A, Yassin A. General Poisoning following ingestion of Narcissus tazetta bulbs by schoolchildren. Bhatia H, Manhas RK, Kumar K, Magotra R. Isr Med Assoc J 2014; 16: 125-6. Traditional knowledge on poisonous plants of Udhampur district of Jammu and Kashmir, India. J Ethnopharmacol 2014; 152: 207-16. Polygonum multiflorum (Chinese knotweed) Molyneux RJ, Panter KE, Zhao M. Dong H, Slain D, Cheng J, Ma W, Liang W. Global perspectives on poisonous plants: The 9th Eighteen cases of liver injury following ingestion of International Symposium on Poisonous Plants. Polygonum multiflorum. J Agric Food Chem 2014; online early: Complement Ther Med 2014; 22: 70-4. doi: 10.1021/jf500540x: Toxicodendron radicans (Poison ivy) Toda M, Uneyama C, Kasuga F. Abbott JT, Zgherea Y, Gierer S. Trends of plant food during the past 50 A case of recurrent severe poison ivy contact dermatitis, years in Japan. treated successfully with seasonal cyclosporine. Shokuhin Eiseigaku Zasshi 2014; 55: 55-63. J Allergy Clin Immunol 2014; 133: AB197.

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ANIMALS Snake bites General General Gokhan S, Cetiner MA, Ozhasenekler A. Dolab JA, de Roodt AR, de Titto EH, García SI, Funes R, A rare cause of acute renal failure: coturnism. Salomón OD, Chippaux J-P. Afr J Emerg Med 2014; 4: 31-3. Epidemiology of snakebite and use of antivenom in Argentina. Trans R Soc Trop Med Hyg 2014; online early: doi: 10.1093/trstmh/tru038:

Nisahan B, Selvaratnam G, Kumanan T. Kularatne SA, Silva A, Weerakoon K, Maduwage K, Myocardial injury following multiple bee stings. Walathara C, Paranagama R, Mendis S. Trop Doct 2014; online early: Revisiting Russell's viper (Daboia russelii) bite in Sri Lanka: doi: 10.1177/0049475514525606: is abdominal pain an early feature of systemic envenoming? PLoS ONE 2014; 9: e90198. Fish/marine poisoning Lazcano-Pérez F, Vivas O, Román-González SA, Rodríguez- Lomonte B, Fernández J, Sanz L, Angulo Y, Sasa M, Bustamante E, Castro H, Arenas I, García DE, Sánchez- Gutiérrez JM, Calvete JJ. Puig N, Arreguín-Espinosa R. Venomous snakes of Costa Rica: biological and medical A purified Palythoa venom fraction delays sodium current implications of their venom proteomic profiles analyzed inactivation in sympathetic neurons. through the strategy of snake venomics. Toxicon 2014; 82: 112-6. J Proteomics 2014; online early:

doi: 10.1016/j.jprot.2014.02.020: Algae Koreiviene J, Anne O, Kasperoviciene J, Burskyte V. Marano M, Pisani M, Stoppa F, Di NM, Pirozzi N, Luca E, Cyanotoxin management and human health risk mitigation Pulitanò S, Conti G, Marzano L, De LD, Valentini P, Pietrini in recreational waters. D, Piastra M. Environ Monit Assess 2014; online early: Antitoxin use and pediatric intensive care for viper bites in doi: 10.1007/s10661-014-3710-0: Rome, Italy. Eur Rev Med Pharmacol Sci 2014; 18: 485-92. Ciguatera Gingold DB, Strickland MJ, Hess JJ. Valenta J, Stach Z, Michalek P. Ciguatera fish poisoning and climate change: analysis of Exotic snake bites in the Czech Republic–Epidemiological National Poison Center Data in the United States, 2001–2011. and clinical aspects during 15-year period (1999–2013). Environ Health Perspect 2014; online early: Clin Toxicol 2014; online early: doi: 10.1289/ehp.1307196: doi: 10.3109/15563650.2014.902066:

Tetrodotoxin van Helden DF, Thomas PA, Dosen PJ, Imtiaz MS, Laver Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A. DR, Isbister GK. Tetrodotoxin: chemistry, toxicity, source, distribution and Pharmacological approaches that slow lymphatic flow as a detection. snakebite first aid. Toxins (Basel) 2014; 6: 693-755. PLoS Negl Trop Dis 2014; 8: e2722.

Puech B, Batsalle B, Roget P, Turquet J, Quod J-P, Allyn J, Vergara I, Pedraza-Escalona M, Paniagua D, Restano- Idoumbin J-P, Chane-Ming J, Villefranque J, Mougin- Cassulini R, Zamudio F, Batista CV, Possani LD, Alagón A. Damour K, Vandroux D, Gaüzère B-A. Eastern coral snake Micrurus fulvius venom toxicity in mice Family tetrodotoxin poisoning in Reunion Island (Southwest is mainly determined by neurotoxic phospholipases A. Indian Ocean) following the consumption of Lagocephalus J Proteomics 2014; online early: sceleratus (Pufferfish). doi: 10.1016/j.jprot.2014.02.027: Bull Soc Pathol Exot 2014; online early: doi: 10.1007/s13149-014-0340-2: Wang W, Chen Q-F, Yin R-X, Zhu J-J, Li Q-B, Chang H-H, Wu Y-B, Michelson E. Micro-organisms Clinical features and treatment experience: a review of Bayer C, Bernard H, Prager R, Rabsch W, Hiller P, Malorny 292 Chinese cobra snakebites. B, Pfefferkorn B, Frank C, de Jong A, Friesema I, Stark K, Environ Toxicol Pharmacol 2014; 37: 648-55. Rosner BM. An outbreak of Salmonella Newport associated with mung Weinstein SA, Griffin R, Ismail AK. bean sprouts in Germany and the Netherlands, October to Non-front-fanged colubroid ("colubrid") snakebites: three November 2011. cases of local envenoming by the mangrove or ringed cat- Euro Surveill 2014; 19: 1-9. eyed snake (Boiga dendrophila; Colubridae, Colubrinae), the Western beaked snake (Rhamphiophis oxyrhynchus; Mukai Y, Shimatani Y, Sako W, Asanuma K, Nodera H, Lamprophiidae, Psammophinae) and the rain forest cat- Sakamoto T, Izumi Y, Kohda T, Kozaki S, Kaji R. eyed snake (Leptodeira frenata; Dipsadidae). Comparison between botulinum neurotoxin type A2 and Clin Toxicol 2014; online early: type A1 by electrophysiological study in healthy individuals. doi: 10.3109/15563650.2014.897352: Toxicon 2014; 81: 32-6. Cobra Wang W, Chen Q-F, Yin R-X, Zhu J-J, Li Q-B, Chang H-H, Pandurang KS, Singh J, Bijesh S, Singh HP. Wu Y-B, Michelson E. Effectiveness of anti scorpion venom for red scorpion Clinical features and treatment experience: a review of 292 envenomation. Chinese cobra snakebites. Indian Pediatr 2014; 51: 131-3. Environ Toxicol Pharmacol 2014; 37: 648-55.

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Coral snake Marano M, Pisani M, Stoppa F, Di NM, Pirozzi N, Luca E, Vergara I, Pedraza-Escalona M, Paniagua D, Restano- Pulitanò S, Conti G, Marzano L, De LD, Valentini P, Pietrini Cassulini R, Zamudio F, Batista CV, Possani LD, Alagón A. D, Piastra M. Eastern coral snake Micrurus fulvius venom toxicity in mice Antitoxin use and pediatric intensive care for viper bites in is mainly determined by neurotoxic phospholipases A. Rome, Italy. J Proteomics 2014; online early: Eur Rev Med Pharmacol Sci 2014; 18: 485-92. doi: 10.1016/j.jprot.2014.02.027: Spiders Krait Gremski LH, Trevisan-Silva D, Ferrer VP, Matsubara FH, Rusmili MR, Yee TT, Mustafa MR, Othman I, Hodgson WC. Meissner GO, Wille AC, Vuitika L, Dias-Lopes C, Ullah A, In-vitro neurotoxicity of two Malaysian krait species (Bungarus Moraes F, Chávez-Olórtegui C, Barbaro KC, Murakami MT, candidus and Bungarus fasciatus) venoms: neutralization by Arni RK, Senff-Ribeiro A, Chaim OM, Veiga SS. monovalent and polyvalent antivenoms from Thailand. Recent advances in the understanding of brown spider Toxins (Basel) 2014; 6: 1036-48. venoms: from the biology of spiders to the molecular mechanisms of toxins. Vipers Toxicon 2014; online early: doi: 10.1016/j.toxicon.2014.02.023: Kularatne SA, Silva A, Weerakoon K, Maduwage K,

Walathara C, Paranagama R, Mendis S. Li J, Li D, Zhang F, Wang H, Yu H, Liu Z, Liang S. Revisiting Russell's viper (Daboia russelii) bite in Sri Lanka: A comparative study of the molecular composition and is abdominal pain an early feature of systemic envenoming? electrophysiological activity of the venoms from two PLoS ONE 2014; 9: e90198. fishing spiders Dolomedes mizhoanus and Dolomedes

sulfurous. Lonati D, Giampreti A, Rossetto O, Petrolini VM, Vecchio S, Toxicon 2014; 83: 35-42. Buscaglia E, Mazzoleni M, Chiara F, Aloise M, Gentilli A,

Montecucco C, Coccini T, Locatelli CA. Peng X, Zhang Y, Liu J, Yu H, Chen J, Lei Q, Wang X, Liang S. Neurotoxicity of European viperids in Italy: Pavia Poison Physiological and biochemical analysis to reveal the Control Centre case series 2001–2011. molecular basis for black widow spiderling toxicity. Clin Toxicol 2014; online early: J Biochem Mol Toxicol 2014; online early: doi: 10.3109/15563650.2014.904046: doi: 10.1002/jbt.21553:

INDEX

2,3-pentanedione ...... 37 Azinphos methyl ...... 47 6:2 fluorotelomer alcohol ...... 37 Barbiturates ...... 26 Acetaminophen ...... 32 Bee sting ...... 49 Acetylcysteine ...... 21 benzalkonium chloride ...... 38 Activated charcoal ...... 21 Benzene ...... 38 Agent orange ...... 47 Benzodiazepines ...... 27 Air pollution ...... 34 Biological warfare ...... 47 Alcohol ...... 37 Biomarkers ...... 6 Algae ...... 49 Bisphenol A ...... 38 Alpha 2 agonists ...... 24 Bleomycin ...... 26 Aluminium ...... 43 Body packers ...... 7 Amfetamines ...... 24 Borate ...... 38 Amiodarone ...... 24 Buprenorphine ...... 22 Anaesthetics ...... 24 Bupropion ...... 25 Analytical toxicology ...... 6 Cadmium ...... 43 Animals, general ...... 49 Caffeine ...... 27 Anthrax ...... 47 Calciferol ...... 34 Antiarrhythmics ...... 24 Calcium channel blockers ...... 27 Antibiotics ...... 25 Cannabis ...... 27 Anticoagulants ...... 25 Capecitabine ...... 26 Anticonvulsants ...... 25 Carbamate insecticides ...... 46 Antidepressants ...... 25 Carbamazepine ...... 25 Antidotes ...... 21 Carbendazim ...... 46 Antifungal drugs ...... 25 Carbon monoxide ...... 38 Antihistamines ...... 26 Carcinogenicity ...... 7 Antineoplastics ...... 26 Cardiotoxicity ...... 7 Antipsychotics ...... 26 Cassia ...... 48 Antituberculous drugs ...... 26 Cassia occidentalis ...... 48 Antivenom ...... 21 Ceftriaxone ...... 25 Antiviral drugs ...... 26 Chemical warfare, general ...... 47 Anxiolytics ...... 26 Chemicals, general ...... 36 Arsenic ...... 43 Chlorine ...... 39 Asbestos...... 38 Chromium ...... 44

51

Ciguatera ...... 49 Guaifenesin ...... 28 Cisplatin ...... 26 Haemodiafiltration ...... 22 Citrate ...... 25 Haemodialysis ...... 22 Clenbuterol ...... 27 Haemoperfusion ...... 22 Clonidine ...... 27 Haloperidol ...... 26 Clozapine...... 26 Halothane ...... 24 Cobalt ...... 44 Hazardous waste ...... 36 Cobra ...... 49 Hepatotoxicity ...... 11 Cocaine ...... 27 Herbal medicines ...... 28 Codeine ...... 31 Herbicides ...... 46 Contrast media ...... 39 Heroin ...... 29 Coral snake ...... 50 Hexachlorocyclohexane ...... 46 Corrosives ...... 39 Hyaluronic acid ...... 40 Cosmetics ...... 39 Hydralazine ...... 29 Crystalline silica ...... 39 Hydrocodone ...... 31 Cyanide ...... 39 Hydrogen sulphide ...... 40 Cyanoacrylate ...... 39 Hyperbaric oxygen therapy ...... 21 Cyclobarbital ...... 26 Hypnotics ...... 29 Cyclosarin ...... 48 Hypoglycaemics ...... 29 Cypermethrin ...... 47 Imidacloprid ...... 46 Dabigatran ...... 25 Immunosuppressants ...... 29 DDT ...... 46 Inhalation toxicity ...... 12 Dermal toxicity...... 8 Insecticides (general) ...... 46 Designer drugs ...... 28 Iron ...... 30, 44 Desomorphine ...... 28 Isocyanates ...... 40 Developmental toxicology ...... 8 Isoniazid ...... 26 Diacetyl ...... 39 Ketamine ...... 30 Diacetylmorphine ...... 29 Ketoconazole ...... 25 Diazepam ...... 27 Kinetics ...... 13 Dichlorvos ...... 47 Krait ...... 50 Diclofenac ...... 30 Lamotrigine ...... 25 Dietary supplements ...... 28 Lead ...... 44 Diethanolamide ...... 39 Lenalidomide ...... 29 DigiFab ...... 21 Levetiracetam ...... 25 Digoxin ...... 28 Lidocaine ...... 24 Diisocyanate ...... 39 Lipid emulsion therapy ...... 21 Dioxin ...... 39 Lisdexamfetamine ...... 24 Diphenhydramine ...... 26 Lithium ...... 30, 45 Diquat ...... 47 Loperamide ...... 30 Docetaxel ...... 26 Magnesium isoglycyrrhizinate ...... 22 Driving under the influence ...... 9 Management, general ...... 20 Dronabinol ...... 22 Manganese ...... 45 Drugs, general ...... 23 Marijuana ...... 27 Dyes ...... 39 MDMA ...... 24 Ecstasy ...... 24 Medication errors ...... 13 Endosulfan ...... 46 Mercaptopurine ...... 29 Epidemiology ...... 9 Mercury ...... 45 Esomeprazole ...... 32 Metabolism ...... 13 Ethanol...... 37 Metaflumizone ...... 46 Ethnic remedies ...... 28 Metals, general ...... 43 Ethylene glycol ...... 39 Methadone ...... 22, 31 Exhaust fumes ...... 36 Methanol...... 40 Expectorants...... 28 Methomyl ...... 46 Fenaminosulf ...... 46 Methotrexate ...... 30 Fentanyl ...... 31 Methylene blue ...... 21 Ferrous sulphate ...... 28 Methylisothiazolinone ...... 40 Fish/marine poisoning ...... 49 Methylphenidate ...... 30 Flecainide ...... 25 Methylthioninium chloride ...... 21 Flumazenil ...... 21 Micro-organisms ...... 49 Fluoride ...... 40 Midazolam ...... 27 Fluorouracil ...... 26 Mushrooms ...... 48 Folic acid ...... 34 Mustard gas ...... 47 Forensic toxicology ...... 10 Mycophenolate ...... 29 Formaldehyde ...... 40 Naloxone ...... 22 Fragrance compounds ...... 40 Nanoparticles ...... 40 Fungi ...... 48 Neonicotinoids ...... 46 Fungicides ...... 46 Nephrotoxicity ...... 13 Gasoline ...... 41 Nerve agents ...... 48 Gastric lavage ...... 22 Neurotoxicity ...... 14 Genotoxicity ...... 11 Nickel ...... 45 Gliclazide ...... 29 Nicotine ...... 30 Glyphosate ...... 46 Nitro musks ...... 40

52

Nitrogen mustard ...... 48 Radiation ...... 42 NSAIDs ...... 30 Reprotoxicity ...... 19 Occupational toxicology ...... 15 Ricin ...... 47 Opioid maintenance therapy ...... 22 Risk assessment ...... 20 Opioids ...... 31 Rodenticides ...... 47 Organochlorine pesticides, general ...... 46 Ropivacaine ...... 24 Organophosphorus insecticides, general ...... 46 Scorpions ...... 49 Oximes ...... 22 Sertraline ...... 33 Oxycodone ...... 32 Sildenafil ...... 32 Paclitaxel ...... 26 Smoke ...... 42 Paediatric toxicology ...... 17 Snake bites ...... 49 Pantoprazole ...... 32 Sodium phosphate ...... 33 Parabens ...... 41 Spiders ...... 50 Paracetamol ...... 32 SSRIs...... 33 Paraphenylenediamine ...... 41 Steroids ...... 33 Paraquat ...... 47 Substance abuse ...... 33 Paroxetine ...... 33 Sucralfate ...... 23 Pentobarbital ...... 27 Suicide ...... 20 Perfluorinated compounds ...... 41 Sunitinib ...... 26 Perlite ...... 41 Synthetic cathinones ...... 28 Perospirone ...... 26 Tamoxifen ...... 34 Pesticides, general ...... 45 Tasers ...... 20 Petrol ...... 41 Telaprevir ...... 26 Petroleum oils ...... 41 Testosterone ...... 33 Phenazopyridine ...... 32 Tetrachlorodibenzo-p-dioxin ...... 39 Phenol ...... 41 Tetrachloroethylene ...... 42 Phenytoin ...... 25 Tetramethyl succinonitrile ...... 42 Phthalate esters ...... 41 Tetrodotoxin ...... 49 Plants, general ...... 48 Thioacetamide ...... 42 Plasmapheresis ...... 22 Tobacco ...... 42 PM10 ...... 36 Toluene ...... 42 P-octopamine ...... 40 Toxicology, general ...... 6 Pollution ...... 36 Trichloroethylene ...... 42 Polybrominated diphenyl ethers ...... 41 Tricyclic antidepressants ...... 34 Polychlorinated dibenzodioxins ...... 41 Trihalomethanes ...... 42 Polycyclic aromatic hydrocarbons ...... 41 Uranium ...... 45 Polymorphisms ...... 19 Valproate ...... 25 Potassium ketoxime ...... 22 Vemurafenib ...... 26 Pralidoxime ...... 22 Vinyl chloride ...... 43 Prallethrin ...... 47 Vipers ...... 50 Pregabalin ...... 25 Vitamins...... 34 Propofol ...... 22 Warfarin ...... 25 Protamine ...... 32 Water ...... 43 Proton pump inhibitors ...... 32 Welding fumes ...... 43 Psychiatric aspects ...... 19 Xylazine ...... 34 Pyrethroid insecticides, general ...... 47 Zolpidem ...... 29 Quercetin ...... 22 Zopiclone ...... 29 Quetiapine ...... 26

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