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

October 2014

CONTENTS

General Toxicology 8 34 Management 19 36 Drugs 20 Chemical Warfare 38 Chemical Incidents & 28 Plants 38 Pollution Chemicals 30 Animals 39

CURRENT AWARENESS PAPERS OF THE MONTH

Treatment for blocker : a systematic review St-Onge M, Dubé P-A, Gosselin S, Guimont C, Godwin J, Archambault PM, Chauny J-M, Frenette AJ, Darveau M, Le sage N, Poitras J, Provencher J, Juurlink DN, Blais R. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.965827: Context Calcium poisoning is a common and sometimes life-threatening ingestion. Objective To evaluate the reported effects of treatments for poisoning. The primary outcomes of interest were mortality and hemodynamic parameters. The secondary outcomes included length of stay in hospital, length of stay in intensive care unit, duration of vasopressor use, functional outcomes, and serum calcium channel blocker concentrations. Methods Medline/Ovid, PubMed, EMBASE, Cochrane Library, TOXLINE, International pharmaceutical abstracts, Google Scholar, and the gray literature up to December 31, 2013 were searched

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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without time restriction to identify all types of studies that examined effects of various treatments for calcium channel blocker poisoning for the outcomes of interest. The searchstrategy included the following Keywords: [calcium channel blockers OR calcium channel antagonist OR calcium channel blocking agent OR ( or or or or or or or or or or or or or or or or or or )] AND [overdose OR errors OR poisoning OR intoxication OR OR adverse effect]. Two reviewers independently selected studies and a group of reviewers abstracted all relevant data using a pilot-tested form. A second group analyzed the risk of bias and overall quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist and the Thomas tool for observational studies, the Institute of Health Economics tool for Quality of Case Series, the ARRIVE (Animal Research: Reporting In Vivo Experiments) guidelines, and the modified NRCNA (National Research Council for the National Academies) list for animal studies. Qualitative synthesis was used to summarize the evidence. Of 15,5577 citations identified in the initial search, 216 were selected for analysis, including 117 case reports. The kappa on the quality analysis tools was greater than 0.80 for all study types. Results The only observational study in humans examined high-dose insulin and extracorporeal life support. The risk of bias across studies was high for all interventions and moderate to high for extracorporeal life support. High-dose insulin High-dose insulin (bolus of 1 unit/kg followed by an infusion of 0.5–2.0 units/kg/h) was associated with improved hemodynamic parameters and lower mortality, at the risks of hypoglycemia and hypokalemia (low quality of evidence). Extracorporeal life support Extracorporeal life support was associated with improved survival in patients with severe shock or cardiac arrest at the cost of limb ischemia, thrombosis, and bleeding (low quality of evidence). Calcium, dopamine, and norepinephrine These agents improved hemodynamic parameters and survival without documented severe side effects (very low quality of evidence). 4-Aminopyridine Use of 4-aminopyridine was associated with improved hemodynamic parameters and survival in animal studies, at the risk of seizures. Lipid emulsion therapy Lipid emulsion was associated with improved hemodynamic parameters and survival in animal models of intravenous verapamil poisoning, but not in models of oral verapamil poisoning. Other studies Studies on decontamination, , glucagon, pacemakers, levosimendan, and plasma exchange reported variable results, and the methodologies used limit their interpretation. No trial was documented in humans poisoned with calcium channel blockers for , CGP 28932, digoxin, cyclodextrin, liposomes, bicarbonate, carnitine, fructose 1,6- diphosphate, PK 11195, or triiodothyronine. Case reports were only found for charcoal hemoperfusion, dialysis, intra-aortic balloon pump, Impella device and methylene blue. Conclusions The treatment for calcium channel blocker poisoning is supported by low-quality evidence drawn from a heterogeneous and heavily biased literature. High-dose insulin and

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extracorporeal life support were the interventions supported by the strongest evidence, although the evidence is of low quality. Full text available from: http://dx.doi.org/10.3109/15563650.2014.965827

An 11-year review of ingestions in children less than 6 years of age Lewis JC, Albertson TE, Walsh MJ. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.965828: Background Levetiracetam is a new anticonvulsant, which works to block high-voltage-activated Ca++ channels in children, for partial-onset seizures. Reports of clinical experience with pediatric ingestions are minimal. The purpose of this study was to characterize the toxicity of accidental levetiracetam exposures in children less than 6 years of age. Methods This was an 11-year retrospective observational case series of pediatric (< 6 years old) levetiracetam ingestions reported to a Control System from 2002 to 2013. Case narratives were individually reviewed to collect desired information on exposure and clinical course. Inclusion criteria were levetiracetam as a single ingested medication, age less than 6 years, treatment in a health care facility, and followed to a known outcome. Results Eighty-two cases met inclusion criteria with 55% female patients and overall median age of 2.0 years (range: 1–60 months). The levetiracetam dose ingested was reported in 69 (84.1%) cases, with exact dose (median dose, 45.0 mg/kg; range, 10.5–1429 mg/kg) reported in 33 cases (40.2%). Of these, twenty-nine cases (88%) involved the oral solution formulation and 28 cases (85%) had unintentional therapeutic error as the cause of the exposure. No dose–response relationship was demonstrated; however, the odds of a levetiracetam-naive patient, (median dose, 26.9 mg/kg; N = 15) with an unintentional exposure, developing drowsiness or ataxia was 6 times that of a patient who was not naïve to levetiracetam (median dose, 70.1 mg/kg; N = 20) (Odds ratio [OR], 6.0; 95% confidence interval [CI], 1.03–35.91).Of the 82 cases, 17 (20.7%) developed untoward clinical effects of drowsiness and/or ataxia. Eighty patients (97.6%) were treated and discharged from the emergency department, and two patients (2.4%) were admitted. The two patients admitted included a two-month old who was accidentally given a dose 10 times that of her usual dose and a 3-year old who was lethargic on arrival to the hospital after ingestion of an unknown dose. Of all patients, 66 patients (80.5%) had no effect from the drug exposure. The medical outcome was considered to be minor in 15 cases (18.3%), and moderate in 1 case (1.2%). There were no cases with major outcomes and no deaths. Conclusions Pediatric levetiracetam exposures were associated with few transient clinical effects. Poison Control Centers may wish to consider acuity of ingestion when developing send-in protocols. Full text available from: http://dx.doi.org/10.3109/15563650.2014.965828

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An 11-year review of insufflation exposures in adults reported to the California Poison Control System Lewis JC, Sutter ME, Albertson TE, Owen KP, Ford JB. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.969372: Background Seizures of both immediate and delayed onset after ingestion of bupropion SR and bupropion XL formulations are well documented, but are less well characterized after insufflation. Bupropion is crushed and insufflated to experience a high similar to that from amphetamines and . We sought to characterize the abuse of bupropion via insufflation in cases reported to the California Poison Control System (CPCS) and the incidence of seizures. Methods An 11-year (2002–2012) retrospective observational case series of insufflated bupropion exposures evaluated in a health care facility (HCF) were reviewed after searching our database for all bupropion insufflation exposures. Patients with coingestants, multiple exposure routes, or age less than 18 were excluded. Data included age, gender, estimated bupropion dose, occurrence of pre-HCF seizures, symptoms and vital signs reported to the CPCS, treatments, and adverse events that occurred until time of discharge. Results 74 cases were identified (1 excluded due to age, 5 excluded due to additional oral ingestion of bupropion, and 1 excluded due to being unable to follow). A total of 67 cases met inclusion criteria. The median age was 36 (range, 18–65) years. The total dose of bupropion insufflated was reported in 52 pts; median dose of 1500 (range, 100–9000) mg. Eighteen cases (27%) involved staggered or chronic exposures. Of the 67 patients, 20 (30%) experienced a seizure prior to arrival at the HCF. Of these, 19 patients (95%) presented with tachycardia. None of these patients had a second seizure in the emergency department. There were no major medical outcomes and no deaths. Of the 67 patients, 9 patients received and 6 patients received single-dose activated charcoal. Conclusion The abuse of bupropion by crushing and insufflating through the nose is uncommon (67/2270 or 3.0%) compared with that by oral bupropion exposures reported to CPCS. Seizures are common but are self-limited. Delayed seizures (more than 8 h after exposure) appear to be rare. Tachycardia is present in almost all patients who have seizures. Full text available from: http://dx.doi.org/10.3109/15563650.2014.969372

Expanding access to in the United States Doyon S, Aks SE, Schaeffer S. Clin Toxicol 2014; online early: doi: 10.3109/15563650.2014.968657: Background deaths have increased steadily in the United States (U.S.) since 1979. During the past three decades, drug overdose deaths have tripled. In 2008, the number of unintentional poisoning deaths exceeded the number of motor vehicle deaths for the first time. Of the 38,329 drug overdose deaths in the United States in 2010, 22,134 (60%) were related to pharmaceuticals, with 75% of those deaths involving prescription analgesics. Concomitantly, heroin deaths have risen by 55% between 2000 and 2010. Deaths from use of fentanyl-laced or acetyl fentanyl-laced heroin were reported in multiple states in 2013. In 2012, the Centers for Disease Control characterized

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deaths as an epidemic. Most of these deaths are preventable. Overdose of , including , oxycodone, hydrocodone, methadone, and fentanyl, cause respiratory depression that can lead to hypoxia and, if untreated, death. The exact neuronal mechanisms by which opioids depress respiration in humans are complex. Opioids reduce the sensitivity of the medullary chemoreceptors to hypercapnia. In addition, opioids depress the ventilatory response to hypoxia. The combined losses of hypercarbic and hypoxic drives deprive the victim of the stimulus to breathe. This results in a disruption of the respiratory pattern with prolongation of inspiration and, at higher doses, reduction of chest wall compliance, decrease in tidal volume, and slowing of respiratory rate and apnea. Naloxone is a medication that displaces the opioid agonist from the mu . Timely administration of naloxone reverses opioid-induced respiratory depression-that is, its primary clinical indication. Naloxone is very effective, inexpensive, and has been used since 1970 in hospitals and by emergency medical systems (EMS) for this purpose. The Food and Drug Administration (FDA) has approved the intravenous, intramuscular, and subcutaneous routes of administration of naloxone for opioid reversal; onset of action is rapid via any of these routes. While not specifically approved by FDA for intranasal administration, multiple scientific studies support this route of administration. Intranasal administration has been routinely used in many pediatric emergency departments for years. Currently in the U.S., naloxone is principally administered in the health care setting, but use by laypersons is becoming more common. Full text available from: http://dx.doi.org/10.3109/15563650.2014.968657

Description of 3,180 courses of chelation with dimercaptosuccinic acid in children ≤5 y with severe in Zamfara, Northern Nigeria: a retrospective analysis of programme data Thurtle N, Greig J, Cooney L, Amitai Y, Ariti C, Brown MJ, Kosnett MJ, Moussally K, Sani-Gwarzo N, Akpan H, Shanks L, Dargan PI. PLoS Med 2014; 11: e1001739. Abstract and full text available from: http://dx.doi.org/10.1371%2Fjournal.pmed.1001739

Glycodeoxycholic acid levels as prognostic biomarker in acetaminophen-induced acute failure patients Woolbright BL, Mcgill MR, Staggs VS, Winefield RD, Gholami P, Olyaee M, Sharpe MR, Curry SC, Lee WM, Jaeschke H, The Acute Liver Failure Study Group. Toxicol Sci 2014; online early: doi: 10.1093/toxsci/kfu195: Abstract and full text available from: http://dx.doi.org/10.1093/toxsci/kfu195

Antihistamines and birth defects: a systematic review of the literature Gilboa SM, Ailes EC, Rai RP, Anderson JA, Honein MA. Expert Opin Drug Saf 2014; online early: doi: 10.1517/14740338.2014.970164: Abstract and full text available from: http://dx.doi.org/10.1517/14740338.2014.970164

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Associations between acetaminophen use during and ADHD symptoms measured at ages 7 and 11 years Thompson JM, Waldie KE, Wall CR, Murphy R, Mitchell EA, the ABC study group. PLoS ONE 2014; 9: e108210. Abstract and full text available from: http://dx.doi.org/10.1371/journal.pone.0108210

Use of selective serotonin-reuptake inhibitors during pregnancy and the risk of clubfoot Yazdy MM, Mitchell AA, Louik C, Werler MM. Epidemiology 2014; 25: 859- 65. Abstract and full text available from: http://dx.doi.org/10.1097/EDE.0000000000000157

Maternal exposure to methotrexate and birth defects: a population-based study Dawson AL, Riehle-Colarusso T, Reefhuis J, Arena JF, the National Birth Defects Prevention Study. Am J Med Genet A 2014; 164: 2212-6. Abstract and full text available from: http://dx.doi.org/10.1002/ajmg.a.36625

Lack of coagulopathy after copperhead Ali AJ, Horwitz DA, Mullins ME. Ann Emerg Med 2014; online early: doi: 10.1016/j.annemergmed.2014.08.006: Abstract and full text available from: http://dx.doi.org/10.1016/j.annemergmed.2014.08.006

Suicide by gases in England and Wales 2001–2011: evidence of the emergence of new methods of suicide Gunnell D, Coope C, Fearn V, Wells C, Chang S-S, Hawton K, Kapur N. J Affect Disord 2014; 170: 190-5. Abstract and full text available from: http://dx.doi.org/10.1016/j.jad.2014.08.055

Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts Willhite CC, Karyakina NA, Yokel RA, Yenugadhati N, Wisniewski TM, Arnold IMF, Momoli F, Krewski D. Crit Rev Toxicol 2014; 44 S4: 1-80. Abstract and full text available from: http://dx.doi.org/10.3109/10408444.2014.934439

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Lead screening and prevalence of blood lead levels in children aged 1-2 years – Child Blood Lead Surveillance System, United States, 2002-2010 and National Health and Nutrition Examination Survey, United States, 1999-2010 Raymond J, Wheeler W, Brown MJ. MMWR Morb Mortal Wkly Rep 2014; 63: 36-42. Abstract and full text available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/su6302a6.htm

Blood acetylcholinesterase and butyrylcholinesterase as biomarkers of cholinesterase depression among handlers Strelitz J, Engel LS, Keifer MC. Occup Environ Med 2014; online early: doi: 10.1136/oemed-2014-102315: Abstract and full text available from: http://dx.doi.org/10.1136/oemed-2014-102315

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Meyer GM, Wink CS, Zapp J, Maurer HH. TOXICOLOGY GC-MS, LC-MS, LC-high resolution-MS, and NMR studies on General the metabolism and toxicological detection of mesembrine Wiegand TJ, Crane PW, Kamali M, Reif M, Wratni R, and mesembrenone, the main alkaloids of the legal high Montante R, Loveland T. "Kanna" isolated from Sceletium tortuosum. Billing and reimbursement for a bedside toxicology service Anal Bioanal Chem 2014; online early: at a tertiary care academic center during its first fiscal year. doi: 10.1007/s00216-014-8109-9: J Med Toxicol 2014; online early: doi: 10.1007/s13181- 014-0423-2: Morris AA, Chester SA, Strickland EC, McIntire GL. Rapid enzymatic hydrolysis using a novel recombinant - Analytical toxicology glucuronidase in urinalysis. J Anal Toxicol 2014; 38: 610-4. Deeb S, McKeown DA, Torrance HJ, Wylie FM, Logan BK, Scott KS. Rizzi N, Ramachandran B, Vantaggiato C, Ciana P, Maggi A. Simultaneous analysis of 22 antiepileptic drugs in Reporter mice for the study of long-term effects of drugs postmortem blood, serum and plasma using LC-MS-MS and toxic compounds. with a focus on their role in forensic cases. Methods Mol Biol 2014; 1204: 45-58. J Anal Toxicol 2014; 38: 485-94. Rosano TG, Na S, Ihenetu K, Swift TA, Wood M. Famele M, Ferranti C, Abenavoli C, Palleschi L, Mancinelli R, Multi-drug and metabolite quantification in postmortem Draisci R. blood by liquid chromatography-high-resolution mass The chemical components of electronic cigarette spectrometry: comparison with nominal mass technology. cartridges and refill fluids: review of analytical methods. J Anal Toxicol 2014; 38: 495-506. Nicotine Tob Res 2014; online early: doi: 10.1093/ntr/ntu197: Sarris G, Borg D, Liao S, Stripp R. Validation of an EMIT® screening method to detect 6- Freijo TD, Jr., Harris SE, Kala SV. acetylmorphine in oral fluid. A rapid quantitative method for the analysis of synthetic J Anal Toxicol 2014; 38: 605-9. by liquid chromatography-tandem mass spectrometry. Sempio C, Morini L, Vignali C, Groppi A. J Anal Toxicol 2014; 38: 466-78. Simple and sensitive screening and quantitative determination of 88 psychoactive drugs and their metabolites in blood Hasegawa K, Suzuki O, Wurita A, Minakata K, Yamagishi I, through LC-MS/MS: application on postmortem samples. Nozawa H, Gonmori K, Watanabe K. J Chromatogr B Biomed Sci Appl 2014; 970: 1-7. Postmortem distribution of -pyrrolidinovalerophenone and its metabolite in body fluids and solid tissues in a fatal Soichot M, Mégarbane B, Houzé P, Chevillard L, Fonsart J, poisoning case measured by LC-MS-MS with the standard Baud FJ, Laprévote O, Bourgogne E. addition method. Development, validation and clinical application of a LC- Forensic Toxicol 2014; 32: 225-34. MS/MS method for the simultaneous quantification of hydroxychloroquine and its active metabolites in human Huybrechts B, Martins JC, Debongnie P, Uhlig S, Callebaut A. whole blood. Fast and sensitive LC-MS/MS method measuring human J Pharm Biomed Anal 2014; 100: 131-7. exposure using biomarkers in urine. Arch Toxicol 2014; online early: doi: 10.1007/s00204- Steuer AE, Forss A-M, Dally AM, Kraemer T. 014-1358-8: Method development and validation for simultaneous quantification of 15 drugs of abuse and prescription drugs Imbert L, Saussereau E, Lacroix C. and 7 of their metabolites in whole blood relevant in the Analysis of eight glycols in serum using LC-ESI-MS-MS. context of driving under the influence of drugs--Usefulness J Anal Toxicol 2014; online early: doi: 10.1093/jat/bku100: of multi-analyte calibration. Forensic Sci Int 2014; 244: 92-101.

Johnson RD, Botch-Jones SR, Flowers T, Lewis CA. Tang MHY, Ching CK, Lee CYW, Lam Y-H, Mak TW. An evaluation of 25B-, 25C-, 25D-, 25H-, 25I- and 25T2- Simultaneous detection of 93 conventional and emerging NBOMe via LC-MS-MS: method validation and analyte drugs of abuse and their metabolites in urine by UHPLC- stability. MS/MS. J Anal Toxicol 2014; 38: 479-84. J Chromatogr B Biomed Sci Appl 2014; 969C: 272-84.

Korb A-S, Cooper G. Thompson KS, Lewis RJ, Ritter RM. Endogenous concentrations of GHB in postmortem blood Analysis of in postmortem fluids and tissues using from deaths unrelated to GHB use. ultra-performance liquid chromatography-mass spectrometry. J Anal Toxicol 2014; 38: 582-8. J Anal Toxicol 2014; 38: 507-12.

Lesiak AD, Cody RB, Dane AJ, Musah RA. Urfer S, Morton J, Beall V, Feldmann J, Gunesch J. Rapid detection by direct analysis in real time-mass Analysis of 9- driving under the spectrometry (DART-MS) of psychoactive plant drugs of influence of drugs cases in Colorado from January 2011 to abuse: the case of Mitragyna speciosa aka "kratom". February 2014. Forensic Sci Int 2014; 242: 210-8. J Anal Toxicol 2014; 38: 575-81.

Lewis RJ, Angier MK, Johnson RD. Watanabe D, Ohta H, Yamamuro T. False positives due to 10,11-dihydro-10- Solid-phase extraction of phosphorous-containing amino hydroxycarbamazepine breakdown in the GC-MS injector acid herbicides from biological specimens with a zirconia- port. coated silica cartridge. J Anal Toxicol 2014; 38: 519-23. J Chromatogr B Biomed Sci Appl 2014; 969: 69-76.

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Analytical toxicology Loomis D, Grosse Y, Lauby-Secretan B, El Ghissassi F, Wohlfarth A, Scheidweiler KB, Castaneto M, Gandhi AS, Bouvard V, Benbrahim-Tallaa L, Guha N, Baan R, Mattock H, Desrosiers NA, Klette KL, Martin TM, Huestis MA. Straif K. Urinary prevalence, metabolite detection rates, temporal IARC evaluation of the carcinogenicity of outdoor air patterns and evaluation of suitable LC-MS/MS targets to pollution. document synthetic intake in US military urine Envir Risques Sante 2014; 13: 347-52. specimens. Clin Chem Lab Med 2014; online early: Ortega-Guerrero MA, Carrasco-Núñez G, Barragán-Campos doi: 10.1515/cclm-2014-0612: H, Ortega MR. High incidence of cancer and malignant mesothelioma Zancajo VM, Brito J, Carrasco MP, Bronze MR, Moreira R, linked to erionite fibre exposure in a rural community in Lopes A. Central Mexico. Analytical profiles of "legal highs" containing cathinones Occup Environ Med 2014; online early: available in the area of Lisbon, Portugal. doi: 10.1136/oemed-2013-101957: Forensic Sci Int 2014; 244: 102-10. Peters S, Glass DC, Greenop KR, Armstrong BK, Kirby M, Milne E, Fritschi L. Biomarkers Childhood brain tumours: associations with parental Kumar J, Lind L, Salihovic S, Van Bavel B, Ingelsson E, occupational exposure to solvents. Lind PM. Br J Cancer 2014; 111: 998-1003. Persistent organic pollutants and liver dysfunction biomarkers in a population-based human sample of men and women. Proctor DM, Suh M, Campleman SL, Thompson CM. Environ Res 2014; 134: 251-6. Assessment of the mode of action for hexavalent chromium- induced lung cancer following inhalation exposures. Scarpa MC, Kulkarni N, Maestrelli P. Toxicology 2014; 325: 160-79. The role of non-invasive biomarkers in detecting acute respiratory effects of traffic-related air pollution. Welling R, Beaumont JJ, Petersen SJ, Alexeeff GV, Clin Exp Allergy 2014; 44: 1100-18. Steinmaus C. Chromium VI and stomach cancer: a meta-analysis of the Strelitz J, Engel LS, Keifer MC. current epidemiological evidence. Blood acetylcholinesterase and butyrylcholinesterase as Occup Environ Med 2014; online early: biomarkers of cholinesterase depression among pesticide doi: 10.1136/oemed-2014-102178: handlers. Occup Environ Med 2014; online early: doi: 10.1136/oemed-2014-102315: Goodman JE, Prueitt RL, Sax SN, Lynch HN, Zu K, Lemay JC, King JM, Venditti FJ. Woolbright BL, Mcgill MR, Staggs VS, Winefield RD, Gholami P, Olyaee M, Sharpe MR, Curry SC, Lee WM, Weight-of-evidence evaluation of short-term ozone Jaeschke H, The Acute Liver Failure Study Group. exposure and cardiovascular effects. Glycodeoxycholic acid levels as prognostic biomarker in Crit Rev Toxicol 2014; 44: 725-90. acetaminophen-induced acute liver failure patients. Toxicol Sci 2014; online early: Jasiak NM, Bostwick JR. doi: 10.1093/toxsci/kfu195: A review of the risk of QT/QTc prolongation among newer non-SSRI antidepressants.

Ann Pharmacother 2014; online early: Zhang J, Sun R, Chen Y, Tan K, Wei H, Yin L, Pu Y. doi: 10.1177/1060028014550645: Small molecule metabolite biomarker candidates in urine from mice exposed to formaldehyde. Int J Mol Sci 2014; 15: 16458-68. Lopez-Ruiz N, Uribe CE. Chloroquine cardiomyopathy: beyond ocular adverse effects. BMJ Case Rep 2014; doi: 10.1136/bcr-2014-205751: Body packers Hantson P, Capron A, Maillart J-F. Mainali P, Pant S, Rodriguez AP, Deshmukh A, Mehta JL. Oesophageal and gastric obstruction in a cocaine body Tobacco and cardiovascular health. packer. Cardiovasc Toxicol 2014; online early: J Forensic Legal Med 2014; 27: 62-4. doi: 10.1007/s12012-014-9280-0:

Carcinogenicity Polk A, Vistisen K, Vaage-Nilsen M, Nielsen DL. Attia D, Mansour N, Taha F, El Dein AS. A systematic review of the pathophysiology of 5-fluorouracil- Assessment of lipid peroxidation and p53 as a biomarker of induced cardiotoxicity. carcinogenesis among workers exposed to formaldehyde in BMC Pharmacol Toxicol 2014; 15: 47. cosmetic industry. Toxicol Ind Health 2014; online early: Prueitt RL, Lynch HN, Zu K, Sax SN, Venditti FJ, Goodman JE. doi: 10.1177/0748233714547152: Weight-of-evidence evaluation of long-term ozone exposure and cardiovascular effects. Choi H-J, Park H-K, Jo W, Ryu J-E, Jang S, Gu H-K, Kim K- Crit Rev Toxicol 2014; 44: 791-822. S, Chung BJ, Son W-C. Carcinogenicity of metamifop, a novel herbicide, in Wistar Roghi A, Stucchi M, Quattrocchi G, Milazzo A, Pedrotti P. rats following oral administration for 104 weeks. Iron and cardiotoxicity. Regul Toxicol Pharmacol 2014; 70: 535-44. Exp Clin Cardiol 2014; 20: 4090-6.

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Cardiotoxicity De Felice A, Venerosi A, Ricceri L, Sabbioni M, Scattoni Zhao A, Chen R, Kuang X, Kan H. ML, Chiarotti F, Calamandrei G. Ambient air pollution and daily outpatient visits for cardiac Sex-dimorphic effects of gestational exposure to the arrhythmia in Shanghai, China. organophosphate insecticide chlorpyrifos on social investigation in mice. J Epidemiol 2014; 24: 321-6. Neurotoxicol Teratol 2014; online early:

doi: 10.1016/j.ntt.2014.09.002: Dermal toxicity Gomulka J, Wilson BD, Joyce JC. Gilboa SM, Ailes EC, Rai RP, Anderson JA, Honein MA. Toxic epidermal necrolysis due to voriconazole: case Antihistamines and birth defects: a systematic review of report and review. the literature. Dermatol Online J 2014; 20: doj_23901. Expert Opin Drug Saf 2014; online early: doi: 10.1517/14740338.2014.970164: Grando LR, Schmitt TAB, Bakos RM. Severe cutaneous reactions to drugs in the setting of a Hystad P, Davies HW, Frank L, Van Loon J, Gehring U, general hospital. Tamburic L, Brauer M. An Bras Dermatol 2014; 89: 758-62. Residential greenness and birth outcomes: evaluating the influence of spatially correlated built-environment factors. Environ Health Perspect 2014; 122: 1095-102. Islam S, Singer M, Kulhanjian JA.

Toxic epidermal necrolysis in a neonate receiving Johnson PI, Sutton P, Atchley DS, Koustas E, Lam J, Sen fluconazole. S, Robinson KA, Axelrad DA, Woodruff TJ. J Perinatol 2014; 34: 792-4. The Navigation Guide–Evidence-based medicine meets

environmental health: systematic review of human Jones RT, Evans W, Mersfelder TL, Kavanaugh K. evidence for PFOA effects on fetal growth. Rare red rashes: a case report of levetiracetam-induced Environ Health Perspect 2014; 122: 1028-39. cutaneous reaction and review of the literature. Am J Ther 2014; online early: Koustas E, Lam J, Sutton P, Johnson PI, Atchley DS, Sen doi: 10.1097/MJT.0000000000000105: S, Robinson KA, Axelrad DA, Woodruff TJ. The Navigation Guide–Evidence-based medicine meets Matos D, Serrano P, Brandão FM. environmental health: systematic review of nonhuman Maculopapular rash of unsuspected cause: systemic evidence for PFOA effects on fetal growth. contact dermatitis to . Environ Health Perspect 2014; 122: 1015-27. Cutan Ocul Toxicol 2014; online early: doi: 10.3109/15569527.2014.952375: Markunas CA, Xu Z, Harlid S, Wade PA, Lie RT, Taylor JA, Wilcox AJ. Ozlu E, Karadag AS, Akdeniz N, Uzuncakmak TK. Identification of DNA methylation changes in newborns Acitretin-induced alopecia areata: a case report. related to maternal during pregnancy. Environ Health Perspect 2014; 122: 1147-53. Cutan Ocul Toxicol 2014; online early: doi: 10.3109/15569527.2014.948684: Muenyi CS, Carrion SL, Jones LA, Kennedy LH, Slominski

AT, Sutter CH, Sutter TR. Yao S-Y, Seo R, Nagano T, Yamazaki K. Effects of in utero exposure of C57BL/6J mice to 2,3,7,8- Pneumatosis cystoides intestinalis associated with toxic tetrachlorodibenzo-p-dioxin on epidermal permeability epidermal necrolysis: a case report. barrier development and function. World J Clin Cases 2014; 2: 469-73. Environ Health Perspect 2014; 122: 1052-8.

Developmental toxicology Parajuli RP, Fujiwara T, Umezaki M, Watanabe C. Bashore CJ, Geer LA, He X, Puett R, Parsons PJ, Palmer Home environment and cord blood levels of lead, arsenic, CD, Steuerwald AJ, Abulafia O, Dalloul M, Sapkota A. and on neurodevelopment of 24 months children Maternal mercury exposure, season of conception and living in Chitwan Valley, Nepal. adverse birth outcomes in an urban immigrant community J Trace Elem Med Biol 2014; online early: in Brooklyn, New York, U.S.A. doi: 10.1016/j.jtemb.2014.08.006: Int J Environ Res Public Health 2014; 11: 8414-42. Pilmis B, Jullien V, Sobel J, Lecuit M, Lortholary O, Charlier C. Antifungal drugs during pregnancy: an updated review. Chen EKC, Zmirou-Navier D, Padilla C, Deguen S. J Antimicrob Chemother 2014; online early: Effects of air pollution on the risk of congenital anomalies: doi: 10.1093/jac/dku355: a systematic review and meta-analysis.

Int J Environ Res Public Health 2014; 11: 7642-68. ter Horst PGJ, Larmené-Beld KHM, Bosman J, van der

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Anticoagulants Bupropion Warfarin Lewis JC, Sutter ME, Albertson TE, Owen KP, Ford JB. Milic N, Milosevic N, Goloeorbin S, Bozic T, Abenavoli L, An 11-year review of bupropion insufflation exposures in Borrelli F. adults reported to the California Poison Control System. Warfarin interactions with medicinal herbs. Clin Toxicol 2014; online early: Nat Prod Commun 2014; 9: 1211-6. doi: 10.3109/15563650.2014.969372:

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Methotrexate Beta blockers Dawson AL, Riehle-Colarusso T, Reefhuis J, Arena JF, the Atenolol National Birth Defects Prevention Study. Sandeep P, Ram R, Sowgandhi N, Reddy SA, Katyarmal Maternal exposure to methotrexate and birth defects: a DT, Kumar BS, Kumar VS. population-based study. Atenolol and amlodipine combination overdose managed with Am J Med Genet A 2014; 164: 2212-6. continuous venovenous hemodiafiltration: a case report.

Indian J Nephrol 2014; 24: 327-9. Antipsychotics Chlorpromazine Metoprolol Broeders JJW, Hermens JLM, Blaauboer BJ, Zurich M-G. Van den Berg MJ, Bosch FH. The in vitro biokinetics of chlorpromazine and diazepam in Case report: hemodynamic instability following severe aggregating rat brain cell cultures after repeated metoprolol and imipramine intoxication successfully exposure. treated with intravenous fat emulsion. Toxicol In Vitro 2014; online early: Am J Ther 2014; online early: doi: 10.1016/j.tiv.2014.07.015: doi: 10.1097/MJT.0000000000000080:

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Digoxin Herbal medicines, ethnic remedies and Mégarbane B, Baud FJ. dietary supplements Early digoxin-specific antibody fragments for treating Di Lorenzo C, Ceschi A, Kupferschmidt H, Lüde S, De patients at risk of life-threatening digoxin toxicity. Souza Nascimento E, Dos Santos A, Colombo F, Frigerio G, Clin Toxicol 2014; online early: Nørby K, Plumb J, Finglas P, Restani P. doi: 10.3109/15563650.2014.968252: Adverse effects of plant food supplements and botanical preparations: a systematic review with critical evaluation of causality. Sabatini D, Truscelli G, Ciccaglioni A, Gaudio C, Grassi MC. Br J Clin Pharmacol 2014; online early: Bidirectional tachycardia after an acute intravenous doi: 10.1111/bcp.12519: administration of digitalis for a suicidal gesture. Case Rep Psychiatry 2014; 2014: 109167. Fong SYK, Efferth TH, Zuo Z. Modulation of the pharmacokinetics, therapeutic and Donepezil adverse effects of NSAIDs by Chinese herbal medicines. Expert Opin Drug Metab Toxicol 2014; online early: doi: Thornton SL, Clark RF. 10.1517/17425255.2014.970167: Encephalopathy from unintentional donepezil and memantine ingestion. Gurley BJ, Steelman SC, Thomas SL. Pediatr Emerg Care 2014; 30: 649-50. Multi-ingredient, caffeine-containing dietary supplements: history, safety, and efficacy. Clin Ther 2014; online early: Ergotamine doi: 10.1016/j.clinthera.2014.08.012: Adam G, Kurt T, Cinar C, Sariyildirim A, Resorlu M, Uysal F, Yener AÜ, Özcan S, Saçar M, Özdemir H. Milic N, Milosevic N, Goloeorbin S, Bozic T, Abenavoli L, Ergotamine-induced vasospastic ischemia mimicking Borrelli F. arterial embolism: unusual case. Warfarin interactions with medicinal herbs. Ulusul Travma Acil Cerrahi Derg 2014; 20: 291-4. Nat Prod Commun 2014; 9: 1211-6.

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Smoke Zhou S, Weitzman M, Vilcassim R, Wilson J, Legrand N, Long AS, Lemieux CL, Yousefi P, Ruiz-Mercado I, Lam NL, Saunders E, Travers M, Chen LC, Peltier R, Gordon T. Orellana CR, White PA, Smith KR, Holland N. Air quality in New York City hookah bars. Human urinary mutagenicity after wood smoke exposure Tob Control 2014; online early: during traditional temazcal use. doi: 10.1136/tobaccocontrol-2014-051763: Mutagenesis 2014; 29: 367-77. Toluene diisocyanate Solvents Gui W, Wisnewski AV, Neamtiu I, Gurzau E, Sparer JA, Stowe MH, Liu J, Slade MD, Rusu OA, Redlich CA. Peters S, Glass DC, Greenop KR, Armstrong BK, Kirby M, Inception cohort study of workers exposed to toluene Milne E, Fritschi L. diisocyanate at a polyurethane foam factory: initial one- Childhood brain tumours: associations with parental year follow-up. occupational exposure to solvents. Am J Ind Med 2014; online early: doi: 10.1002/ajim.22385: Br J Cancer 2014; 111: 998-1003.

Tricresyl phosphates Tetrachlorodibenzodioxin de Ree H, van den Berg M, Brand T, Mulder GJ, Simons R, Muenyi CS, Carrion SL, Jones LA, Kennedy LH, Slominski Veldhuijzen van Zanten B, Westerink RHS. AT, Sutter CH, Sutter TR. Health risk assessment of exposure to tricresyl phosphates Effects of in utero exposure of C57BL/6J mice to 2,3,7,8- (TCPs) in aircraft: a commentary. tetrachlorodibenzo-p-dioxin on epidermal permeability Neurotoxicology 2014; online early: barrier development and function. doi: 10.1016/j.neuro.2014.08.011: Environ Health Perspect 2014; 122: 1052-8. Tutin Tobacco Fields BA, Reeve J, Bartholomaeus A, Mueller U. Cobb CO, Blank MD, Morlett A, Shihadeh A, Jaroudi E, Human pharmacokinetic study of tutin in honey; a plant- Karaoghlanian N, Kilgalen B, Austin J, Weaver MF, derived neurotoxin. Eissenberg T. Food Chem Toxicol 2014; 72: 234-41. Comparison of puff topography, exposure, and subjective effects in low- and high-frequency waterpipe Welding fumes users: a double-blind, placebo-control study. Castano R, Suarthana E. Nicotine Tob Res 2014; online early: Occupational rhinitis due to steel welding fumes. doi: 10.1093/ntr/ntu196: Am J Ind Med 2014; online early: doi: 10.1002/ajim.22365: Dervisogullari MS, Totan Y, Tenlik A, Yuce A. Effects of cigarette smoking on choroidal and Persoons R, Arnoux D, Monssu T, Culié O, Roche G, thickness and ocular pulse amplitude. Duffaud B, Chalaye D, Maitre A. Cutan Ocul Toxicol 2014; online early: Determinants of occupational exposure to metals by gas doi: 10.3109/15569527.2014.950380: metal arc welding and risk management measures: a biomonitoring study. Mainali P, Pant S, Rodriguez AP, Deshmukh A, Mehta JL. Toxicol Lett 2014; online early: Tobacco and cardiovascular health. doi: 10.1016/j.toxlet.2014.09.008: Cardiovasc Toxicol 2014; online early: doi: 10.1007/s12012-014-9280-0: METALS

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METALS Chromium General Proctor DM, Suh M, Campleman SL, Thompson CM. Assessment of the mode of action for hexavalent chromium- Persoons R, Arnoux D, Monssu T, Culié O, Roche G, induced lung cancer following inhalation exposures. Duffaud B, Chalaye D, Maitre A. Toxicology 2014; 325: 160-79. Determinants of occupational exposure to metals by gas metal arc welding and risk management measures: a biomonitoring study. Welling R, Beaumont JJ, Petersen SJ, Alexeeff GV, Toxicol Lett 2014; online early: Steinmaus C. doi: 10.1016/j.toxlet.2014.09.008: Chromium VI and stomach cancer: a meta-analysis of the current epidemiological evidence.

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Lead Teixeira FB, Fernandes RM, Farias-Junior PM, Costa NM, Raymond J, Wheeler W, Brown MJ. Fernandes LM, Santana LN, Silva-Junior AF, Silva MC, Maia Lead screening and prevalence of blood lead levels in CS, Lima RR. children aged 1-2 years — Child Blood Lead Surveillance Evaluation of the effects of chronic intoxication with System, United States, 2002-2010 and National Health inorganic mercury on memory and motor control in rats. and Nutrition Examination Survey, United States, 1999- Int J Environ Res Public Health 2014; 11: 9171-85. 2010. MMWR Morb Mortal Wkly Rep 2014; 63: 36-42. Zhou Z, Zhang X, Cui F, Liu R, Dong Z, Wang X, Yu S. Subacute motor neuron hyperexcitability with mercury Seo J, Lee B-K, Jin S-U, Park JW, Kim Y-T, Ryeom H-K, poisoning: a case series and literature review. Lee J, Suh KJ, Kim SH, Park S-J, Jeong KS, Ham J-O, Kim Eur Neurol 2014; 72: 218-22. Y, Chang Y. Lead-induced impairments in the neural processes related Tin to working memory function. Ho KKY, Leung KMY. PLoS ONE 2014; 9: e105308. Organotin contamination in and its implication for human health risk in Hong Kong. Shaik AP, Sultana SA, Alsaeed AH. Mar Pollut Bull 2014; 85: 634-40. Lead exposure: a summary of global studies and the need for new studies from Saudi Arabia. Dis Markers 2014; 2014: 415160. Uranium Konietzka R. Staff JF, Harding A-H, Morton J, Jones K, Guice EA, Gastrointestinal absorption of uranium compounds – A McCormick T. review. Investigation of saliva as an alternative matrix to blood for Regul Toxicol Pharmacol 2014; online early: doi: the biological monitoring of inorganic lead. 10.1016/j.yrtph.2014.08.012: Toxicol Lett 2014; online early: doi: 10.1016/j.toxlet.2014.09.018: PESTICIDES General Thurtle N, Greig J, Cooney L, Amitai Y, Ariti C, Brown MJ, Kosnett MJ, Moussally K, Sani-Gwarzo N, Akpan H, Shanks Jayasumana C, Gajanayake R, Siribaddana S. L, Dargan PI. Importance of arsenic and pesticides in epidemic chronic Description of 3,180 courses of chelation with kidney disease in Sri Lanka. dimercaptosuccinic acid in children 5 y with severe lead BMC Nephrol 2014; 15: 124. poisoning in Zamfara, Northern Nigeria: a retrospective analysis of programme data. Lozowicka B. PLoS Med 2014; 11: e1001739. Health risk for children and adults consuming apples with pesticide residue. Yildizgören MT, Baki AE, Kara M, Ekiz T, Tiftik T, Tutkun E, Sci Total Environ 2014; 502: 184-98. Yilmaz H, Özçakar L. Ultrasonographic measurement of the femoral cartilage Marx-Stoelting P, Niemann L, Ritz V, Ulbrich B, Gall A, thickness in patients with occupational lead exposure. Hirsch-Ernst KI, Pfeil R, Solecki R. J Expos Sci Environ Epidemiol 2014; online early: doi: Assessment of three approaches for regulatory decision 10.1038/jes.2014.64: making on pesticides with endocrine disrupting properties. Regul Toxicol Pharmacol 2014; online early: Yu H, Li T, Cui Y, Liao Y, Wang G, Gao L, Zhao F, Jin Y. doi: 10.1016/j.yrtph.2014.09.001: Effects of lead exposure on D- metabolism in the hippocampus of mice at the early developmental stages. Fungicides Toxicology 2014; 325: 189-99. Christen V, Crettaz P, Fent K. Additive and synergistic antiandrogenic activities of Lithium mixtures of azol fungicides and vinclozolin. Umesh S, Sinha VK. Toxicol Appl Pharmacol 2014; 279: 455-66. Acute high dose lithium-induced exacerbation of obsessive compulsive symptoms. Heise T, Schmidt F, Knebel C, Rieke S, Haider W, Pfeil R, Toxicol Int 2014; 21: 222-3. Kneuer C, Niemann L, Marx-Stoelting P. Hepatotoxic effects of (tri)azole fungicides in a broad dose range. Manganese Arch Toxicol 2014; online early: doi: 10.1007/s00204- Chen P, Parmalee N, Aschner M. 014-1336-1: Genetic factors and manganese-induced neurotoxicity. Front Genet 2014; 5: 265. Mancozeb

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Herbicides Pechuho SI, Sattar RA, Kumar S, Pechucho TA, Qureshi Cherukuri H, Pramoda K, Rohini D, Thunga G, MA, Khanani MR. Vijaynarayana K, Sreedharan N, Varma M, Pandit V. Respiratory failure and thrombocytopenia in patients with organophosphorus insecticide poisoning. Demographics, clinical characteristics and management of Rawal Med J 2014; 39: 246-50. herbicide poisoning in tertiary care hospital.

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Chlorpyrifos CHEMICAL WARFARE, Wang T, Zhao L, Liu M, Xie F, Ma X, Zhao P, Liu Y, Li J, Wang M, Yang Z, Zhang Y. BIOLOGICAL WARFARE AND Oral intake of hydrogen-rich water ameliorated chlorpyrifos- RIOT CONTROL AGENTS induced neurotoxicity in rats. Chemical warfare Toxicol Appl Pharmacol 2014; 280: 169-76. General Dalton CH, Hall CA, Lydon HL, Chipman JK, Graham JS, Fenitrothion Jenner J, Chilcott RP. Ito Y, Tomizawa M, Suzuki H, Okamura A, Ohtani K, Development of haemostatic decontaminants for the Nunome M, Noro Y, Wang D, Nakajima T, Kamijima M. treatment of wounds contaminated with chemical warfare Fenitrothion action at the endocannabinoid system leading agents. 2: evaluation of in vitro topical decontamination to spermatotoxicity in Wistar rats. efficacy using undamaged skin. Toxicol Appl Pharmacol 2014; 279: 331-7. J Appl Toxicol 2014; online early: doi: 10.1002/jat.3060:

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INDEX

6-acetylmorphine ...... 27 Acitretin ...... 21 Acetaminophen ...... 27 Acrylonitrile ...... 30

40

Aerosols ...... 30 Designer drugs ...... 24 AH-7921 ...... 27 Detergents ...... 31 Air pollution ...... 28 Developmental toxicology ...... 10 Alcohol ...... 30 Diacetyl ...... 31 Aliphatic amines ...... 30 Diacetylmorphine...... 25 Alpha2-adrenoreceptor agonists ...... 19 Diazepam ...... 23 Alpha-pyrrolidinovalerophenone ...... 21 Dietary supplements ...... 25 Aluminium ...... 35 Diethylene glycol ...... 31 Amanita mushrooms ...... 38 Digoxin ...... 25 Amantadine ...... 19 Dioxin ...... 31 Amfetamines ...... 21 Diquat ...... 38 Amlodipine ...... 23 DMSA ...... 19 Amphotericin B ...... 22 Donepezil ...... 25 Anaesthetics ...... 21 Driving under the influence ...... 11 Analytical toxicology ...... 8 Drugs, general ...... 20 Animals, general ...... 39 Dyes ...... 31 Antibiotics ...... 21 E-cigarettes ...... 31 Anticoagulants ...... 22 Ecstasy ...... 21 Anticonvulsants ...... 22 Epidemiology...... 11 Antidepressants ...... 22 Ergotamine ...... 25 Antidotes ...... 19 Ethanol ...... 30 Antifungal drugs ...... 22 Ethnic remedies ...... 25 Antihistamines ...... 22 Ethylphenidate ...... 25 Antihypertensive drugs ...... 22 Exhaust fumes ...... 29 Antimalarial drugs ...... 22 Extracorporeal treatments ...... 20 Antineoplastics ...... 22 Eye drops...... 25 Antipsychotics ...... 23 Fab fragments ...... 19 Antituberculous drugs ...... 23 Fenitrothion ...... 38 Antivenom ...... 19 Fentanyl...... 27 Antiviral drugs ...... 23 Fish/marine poisoning ...... 39 Arsenic ...... 35 Flame retardants ...... 31 Asbestos...... 30 Flavonoids...... 31 Atenolol ...... 23 Fluconazole ...... 22 Atropine ...... 23 Fluorescein ...... 31 Benzene ...... 30 Fluoride ...... 32 Benzocaine ...... 21 Fluorotelomer alcohol ...... 32 Benzodiazepines ...... 23 Fluorouracil ...... 22 Beta blockers ...... 23 Fomepizole...... 19 Biological warfare...... 38 Forensic toxicology ...... 11 Biomarkers ...... 9 Fungicides ...... 36 Bisphenol A ...... 31 Gamma hydroxybutyrate ...... 25 Body packers ...... 9 Genotoxicity ...... 12 Bortezomib ...... 22 Glyphosate ...... 37 Bupropion ...... 22 Haemodiafiltration ...... 20 Cadmium ...... 35 Hallucinogenic drugs ...... 25 Caffeine...... 23 Hazardous waste ...... 29 Calcium channel blockers...... 23 Hepatotoxicity ...... 12 Cannabis ...... 23 Herbal medicines ...... 25 Caramiphen ...... 19 Herbicides ...... 37 Carbamazepine ...... 22 Heroin ...... 25 Carbon monoxide ...... 31 Honey ...... 32 Carbon tetrachloride ...... 31 Hydrochloric acid ...... 32 Carcinogenicity ...... 9 Hydrofluoric acid ...... 32 Cardiotoxicity ...... 9 Hydroxychloroquine ...... 25 Chemical incidents ...... 29 Hypnotics ...... 25 Chemical warfare, general ...... 38 Hypoglycaemics ...... 26 Chemicals, general ...... 30 Imipramine ...... 28 Chloroquine ...... 22 Inhalation toxicity ...... 13 Chlorpromazine ...... 23 Iridium ...... 35 Chlorpyrifos ...... 37 Iron ...... 35 Chromium ...... 35 Isoniazid ...... 23 Cinchocaine ...... 21 Kanna ...... 26, 39 Clonidine ...... 20 Ketamine ...... 26 Cocaine ...... 24 Kinetics ...... 13 Colchicine ...... 24 Kratom ...... 38 Contrast media ...... 31 Krokodil ...... 26 Copper ...... 35 Lead ...... 35 Copperhead snake ...... 39 Levetiracetam ...... 22 Crotalinae ...... 39 Lidocaine ...... 21 Cytotoxic drugs ...... 24 Lipid emulsion therapy ...... 19 Daptomycin ...... 21 Lithium ...... 26, 36 Dermal toxicity...... 10 Locust bean gum ...... 32

41

Malathion ...... 38 Phthalate esters ...... 33 Management, general ...... 19 Pit-vipers ...... 39 Mancozeb ...... 36 Plants, general ...... 38 Manganese ...... 36 Plasmapheresis ...... 20 Marijuana ...... 23 Poison information centres ...... 18 MDMA ...... 21 Poisons information ...... 18 Mechanisms ...... 13 Pollution ...... 29 Medication errors ...... 13 Polybrominated biphenyl ethers ...... 33 Memantine ...... 26 Polybrominated diphenyl ethers ...... 33 Mercury ...... 36 Polychlorinated biphenyls ...... 33 Metals, general ...... 34 Polymorphisms ...... 18 Metamifop ...... 37 Pregabalin ...... 22 Metformin ...... 26 Prilocaine ...... 21 Methadone ...... 27 Psychiatric aspects ...... 18 Methanol ...... 32 Pyrethroid insecticides, general ...... 38 Methotrexate ...... 23 Radiation ...... 33 Metoprolol ...... 23 Radon ...... 33 Mineral fibres ...... 32 Reprotoxicity ...... 18 Mitragyna speciosa...... 38 Rhododendron spp...... 39 Monoclonal antibodies ...... 20 Risk assessment ...... 18 Monocrotophos ...... 38 Risperidone ...... 23 Montelukast ...... 26 Salicylate ...... 27 Mushrooms ...... 38 Sceletium tortuosum ...... 39 ...... 39 Scorpions ...... 39 Naloxone ...... 20 Smoke ...... 34 Nanoparticles ...... 32 Snake bites ...... 39 Neonicotinoids ...... 37 Solvents ...... 34 Nephrotoxicity ...... 14 Spiders ...... 39 Nerve agents ...... 38 SSRIs and SNRIs ...... 27 Neurotoxicity ...... 14 Statins ...... 27 Nicotine ...... 26 Substance abuse ...... 27 Nitrates ...... 32 Suicide ...... 18 Nitrogen dioxide ...... 32 Synthetic cannabinoids ...... 28 NSAIDs ...... 26 Synthetic cathinones ...... 28 Occupational toxicology ...... 15 Tenofovir ...... 23 Ocular toxicity ...... 16 Tetrachlorodibenzodioxin ...... 34 Oestrogens ...... 26 Tin ...... 36 Olanzapine ...... 23 Tobacco ...... 34 Opioid maintenance therapy ...... 20 Toluene diisocyanate ...... 34 Opioids ...... 26 Toxicology, general ...... 8 Organochlorine pesticides, general ...... 37 Tricresyl phosphates ...... 34 Organophosphorus insecticides, general ...... 37 Tricyclic antidepressants ...... 28 Oximes ...... 20 True vipers...... 39 Ozone ...... 32 Tutin ...... 34 Paediatric toxicology ...... 16 Uranium ...... 36 Paint thinners ...... 33 Valerian ...... 39 Parabens ...... 33 Valeriana spp...... 39 Paracetamol ...... 27 Valproate ...... 22 Paraoxon ...... 38 Venlafaxine ...... 27 Paraquat ...... 38 Viperniae ...... 39 Perchlorates ...... 33 Vitamin A ...... 28 Perfluorinated compounds ...... 33 Vitamin E ...... 20 Pesticides, general ...... 36 Voriconazole ...... 22 Phenols ...... 33 Warfarin ...... 22 Phenytoin ...... 22 Welding fumes ...... 34 Phosgene ...... 38 Zolpidem ...... 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