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

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

August 2016

CONTENTS General Toxicology 6 Metals 30 Management 14 Pesticides 31 Drugs 16 Chemical Warfare 33 Chemical Incidents & 24 Plants 34 Pollution Chemicals 25 Animals 34

CURRENT AWARENESS PAPERS OF THE MONTH

Toxicity evaluation of α-pyrrolidinovalerophenone (α-PVP): results from intoxication cases within the STRIDA project Beck O, Franzén L, Bäckberg M, Signell P, Helander A. Clin Toxicol 2016; 54: 568-75. Context An increasing number of new psychoactive substances (NPS) of different chemical classes have become available through marketing and sale over the Internet. This report from the Swedish STRIDA project presents the prevalence, laboratory results, and clinical features in a series of intoxications involving the stimulant NPS -pyrrolidinovalerophenone (-PVP), a potent dopamine re-uptake inhibitor, over a 4-year period. Study design Observational case series of consecutive patients with admitted or suspected intake of NPS presenting to hospitals in Sweden from 2012 to 2015. Patients and methods In the STRIDA project, blood and urine samples are collected from intoxicated patients with admitted or suspected intake of NPS or unknown drugs presenting to hospitals over the country. Analysis of NPS is performed by mass spectrometry multicomponent methods. Clinical data are collected when caregivers consult the Swedish Poisons Information Centre

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

(PIC), and retrieved from medical records. The severity of poisoning is graded retrospectively using the Poisoning Severity Score (PSS). The inclusion criteria for this study included absence of other stimulants than -PVP. Results During the 4-year study period, 23 intoxications were originally coded as "-PVP related" out of a total 3743 NPS-related inquiries (0.6%) at the PIC. The present study covered 42 analytically confirmed cases in which -PVP was the only stimulant detected. The age range of patients was 20–58 (median 32) years, of which 79% were males. The -PVP concentration in serum was 4.0-606 (median 64; n = 42) ng/mL and 2.0–41,294 (median 1782; n = 25) ng/mL in urine. There was no statistically significant association between the serum -PVP concentration and urinary -PVP/creatinine ratio in 25 cases, where both sets of data were available. In 14/42 (33%) cases, -PVP was the only psychoactive substance identified. In the remaining cases, additional substances comprised opioids, benzodiazepines, and ethanol. The main clinical manifestations were tachycardia (80%), agitation (70%), hypertension (33%), hallucinations (20%), and delirium (18%). Classification of poisoning severity yielded 25 (60%) moderate (PSS 2), 7 (17%) severe (PSS 3), and 2 fatal cases (PSS 4). Conclusions In analytically confirmed -PVP intoxication cases involving no other stimulant drugs, the urine and serum concentrations showed high variability. The clinical features were consistent with a severe sympathomimetic toxidrome. The results further demonstrated that -PVP prevailed as a drug of abuse after being classified as a narcotic substance, and despite a high incidence of severe poisonings and fatalities. However, the low prevalence of -PVP cases registered at the PIC suggested that many were unaware of the actual substance they had taken. Full text available from: http://dx.doi.org/10.1080/15563650.2016.1190979

Toxicity of soluble film automatic dishwashing products as reported to the United Kingdom National Poisons Information Service 2008–2015 Day R, Eddleston M, Thomas SHL, Thompson JP, Vale JA. Clin Toxicol 2016; online early: doi: 10.1080/15563650.2016.1209762: Introduction Soluble film automatic dishwashing tablets, unlike their traditional counterparts, require no removal from an outer protective wrapper prior to use. Instead, the tablets are enclosed by a water-soluble polyvinyl alcohol film and are loaded straight into the dishwashing machine. They most commonly contain a source of hydrogen peroxide (often as sodium percarbonate) and non-ionic surfactants. Other constituents in some formulations include sodium carbonate, sodium tripolyphosphate and sodium silicate, which reduce water hardness. The pH once dissolved in water is alkaline. Objective To determine the toxicity from exposure to soluble film automatic dishwashing tablets. Methods Telephone enquiries to the United Kingdom National Poisons Information Service regarding soluble film automatic dishwashing products were analysed retrospectively for the period January 2008 to December 2015. Results There were 498 enquiries relating to 488 patients. Almost all exposures occurred in the home (98.4%) and involved children aged ≤5 years (92.8%). Exposure occurred mainly as a result of ingestion alone (n = 470, 96.3%); eye contact alone (n = 9, 1.8%) and exposures

involving multiple routes (ingestion with skin or eye contact; n = 9, 1.8%) made up the remaining cases. The majority of patients were asymptomatic following exposure (n = 325, 67.4%). The most common feature following ingestion was vomiting which occurred in 121 of 474 cases (25.5%) where clinical data were available. Nausea (n = 8, 1.7%) and coughing (n = 6, 1.3%) were also reported; three patients developed stomatitis and another five developed a rash where ingestion alone was considered to be the sole route of exposure. Ocular exposure to the tablet contents resulted in blurred vision, eye pain or conjunctivitis in seven of ten patients. Conclusion Ingestion of a soluble film automatic dishwashing tablet rarely resulted in clinically significant symptoms, which is surprising given the potential hazard of the ingredients. Hence, it seems probable that the amount of material actually ingested was very small or that most was spat out. Full text available from: http://dx.doi.org/10.1080/15563650.2016.1209762

Characterization of edible marijuana product exposures reported to United States poison centers Cao D, Srisuma S, Bronstein AC, Hoyte CO. Clin Toxicol 2016; online early: doi: 10.1080/15563650.2016.1209761: Context Edible marijuana products are sold as brownies, cookies, and candies, which may be indistinguishable from counterparts without marijuana and are palatable to children and adults. The consumption of an entire product containing multiple dose-units may result in overdose. Objective To characterize edible marijuana exposures reported to US poison centers with subgroup analysis by age. Methods We analyzed single substance, human exposure calls coded to marijuana brownies, candies, cookies, beverages, or other foods reported to the National Poison Data System from January 2013 to December 2015. Calls were analyzed by state, age, gender, exposure route, clinical effect, therapies, and level of healthcare facility utilization. Results Four-hundred and thirty calls were reported: Colorado (N = 166, 1.05/100,000 population/ year) and Washington (96, 0.46) yielded the highest number of exposures. Three hundred and eighty-one (91%) calls occurred in states with decriminalized medical/recreational marijuana. The number of calls increased every year of the study. The most common age groups were: ≤5 years (N = 109, 0.15/100,000 population/year) and 13-19 (78, 0.09). The most frequent clinical effects were drowsiness/lethargy (N = 118, percentage = 43%), tachycardia (84, 31%), agitated/irritable (37, 14%), and confusion (37, 14%). Children ≤5 years have more drowsiness/lethargy, ataxia, and red eye/conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20%), dilute/irrigate/wash (48, 11 %), and benzodiazepines (47, 11%). Three patients (ages 4, 10, and 57 years) received intubation. 97 (23%), 217 (50%), and 12 (3%) calls were managed at home, treated/released, admitted to a critical care unit, respectively. Discussion Although most clinical effects are minor, ventilatory support may be necessary for children and adults. We speculate the increasing exposures may be related to a combination of delayed absorption kinetics of Δ9-tetrahydrocannablnol, lagging packaging regulations, increased

accessibility in decriminalized states, and increased familiarity of poison center specialists with edible product codes. Conclusions Edible marijuana exposures are increasing and may lead to severe respiratory depression. Full text available from: http://dx.doi.org/10.1080/15563650.2016.1209761

Delays during the administration of acetylcysteine for the treatment of paracetamol overdose Bailey GP, Najafi J, Elamin MEMO, Waring WS, Thomas SHL, Archer JRH, Wood DM, Dargan PI. Br J Clin Pharmacol 2016; online early: doi: 10.1111/bcp.13063: Abstract and full text available from: http://dx.doi.org/10.1111/bcp.13063

Idarucizumab for reversal of dabigatran Yogaratnam D, Ditch K, Medeiros K, Doyno C, Fong JJ. Ann Pharmacother 2016; online early: doi: 10.1177/1060028016659504: Abstract and full text available from: http://dx.doi.org/10.1177/1060028016659504

Effects of neonicotinoid pesticide exposure on human health: a systematic review Cimino AM, Boyles AL, Thayer KA, Perry MJ. Environ Health Perspect 2016; online early: doi: 10.1289/EHP515: Abstract and full text available from: http://dx.doi.org/10.1289/EHP515

Memory impairment due to fipronil pesticide exposure occurs at the GABAA receptor level, in rats Godinho AF, de Oliveira Souza AC, Carvalho CC, Horta DF, De Fraia D, Anselmo F, Chaguri JL, Faria CA. Physiol Behav 2016; 165: 28-34. Abstract and full text available from: http://dx.doi.org/10.1016/j.physbeh.2016.06.035

Hypokalemia is a biochemical signal of poor prognosis for acute paraquat poisoning within 4 hours Liu Z-Q, Wang H-S, Gu Y. Intern Emerg Med 2016; online early: doi: 10.1007/s11739-016-1491-x: Abstract and full text available from: http://dx.doi.org/10.1007/s11739-016-1491-x

Acute illness associated with exposure to a new soil fumigant containing dimethyl disulfide — Hillsborough County, Florida, 2014 Mulay PR, Cavicchia P, Watkins SM, Tovar-Aguilar A, Wiese M, Calvert GM. J Agromed 2016; online early: doi: 10.1080/1059924X.2016.1211574: Abstract and full text available from: http://dx.doi.org/10.1080/1059924X.2016.1211574

Tetramethylenedisulfotetramine: pest control gone awry Shakarjian MP, Laukova M, Velíšková J, Stanton PK, Heck DE, Velíšek L. Ann N Y Acad Sci 2016; online early: doi: 10.1111/nyas.13120: Abstract and full text available from: http://dx.doi.org/10.1111/nyas.13120

Toxicology of organophosphorus compounds in view of an increasing terrorist threat Worek F, Wille T, Koller M, Thiermann H. Arch Toxicol 2016; online early: doi: 10.1007/s00204-016-1772-1: Abstract and full text available from: http://dx.doi.org/10.1007/s00204-016-1772-1

Relationship between cumulative exposure to 1,2- dichloropropane and incidence risk of cholangiocarcinoma among offset printing workers Kumagai S, Sobue T, Makiuchi T, Kubo S, Uehara S, Hayashi T, Sato KK, Endo G. Occup Environ Med 2016; 73: 545-52. Abstract and full text available from: http://dx.doi.org/10.1136/oemed-2015-103427

Five-year review of a UK 24 hour testing service for plasma ethylene glycol and diethylene glycol Ford LT, Berg JD. Ann Clin Biochem 2016; 53: 459-65. Abstract and full text available from: http://dx.doi.org/10.1177/0004563215603731

Rapid and selective detection of experimental snake envenomation – Use of gold nanoparticle based lateral flow assay Pawade BS, Salvi NC, Shaikh IK, Waghmare AB, Jadhav ND, Wagh VB, Pawade AS, Waykar IG, Potnis-Lele M. Toxicon 2016; 119: 299-306. Abstract and full text available from: http://dx.doi.org/10.1016/j.toxicon.2016.06.023

Scorpion envenomation in pregnancy Shah N, Martens MG. South Med J 2016; 109: 338-41. Abstract and full text available from: http://dx.doi.org/10.14423/SMJ.0000000000000470

Application of rapid test kits for the determination of Paralytic Shellfish Poisoning (PSP) toxins in bivalve molluscs from Great Britain Harrison K, Johnson S, Turner AD. Toxicon 2016; 119: 352-61. Abstract and full text available from: http://dx.doi.org/10.1016/j.toxicon.2016.06.019

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Analytical toxicology Shi H, Hu L, Chen S, Bao W, Yang S, Zhao X, Sun C. Bergstrand MP, Helander A, Hansson T, Beck O. Metabolomics analysis of urine from rats administered Detectability of designer benzodiazepines in CEDIA, EMIT II with long-term, low-dose acrylamide by ultra-performance Plus, HEIA, and KIMS II immunochemical screening assays. liquid chromatography-mass spectrometry. Drug Test Anal 2016; online early: Xenobiotica 2016; online early: doi: 10.1002/dta.2003: doi: 10.1080/00498254.2016.1196509:

Cummings OT, Enders JR, McIntire GL, Backer R, Poklis A. Skov L, Holm KMD, Johansen SS, Linnet K. Fentanyl-norfentanyl concentrations during transdermal Postmortem brain and blood reference concentrations of patch application: LC-MS-MS urine analysis. alprazolam, bromazepam, chlordiazepoxide, diazepam, and J Anal Toxicol 2016; online early: their metabolites and a review of the literature. doi: 10.1093/jat/bkw067: J Anal Toxicol 2016; online early: doi: 10.1093/jat/bkw059:

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Zhang X, Lin Z, Li J, Huang Z, Rao Y, Liang H, Yan J, Grasing K, Mathur D, DeSouza C, Newton TF, Moody DE, Zheng F. Sturgill M. Rapid determination of nine barbiturates in human whole Cocaine cardiovascular effects and pharmacokinetics after blood by liquid chromatography-tandem mass spectrometry. treatment with the acetylcholinesterase inhibitor donepezil. Drug Test Anal 2016; online early: doi: 10.1002/dta.2002: Am J Addict 2016; online early: doi: 10.1111/ajad.12402:

Biomarkers Haddad L, Kelly DL, Weglicki LS, Barnett TE, Ferrell AV, Ghadban R. D'Ruiz CD, Graff DW, Robinson E. A systematic review of effects of waterpipe smoking on Reductions in biomarkers of exposure, impacts on smoking cardiovascular and respiratory health outcomes. urge and assessment of product use and tolerability in adult Tob Use Insights 2016; 9: 13-28. smokers following partial or complete substitution of cigarettes with electronic cigarettes. Ishizue N, Niwano S, Saito M, Fukaya H, Nakamura H, BMC Public Health 2016; 16: 543. Igarashi T, Fujiishi T, Yoshizawa T, Oikawa J, Satoh A,

Kishihara J, Murakami M, Niwano H, Miyaoka H, Ako J. Body packers Polytherapy with sodium channel-blocking antiepileptic Alipour-Faz A, Shadnia S, Hadi S, Peyvandi M, Oroei M, drugs is associated with arrhythmogenic ST-T abnormality Shafagh O, Peyvandi H, Peyvandi AA. in patients with epilepsy. Assessing the epidemiological data and management Seizure 2016; 40: 81-7. methods of body packers admitted to a referral center in Iran. Medicine 2016; 95: e3656. Kamendi H, Barthlow H, Lengel D, Beaudoin M-E, Snow D, Mettetal JT, Bialecki RA. Carcinogenicity Quantitative PK/PD modeling of baclofen-mediated cardiovascular effects using blood pressure and heart rate Bini I, Annabi A, Jallouli M, Marzouki S, Gharbi N, Elfazaa in rats. S, Lasram MM. Br J Pharmacol 2016; online early: doi: 10.1111/bph.13561: Carbamates pesticides induced immunotoxicity and carcinogenicity in human: a review. Mariana M, Feiteiro J, Verde I, Cairrao E. J Appl Biomed 2016; 14: 85-90. The effects of phthalates in the cardiovascular and repro-

ductive systems: a review. Kumagai S, Sobue T, Makiuchi T, Kubo S, Uehara S, Environ Int 2016; online early: Hayashi T, Sato KK, Endo G. doi: 10.1016/j.envint.2016.07.004: Relationship between cumulative exposure to 1,2- dichloropropane and incidence risk of cholangiocarcinoma Muscogiuri G, Colao A. among offset printing workers. Phtalates: new cardiovascular health disruptors? Occup Environ Med 2016; 73: 545-52. Arch Toxicol 2016; online early: doi: 10.1007/s00204-

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Potential carcinogenicity predicted by computational toxicity Park S-I, An H, Kim A, Jang I-J, Yu K-S, Chung J-Y. evaluation of thiophosphate pesticides using QSTR/ An analysis of QTc prolongation with atypical antipsychotic QSCarciAR model. medications and selective serotonin reuptake inhibitors Drug Chem Toxicol 2016; online early: using a large ECG record database. doi: 10.1080/01480545.2016.1209771: Expert Opin Drug Saf 2016; 15: 1013-9.

Pflaum T, Hausler T, Baumung C, Ackermann S, Kuballa T, Ralapanawa U, Jayawickreme KP, Ekanayake EMM, Rehm J, Lachenmeier DW. Dhammika Menike Dissanayake AMS. Carcinogenic compounds in alcoholic beverages: an update. A study on paracetamol cardiotoxicity. Arch Toxicol 2016; online early: doi: 10.1007/s00204- BMC Pharmacol Toxicol 2016; 17: 30. 016-1770-3: Singh H, Luni FK, Marwaha B, Ali SS, Alo M. Terrell ML, Rosenblatt KA, Wirth J, Cameron LL, Marcus M. Transient complete heart block secondary to bed bug Breast cancer among women in Michigan following insecticide: a case of pyrethroid cardiac toxicity. exposure to brominated flame retardants. Cardiology 2016; 135: 160-3. Occup Environ Med 2016; 73: 564-7. Valentino MA, Panakos A, Ragupathi L, Williams J, Pavri BB. Cardiotoxicity Flecainide toxicity: a case report and systematic review of Costal-Oliveira F, Guerra-Duarte C, Oliveira MS, de Castro its electrocardiographic patterns and management. KLP, Lopes-de-Sousa L, Lara A, de Morias Gomes ER, Cardiovasc Toxicol 2016; online early: Bonilla C, Guatimosim S, Melo MM, Chávez-Olórtegui C. doi: 10.1007/s12012-016-9380-0: Cardiorespiratory alterations in rodents experimentally envenomed with Hadruroides lunatus scorpion venom. Wong LY, Wong A, Robertson T, Burns K, Roberts M, J Venom Anim Toxins Incl Trop Dis 2016; 23: 2. Isbister GK. Severe hypertension and bradycardia secondary to midodrine Fabrizio C, Desiderio M, Coyne RF. overdose. Electrocardiogram abnormalities of caffeine overdose. J Med Toxicol 2016; online early: doi: 10.1007/s13181- Circ Arrhythm Electrophysiol 2016; 9: e003088. 016-0574-4:

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Beedie SL, Mahony C, Walker HM, Chau CH, Figg WD, Driving under the influence of alcohol Vargesson N. and other drugs Shared mechanism of teratogenicity of anti-angiogenic Kummer N, Wille SMR, Poll A, Lambert WEE, Samyn N, drugs identified in the chicken embryo model. Stove CP. Sci Rep 2016; 6: 30038. Quantification of EtG in hair, EtG and EtS in urine and PEth species in capillary dried blood spots to assess the Callan AC, Rotander A, Thompson K, Heyworth J, Mueller alcohol consumption in driver's licence regranting cases. JF, Odland JØ, Hinwood AL. Drug Alcohol Depend 2016; 165: 191-7. Maternal exposure to perfluoroalkyl acids measured in whole blood and birth outcomes in offspring. Rojek S, Kula K, Maciów-Glab M, Klys M. Sci Total Environ 2016; online early: New psychoactive substance -PVP in a traffic accident doi: 10.1016/j.scitotenv.2016.06.177: case.

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Watkins DJ, Milewski S, Domino SE, Meeker JD, Padmanabhan V. Radiation Maternal phthalate exposure during early pregnancy and Hall S, Rudrawar S, Zunk M, Bernaitis N, Arora D, McDermott at delivery in relation to gestational age and size at birth: CM, Anoopkumar-Dukie S. A preliminary analysis. Protection against radiotherapy-induced toxicity. Reprod Toxicol 2016; online early: Antioxidants (Basel) 2016; 5: 22. doi: 10.1016/j.reprotox.2016.06.021: S,S-dimethyl Yaghjyan L, Ghita GL, Dumont-Driscoll M, Yost RA, cyanoimidodithiocarbonate Chang S-H. Schedel F, Herrnstadt G, Ehrchen J. Maternal exposure to di-2-ethylhexylphthalate and adverse Stevens Johnson syndrome/toxic epidermal necrolysis after delivery outcomes: a systematic review. exogenous contact to S,S-dimethyl cyanoimidodithio- Reprod Toxicol 2016; 65: 76-86. carbonate. J Eur Acad Dermatol Venereol 2016; online early: doi: Plasticisers 10.1111/jdv.13804: Boisvert A, Jones S, Issop L, Erythropel HC, Papadopoulos V, Culty M. Silica In vitro functional screening as a means to identify new Matsuo K, Hirobe S, Okada N, Nakagawa S. plasticizers devoid of reproductive toxicity. Analysis of skin permeability and toxicological properties Environ Res 2016; 150: 496-512. of amorphous silica particles. Biol Pharm Bull 2016; 39: 1201-5. Polybrominated diphenyl ethers Marchitti SA, Fenton SE, Mendola P, Kenneke JF, Hines EP. Sodium metabisulphite Polybrominated diphenyl ethers in human milk and serum Dalefield RR, Mueller U. from the US EPA MAMA study: modeled predictions of Gastric mucosal irritation following oral exposure to sodium infant exposure and considerations for risk assessment. metabisulphite: a reproducible effect? Environ Health Perspect 2016; online early: doi: Regul Toxicol Pharmacol 2016; online early: 10.1289/EHP332: doi: 10.1016/j.yrtph.2016.07.005:

Polychlorinated biphenyls Tobacco Caspersen IH, Aase H, Biele G, Brantsæter AL, Haugen M, Almedawar MM, Walsh JL, Isma'eel HA. Kvalem HE, Skogan AH, Zeiner P, Alexander J, Meltzer Waterpipe smoking and risk of coronary artery disease. HM, Knutsen HK. Curr Opin Cardiol 2016; online early:

doi: 10.1097/HCO.0000000000000319: Int Sch Res Notices 2016; 2016: 6296458.

Haddad L, Kelly DL, Weglicki LS, Barnett TE, Ferrell AV, Sun J, Yu G, Zhang Y, Liu X, Du C, Wang L, Li Z, Wang C. Ghadban R. Heavy metal level in human semen with different fertility: A systematic review of effects of waterpipe smoking on a meta-analysis. cardiovascular and respiratory health outcomes. Biol Trace Elem Res 2016; online early: Tob Use Insights 2016; 9: 13-28. doi: 10.1007/s12011-016-0804-2:

Jawad M, Roderick P. Integrating the impact of cigarette and waterpipe tobacco Aluminium use among adolescents in the Eastern Mediterranean Mai S, He Q, Wang H, Hu X, Luo Y, Yang Y, Kuang S, Tian Region: a cross-sectional, population-level model of X, Ma J, Yang J. toxicant exposure. 5-lipoxygenase activation is involved in the mechanisms of Tob Control 2016; online early: chronic hepatic injury in a rat model of chronic aluminum doi: 10.1136/tobaccocontrol-2015-052777: overload exposure. Toxicol Appl Pharmacol 2016; 305: 259-66. Veen M. Carbon monoxide poisoning caused by water pipe smoking: Arsenic a case series. Chávez-Capilla T, Beshai M, Maher W, Kelly T, Foster S. J Emerg Med 2016; online early: Bioaccessibility and degradation of naturally occurring arsenic doi: 10.1016/j.jemermed.2016.05.046: species from food in the human gastrointestinal tract.

Food Chem 2016; 212: 189-97. Trifluoroacetic acid Solomon KR, Velders GJ, Wilson SR, Madronich S, Longstreth J, Aucamp PJ, Bornman JF. Cadmium Sources, fates, toxicity, and risks of trifluoroacetic acid Wang H, Liu L, Hu Y-F, Hao J-H, Chen Y-H, Su P-Y, Yu Z, Fu and its salts: relevance to substances regulated under the L, Tao F-B, Xu D-X. Montreal and Kyoto Protocols. Association of maternal serum cadmium level during J Toxicol Environ Health B Crit Rev 2016; online early: pregnancy with risk of preterm birth in a Chinese population. doi: 10.1080/10937404.2016.1175981: Environ Pollut 2016; online early: doi: 10.1016/j.envpol.2016.06.058: Welding fumes Miettinen M, Torvela T, Leskinen JT. Wu H, Liao Q, Chillrud SN, Yang Q, Huang L, Bi J, Yan B. Physicochemical characterization of aerosol generated in Environmental exposure to cadmium: health risk the gas tungsten arc welding of stainless steel. assessment and its associations with hypertension and Ann Occup Hyg 2016; online early: impaired kidney function. doi: 10.1093/annhyg/mew039: Sci Rep 2016; 6: 29989.

Yellow phosphorus Yang D, Guo Z, Green ID, Xie D. Kamarthi P, Subramani P, Gopu AV, Prasad R, Srinivasa C. Effect of cadmium accumulation on mineral nutrient levels Acute pancreatitis, hepatitis and bone erosion in acute yellow in vegetable crops: potential implications for human health. Environ Sci Pollut Res 2016; online early: phosphorous compound poisoning – A rare complication. J Clin Diagn Res 2016; 10: DD03-DD05. doi: 10.1007/s11356-016-7186-z:

METALS Cobalt Grant ML, Karp JK, Palladino M, Le N, Hall N, Herman JH. General Does therapeutic plasma exchange have a role in the Ivankovic D, Erk M, Župan I, Culin J, Dragun Z, Bacic N, treatment of prosthetic hip-associated cobalt toxicity? a Cindric A-M. case report and literature review. Trace metals in Noah's Ark shells (Arca noae Linnaeus, Transfusion 2016; online early: doi: 10.1111/trf.13720: 1758): impact of tourist season and human health risk.

Arch Environ Contam Toxicol 2016; online early: doi: Vasukutty NL, Minhas THA. 10.1007/s00244-016-0298-0: Systemic effects of cobalt toxicity after revision hip Javed M, Usmani N. replacement can manifest in intermediate to long term follow- Accumulation of heavy metals and human health risk up. assessment via the consumption of freshwater fish HIP Int 2016; 26: e31-e34. Mastacembelus armatus inhabiting, thermal power plant effluent loaded canal. Copper Springerplus 2016; 5: 776. Hashish EA, Elgaml SA. Hepatoprotective and nephroprotective effect of curcumin Miettinen M, Torvela T, Leskinen JT. against copper toxicity in rats. Physicochemical characterization of aerosol generated in Indian J Clin Biochem 2016; 31: 270-7. the gas tungsten arc welding of stainless steel. Ann Occup Hyg 2016; online early: doi: 10.1093/annhyg/mew039: Iron Hassan MAM, Tolba OA. Nouioui MA, Mahjoubi S, Ghorbel A, Ben Haj Yahia M, Iron chelation monotherapy in transfusion-dependent Amira D, Ghorbel H, Hedhili A. beta-thalassemia major patients: a comparative study of Health risk assessment of heavy metals in traditional deferasirox and deferoxamine. cosmetics sold in Tunisian local markets. Electron Physician 2016; 8: 2425-31.

Lead Egg white hydrolysate promotes neuroprotection for Assi MA, Hezmee MN, Haron AW, Sabri MY, Rajion MA. neuropathic disorders induced by chronic exposure to low concentrations of mercury. The detrimental effects of lead on human and animal health. Brain Res 2016; online early: Vet World 2016; 9: 660-71. doi: 10.1016/j.brainres.2016.06.037:

Cai F, Calisi RM. Seasons and neighborhoods of high lead toxicity in New Platinum York City: the feral pigeon as a bioindicator. Oldenburg J, Gietema JA. Chemosphere 2016; 161: 274-9. The sound of silence: a proxy for platinum toxicity. J Clin Oncol 2016; online early: Dobrakowski M, Kasperczyk A, Czuba ZP, Machon-Grecka doi: 10.1200/JCO.2016.68.2476: A, Szlacheta Z, Kasperczyk S. The influence of chronic and subacute exposure to lead on Silver the levels of prolactin, leptin, osteopontin, and follistatin in Sprando RL, Black T, Keltner Z, Olejnik N, Ferguson M. humans. Silver acetate exposure: effects on reproduction and post Hum Exp Toxicol 2016; online early: natal development. doi: 10.1177/0960327116658106: Food Chem Toxicol 2016; online early:

doi: 10.1016/j.fct.2016.06.022: Ford DM.

Re: Letter to the editor in response to Pigatto et al., 'Characteristics of childhood lead poisoning among Tennessee Vanadium children ages 1 to 5 years, 2009–2013'. Jiang M, Li Y, Zhang B, Zhou A, Zheng T, Qian Z, Du X, Zhou Public Health 2016; online early: Y, Pan X, Hu J, Wu C, Peng Y, Liu W, Zhang C, Xia W, Xu S. doi: 10.1016/j.puhe.2016.05.021: A nested case-control study of prenatal vanadium exposure and low birthweight. Gostin LO. Hum Reprod 2016; online early: Politics and public health: the Flint drinking water crisis. doi: 10.1093/humrep/dew176: Hastings Cent Rep 2016; 46: 5-6. PESTICIDES Pelclová D, Štastná J, Vlcková Š, Vlceká K, Urban M, Laštovková A, Doležel Z. General Is central Europe safe from environmental lead intoxications? Asghari MH, Moloudizargari M, Bahadar H, Abdollahi M. A case series. A review of the protective effect of melatonin in pesticide- Cent Eur J Public Health 2016; 24: 120-2. induced toxicity. Expert Opin Drug Metab Toxicol 2016; online early: doi: Sajitha GR, Augusti KT, Jose R. 10.1080/17425255.2016.1214712: Prophylactic effects of garlic oil and onion oil fractions as compared to vitamin E on rats orally fed with lead acetate da Silva M, Stadlinger N, Mmochi AJ, Lundborg CS, solution. Marrone G. Indian J Clin Biochem 2016; 31: 260-9. Pesticide use and self-reported health symptoms among rice farmers in Zanzibar. Taylor JY, Wright ML, Housman D. J Agromed 2016; online early: Lead toxicity and genetics in Flint, MI. doi: 10.1080/1059924X.2016.1211572: NPJ Genom Med 2016; online early: doi: 10.1038/npjgenmed.2016.18: Lee S-H, Park S, Lee J-W, Hwang I-W, Moon H-J, Kim K-H, Park S-Y, Gil H-W, Hong S-Y. Zhang F, Liu Y, Zhang H, Ban Y, Wang J, Liu J, Zhong L, Chen The anion gap is a predictive clinical marker for death in X, Zhu B. patients with acute pesticide intoxication. Investigation and evaluation of children's blood lead levels J Korean Med Sci 2016; 31: 1150-9. around a lead battery factory and influencing factors. Int J Environ Res Public Health 2016; 13: 541. Aluminium phosphide

Marashi SM, Nasrabadi ZN, Jafarzadeh M, Mohammadi S. Lithium Hydroxyethyl starch could save a patient with acute Patil V, Gupta R, Verma R, Balhara YP. aluminum phosphide poisoning. Neuroleptic malignant syndrome associated with lithium Acta Med Iran 2016; 54: 475-8. toxicity. Oman Med J 2016; 31: 309-11. Carbamate insecticides

Manganese General Bini I, Annabi A, Jallouli M, Marzouki S, Gharbi N, Elfazaa Beaudin SA, Strupp BJ, Strawderman M, Smith DR. S, Lasram MM. Early postnatal manganese exposure causes lasting impairment of selective and focused attention and arousal Carbamates pesticides induced immunotoxicity and regulation in adult rats. carcinogenicity in human: a review. Environ Health Perspect 2016; online early: J Appl Biomed 2016; 14: 85-90. doi: 10.1289/EHP258: Fumigants Mercury Dimethyl Disulfide Rizzetti DA, Fernandez F, Moreno S, Uranga Ocio JA, Mulay PR, Cavicchia P, Watkins SM, Tovar-Aguilar A, Peçanha FM, Vera G, Vassallo DV, Castro MM, Wiggers GA. Wiese M, Calvert GM.

Acute illness associated with exposure to a new soil Public health and chronic low chlordecone exposure in fumigant containing dimethyl disulfide - Hillsborough Guadeloupe, Part 1: hazards, exposure-response functions, County, Florida, 2014. and exposures. J Agromed 2016; online early: Environ Health 2016; 15: 75. doi: 10.1080/1059924X.2016.1211574: Nedellec V, Rabl A, Dab W. Herbicides Public health and chronic low chlordecone exposures in Sapcanin A, Cakal M, Imamovic B, Salihovic M, Pehlic E, Guadeloupe; Part 2: health impacts, and benefits of Jacimovic Z, Jancan G. prevention. Herbicide and pesticide occurrence in the soils of children's Environ Health 2016; 15: 78. playgrounds in Sarajevo, Bosnia and Herzegovina. Environ Monit Assess 2016; 188: 450. Organophosphorus insecticides General Flurochloridone Ghanbari F, Moattar F, Monavari SM, Arjmandi R. Shi J, Xie C, Liu H-B, Krausz KW, Bewley CA, Zhang S, Human health risk assessment of organophosphorus Tang L, Zhou Z, Gonzalez FJ. pesticide in rice crop from selected districts of Anzali Metabolism and bioactivation of flurochloridone, a novel International Wetland basin, Iran. selective herbicide, in vivo and in vitro. Hum Exp Toxicol 2016; online early: Environ Sci Technol 2016; online early: doi: 10.1177/0960327116657603: doi: 10.1021/acs.est.6b02113: Jamal F, Haque QS, Singh S. Glyphosate Interrelation of glycemic status and neuropsychiatric Stephenson CL, Harris CA. disturbances in farmers with organophosphorus pesticide An assessment of dietary exposure to glyphosate using toxicity. refined deterministic and probabilistic methods. Open Biochem J 2016; 10: 27-34. Food Chem Toxicol 2016; 95: 28-41. Kovalevsky A, Blumenthal DK, Cheng X, Taylor P, Radic Z. Insecticides (general) Limitations in current acetylcholinesterase structure-based design of oxime antidotes for organophosphate poisoning. Fipronil Ann N Y Acad Sci 2016; online early: Godinho AF, de Oliveira Souza AC, Carvalho CC, Horta DF, doi: 10.1111/nyas.13128: De Fraia D, Anselmo F, Chaguri JL, Faria CA. Memory impairment due to fipronil pesticide exposure Rosenberg YJ, Fink JB. occurs at the GABAA receptor level, in rats. Creation of a protective pulmonary bioshield against inhaled Physiol Behav 2016; 165: 28-34. organophosphates using an aerosolized bioscavenger. Ann N Y Acad Sci 2016; 1374: 151-8. Sulfuryl fluoride Mulay PR, Clark G, Jackson WL, Calvert GM. Parathion Notes from the field: acute sulfuryl fluoride poisoning in a Jan Y-H, Richardson JR, Baker AA, Mishin V, Heck DE, family – Florida, August 2015. Laskin DL, Laskin JD. MMWR Morb Mortal Wkly Rep 2016; 65: 698-9. Novel approaches to mitigating parathion toxicity: targeting cytochrome P450-mediated metabolism with menadione. Neonicotinoids Ann N Y Acad Sci 2016; online early: Cimino AM, Boyles AL, Thayer KA, Perry MJ. doi: 10.1111/nyas.13156: Effects of neonicotinoid pesticide exposure on human health: a systematic review. Paraquat and diquat Environ Health Perspect 2016; online early: Chen H, Hu L, Li H, Hong G, Zhang T, Ma J, Lu Z. doi: 10.1289/EHP515: An effective machine learning approach for prognosis of paraquat poisoning patients using blood routine indexes. Acetamiprid Basic Clin Pharmacol Toxicol 2016; online early: doi: Sano K, Isobe T, Yang J, Win-Shwe TT, Yoshikane M, 10.1111/bcpt.12638: Nakayama SF, Kawashima T, Suzuki G, Hashimoto S, Nohara K, Tohyama C, Maekawa F. Lee JH, Hwang SY, Kim HR, Kim YW, Kang MJ, Cho KW, In utero and lactational exposure to acetamiprid induces Lee DW, Kim YH. abnormalities in socio-sexual and anxiety-related behaviors Effectiveness of the sequential organ failure assessment, of male mice. acute physiology and chronic health evaluation II, and Front Neurosci 2016; 10: 228. simplified acute physiology score II prognostic scoring systems in paraquat-poisoned patients in the intensive Organochlorine pesticides care unit. Hum Exp Toxicol 2016; online early: General doi: 10.1177/0960327116657602: Gauri BB, Raushan IB, Akmaral ZR, Raushan NG, Saltanat KN, Renata TT. Liu Z-Q, Wang H-S, Gu Y. Organochlorine pesticides and female puberty in South Hypokalemia is a biochemical signal of poor prognosis for Kazakhstan. acute paraquat poisoning within 4 hours. Reprod Toxicol 2016; online early: Intern Emerg Med 2016; online early: doi: 10.1016/j.reprotox.2016.06.017: doi: 10.1007/s11739-016-1491-x:

Chlordecone Milczarek R, Sokolowska E, Rybakowska I, Kaletha K, Nedellec V, Rabl A, Dab W. Klimek J.

Paraquat inhibits progesterone synthesis in human placental mitochondria. CHEMICAL WARFARE, Placenta 2016; 43: 41-6. BIOLOGICAL WARFARE AND RIOT CONTROL AGENTS Ortiz MS, Forti KM, Suárez Martinez EB, Muñoz LG, Husain K, Muñiz WH. Chemical warfare Effects of antioxidant N-acetylcysteine against paraquat- General induced oxidative stress in vital tissues of mice. Worek F, Wille T, Koller M, Thiermann H. Int J Sci Basic Appl Res 2016; 26: 26-46. Toxicology of organophosphorus compounds in view of an increasing terrorist threat. Arch Toxicol 2016; online early: doi: 10.1007/s00204- Pourgholamhossein F, Sharififar F, Rasooli R, Pourgholi L, Nakhaeipour F, Samareh-Fekri H, Iranpour M, Mandegary A. 016-1772-1:

Thymoquinone effectively alleviates lung fibrosis induced by paraquat herbicide through down-regulation of pro- Mustard gas fibrotic genes and inhibition of oxidative stress. Joseph LB, Composto GM, Heck DE. Environ Toxicol Pharmacol 2016; 45: 340-5. Tissue injury and repair following cutaneous exposure of mice to sulfur mustard.

Ann N Y Acad Sci 2016; online early: Sun L, Yan P, Zhang Y-H, Wei L-Q, Li G. doi: 10.1111/nyas.13125: Continuous plasma perfusion of dual cartridges in series: rationale and early clinical experience. Malaviya R, Sunil VR, Venosa A, Vayas KN, Businaro R, J Artif Organs 2016; online early: doi: 10.1007/s10047- Heck DE, Laskin JD, Laskin DL. 016-0917-6: Macrophages and inflammatory mediators in pulmonary injury induced by mustard vesicants. Pyrethroid insecticides Ann N Y Acad Sci 2016; 1374: 168-75.

General Sassolini A, Brinchi G, Di GA, Dionisi S, Dominici C, Azab M, Khabour OF, Alzoubi KH, Hawamdeh H, Quttina Fantozzi L, Onofri G, Piazza R, Guidotti M. M, Nassar L. Evaluation of molecular markers and analytical methods Assessment of genotoxicity of pyrethrin in cultured human documenting the occurrence of mustard gas and arsenical lymphocytes. warfare agents in soil. Bull Environ Contam Toxicol 2016; online early: doi: Drug Chem Toxicol 2016; online early: 10.1007/s00128-016-1860-1: doi: 10.1080/01480545.2016.1209679:

Xu B, Zong C, Zhang Y, Zhang T, Wang X, Qi M, Wu J, Singh H, Luni FK, Marwaha B, Ali SS, Alo M. Guo L, Wang P, Chen J, Liu Q, Xu H, Xie J, Zhang Z. Transient complete heart block secondary to bed bug Accumulation of intact sulfur mustard in adipose tissue and insecticide: a case of pyrethroid cardiac toxicity. toxicokinetics by chemical conversion and isotope-dilution Cardiology 2016; 135: 160-3. liquid chromatography-tandem mass spectrometry. Arch Toxicol 2016; online early: doi: 10.1007/s00204- 016-1774-z: Rodenticides Muscarella M, Armentano A, Iammarino M, Palermo C, Nerve agents Amorena M. Chambers JE, Chambers HW, Funck KE, Meek EC, Pringle Anticoagulant rodenticide poisoning in animals of Apulia RB, Ross MK. and Basilicata, Italy. Efficacy of novel phenoxyalkyl pyridinium oximes as brain- Vet Ital 2016; 52: 153-9. penetrating reactivators of cholinesterase inhibited by surrogates of sarin and VX. Tetramethylenedisulfotetramine Chem Biol Interact 2016; online early: doi: 10.1016/j.cbi.2016.07.004: Shakarjian MP, Laukova M, Velíšková J, Stanton PK, Heck DE, Velíšek L. Pearson JN, Patel M. Tetramethylenedisulfotetramine: pest control gone awry. The role of oxidative stress in organophosphate and nerve Ann N Y Acad Sci 2016; online early: agent toxicity. doi: 10.1111/nyas.13120: Ann N Y Acad Sci 2016; online early: doi: 10.1111/nyas.13115:

Zinc phosphide Snider TH, Babin MC, Jett DA, Platoff GE, Jr., Yeung DT. Shakoori V, Agahi M, Vasheghani-Farahani M, Marashi SM. Toxicity and median effective doses of oxime therapies Successful management of zinc phosphide poisoning. against percutaneous organophosphorus pesticide and Indian J Crit Care Med 2016; 20: 368-70. nerve agent challenges in the Hartley guinea pig. J Toxicol Sci 2016; 41: 511-21.

Thiophosphate pesticides VX Petrescu A-M, Ilia G. Wille T, Neumaier K, Koller M, Ehinger C, Aggarwal N, Potential carcinogenicity predicted by computational Ashani Y, Goldsmith M, Sussman JL, Tawfik DS, Thiermann toxicity evaluation of thiophosphate pesticides using H, Worek F. QSTR/QSCarciAR model. Single treatment of VX poisoned guinea pigs with the Drug Chem Toxicol 2016; online early: phosphotriesterase mutant C23AL: Intraosseous versus doi: 10.1080/01480545.2016.1209771: intravenous injection.

Toxicol Lett 2016; 258: 198-206. Toxicon 2016; 119: 319-29.

PLANTS Fish/marine poisoning Datura spp. (Devil s trumpet) Botana LM, Alfonso A, Rodríguez I, Botana AM, del ’ Carmen Louzao M, Vieytes MR. Kanchan T, Atreya A. How safe is safe for marine toxins monitoring? Datura: the roadside poison. Toxins (Basel) 2016; 8: 208. Wilderness Environ Med 2016; online early: doi: 10.1016/j.wem.2016.04.007: Paralytic shellfish poisoning Digitalis spp. (Foxgloves) Harrison K, Johnson S, Turner AD. López-Briz E, López-Salvador B. Application of rapid test kits for the determination of Yew (Taxus baccata) and foxglove (Digitalis spp.): toxic Paralytic Shellfish Poisoning (PSP) toxins in bivalve molluscs principles are very different. from Great Britain. Med Intensiva 2016; online early: Toxicon 2016; 119: 352-61. doi: 10.1016/j.medin.2016.03.010: Scorpions Mushrooms and other fungi Chippaux J-P. Grama A, Bizo A, Delean D, Aldea C, Stefanescu A, Pop TL. Management of scorpion stings in Africa and the Evolution of fulminant liver failure in mushroom poisoning Mediterranean region. in children. Med Sante Trop 2016; 26: 130-3. J Pediatr Gastroenterol Nutr 2016; 62: 602. Costal-Oliveira F, Guerra-Duarte C, Oliveira MS, de Castro Krasnodebski M, Grat M, Holowko W, Masior L, Wronka KLP, Lopes-de-Sousa L, Lara A, de Morias Gomes ER, KM, Grat K, Stypulkowski J, Patkowski W, Krawczyk M. Bonilla C, Guatimosim S, Melo MM, Chávez-Olórtegui C. Results of liver transplantation in patients with acute liver Cardiorespiratory alterations in rodents experimentally failure due to Amanita phalloides and paracetamol envenomed with Hadruroides lunatus scorpion venom. (acetaminophen) intoxication. J Venom Anim Toxins Incl Trop Dis 2016; 23: 2. Prz Gastroenterol 2016; 11: 90-5. Monteiro WM, de Oliveira SS, Pivoto G, Alves EC, de Amanita mushrooms Almeida Gonçalves Sachett J, Alexandre CN, Fe NF, Stankiewicz R, Lewandowski Z, Kotulski M, Patkowski W, Barbosa Guerra MdGV, da Silva IM, Tavares AM, Ferreira Krawczyk M. LCdL, Lacerda MVG. Effectiveness of fractionated plasma separation and Scorpion envenoming caused by Tityus cf. silvestris evolving absorption as a treatment for Amanita phalloides poisoning. with severe muscle spasms in the Brazilian Amazon. Ann Transplant 2016; 21: 428-32. Toxicon 2016; 119: 266-9.

Mycotoxins Shah N, Martens MG. Scorpion envenomation in pregnancy. Tanaka T, Hasegawa-Baba Y, Watanabe Y, Mizukami S, Kangawa Y, Yoshida T, Shibutani M. South Med J 2016; 109: 338-41. Maternal exposure to ochratoxin A targets intermediate progenitor cells of hippocampal neurogenesis in rat Snake bites offspring via cholinergic signal downregulation and oxidative General stress responses. Ediriweera DS, Kasturiratne A, Pathmeswaran A, Reprod Toxicol 2016; online early: Gunawardena NK, Wijayawickrama BA, Jayamanne SF, doi: 10.1016/j.reprotox.2016.06.018: Isbister GK, Dawson A, Giorgi E, Diggle PJ, Lalloo DG, De

Silva HJ. Taxus baccata (Yew) Mapping the risk of snakebite in Sri Lanka - a national survey Arens AM, Anaebere TC, Horng H, Olson K. with geospatial analysis. Fatal Taxus baccata ingestion with perimortem serum PLoS Negl Trop Dis 2016; 10: e0004813. taxine B quantification. Clin Toxicol 2016; online early: Mallik S, Singh SR, Mohanty MK, Padhy N. doi: 10.1080/15563650.2016.1209765: Attempted suicide by snake bite: a case study. Med Sci Law 2016; online early: López-Briz E, López-Salvador B. doi: 10.1177/0025802416659160: Yew (Taxus baccata) and foxglove (Digitalis spp.): toxic principles are very different. Pawade BS, Salvi NC, Shaikh IK, Waghmare AB, Jadhav Med Intensiva 2016; online early: ND, Wagh VB, Pawade AS, Waykar IG, Potnis-Lele M. doi: 10.1016/j.medin.2016.03.010: Rapid and selective detection of experimental snake

envenomation – Use of gold nanoparticle based lateral ANIMALS flow assay. General Toxicon 2016; 119: 299-306.

Harris RJ, Arbuckle K. Tempo and mode of the evolution of venom and poison in Colubridae tetrapods. Torres-Bonilla KA, Schezaro-Ramos R, Floriano RS, Rodrigues- Toxins (Basel) 2016; 8: 193. Simioni L, Bernal-Bautista MH, da Cruz-Höfling MA. Biological activities of Leptodeira annulata (banded cat-eyed Renar KS, Iskra J, Krizaj I. snake) venom on vertebrate neuromuscular preparations. Understanding malarial toxins. Toxicon 2016; 119: 345-51.

Viperinae (True vipers) Rare case of dermonecrosis caused by a recluse spider Firth GB, Street M, Ramguthy Y, Doedens L. bite in Europe. Mortality following snake bite envenomation by Bitis BMJ Case Rep 2016; doi: 10.1136/bcr-2016-215832: arietans in an HIV positive child: A case report. Medicine (Baltimore) 2016; 95: e4001. Toads Kerkhoff J, da C Noronha J, Bonfilio R, Sinhorin AP, de J Silva A, Kuruppu S, Othman I, Goode RJA, Hodgson WC, Rodrigues D, Chaves MH, Vieira Júnior GM. Isbister GK. Quantification of bufadienolides in the poisons of Rhinella Neurotoxicity in Sri Lankan Russell's viper (Daboia russelii) marina and Rhaebo guttatus by HPLC-UV. envenoming is primarily due to U1-viperitoxin-Dr1a, a pre- Toxicon 2016; 119: 311-8. synaptic neurotoxin. Neurotox Res 2016; online early: doi: 10.1007/s12640- Kwon K-R, Yu J-S, Sun S-H, Lee K-H. 016-9650-4: Study of intravenous single-dose toxicity test of Bufonis venonum pharmacopuncture in Sprague-Dawley Rats. Spiders J Pharmacopuncture 2016; 19: 155-62. Cachia M, Mercieca L, Mallia Azzopardi C, Boffa MJ.

INDEX

3-methylpentane ...... 25 Calcium channel blockers ...... 20 Acetaminophen ...... 23 Cannabis ...... 20 Acetamiprid ...... 32 Capecitabine ...... 18 Acetylcysteine ...... 14 Carbamate insecticides ...... 31 Aconitine ...... 16 Carbamazepine ...... 18 Acrylamide ...... 25 Carbon monoxide ...... 26 Air pollution ...... 24 Carcinogenicity ...... 7 Alcohol ...... 25 Cardiotoxicity ...... 7 Alkyl nitrites ...... 17 Chelating agents ...... 14 Alpha-terpinene ...... 26 Chemical incidents ...... 25 Alprazolam ...... 20 Chemical warfare, general ...... 33 Aluminium ...... 30 Chemicals, general ...... 25 Aluminium phosphide ...... 31 Chlordecone ...... 32 Amanita mushrooms ...... 34 Chlorhexidine ...... 20 Amfetamines ...... 17 Chlorine ...... 26 Amitriptyline ...... 24 Chlormequat ...... 26 Anaesthetics ...... 17 Cisplatin ...... 18 Analytical toxicology ...... 6 Clenbuterol ...... 20 Animals, general ...... 34 Cobalt ...... 30 Anthracyclines ...... 18 Cocaine...... 20 Anti-angiogenetic drugs ...... 17 Colubridae ...... 34 Antiarrhythmic drugs ...... 17 Copper ...... 30 Antibiotics ...... 17 Corrosives ...... 27 Anticoagulants ...... 17 Corticosteroids ...... 20 Anticonvulsants ...... 18 Cosmetics ...... 27 Antidepressants ...... 18 Curcumin ...... 15 Antidotes ...... 14 Cyanide ...... 27 Antifungal drugs ...... 18 Cyclobenzaprine ...... 20 Antihistamines ...... 18 Dabigatran ...... 17 Antimalarial drugs ...... 18 Dapsone ...... 17 Antineoplastics ...... 18 Datura spp ...... 34 Antipsychotics ...... 19 Dermal toxicity ...... 7 Antiviral drugs ...... 19 Designer drugs ...... 20 Apixaban ...... 17 Desomorphine ...... 21 Arsenic ...... 30 Detergents ...... 27 Baclofen ...... 19 Developmental toxicology ...... 8 Barbiturates ...... 19 Devil’s trumpet ...... 34 Benzalkonium chloride ...... 26 Diacetylmorphine...... 22 Benzodiazepines ...... 19 Dichloropropane ...... 27 Beta blockers ...... 20 Dietary supplements ...... 21 Biological warfare...... 33 Digitalis spp...... 34 Biomarkers ...... 7 Digoxin ...... 21 Bioscavengers ...... 14 Diketopyrrolopyrrole pigments ...... 27 Bisphenol A ...... 26 Dimethyl Disulfide ...... 31 Body packers ...... 7 Dioxins ...... 27 Bupropion ...... 18 Diphenhydramine ...... 18 Cadmium ...... 30 Diquat ...... 32 Caffeine...... 20 Disinfectants ...... 27

Disulfiram ...... 21 Metals, general ...... 30 Dithiothreitol ...... 15 Metalworking fluids ...... 28 Driving under the influence ...... 8 Metformin ...... 22 Drugs, general ...... 16 Methadone ...... 16 E-cigarettes and e-liquids ...... 27 Methotrexate ...... 19 Ecstasy ...... 17 Methylene blue ...... 22 Epidemiology ...... 9 Methylphenidate ...... 22 Essential oils ...... 28 Methylthioninium chloride ...... 22 Estrogens ...... 21 Metoprolol ...... 20 Ethanol...... 25 Midodrine ...... 22 Ethnic remedies ...... 21 Monoclonal antibodies ...... 22 Ethylene glycol ...... 28 Monosodium glutamate ...... 28 Extracorporeal treatments ...... 15 Mushrooms ...... 34 Eye drops ...... 21 Mustard gas ...... 33 Fentanyl ...... 23 Mycotoxins ...... 34 Fipronil ...... 32 Naloxone ...... 15 Fish/marine poisoning ...... 34 Nanoparticles ...... 28 Flame retardants ...... 28 Neonicotinoids ...... 32 Flecainide ...... 17 Nephrotoxicity ...... 11 Fluoropyrimidine ...... 18 Nerve agents ...... 33 Fluorouracil ...... 19 Neurotoxicity ...... 11 Fluoxetine ...... 24 Nicotine ...... 22 Flurochloridone ...... 32 Nitrofurantoin ...... 17 Forensic toxicology ...... 9 Occupational toxicology ...... 11 Formic acid ...... 28 Ocular toxicity ...... 11 Foxgloves ...... 34 Olanzapine ...... 19 Fumigants ...... 31 Opioid maintenance therapy ...... 16 Gamma hydroxybutyrate ...... 21 Organochlorine pesticides, general ...... 32 Genotoxicity ...... 9 Organophosphate esters ...... 28 Glyphosate ...... 32 Organophosphorus insecticides, general ...... 32 Graphene ...... 28 Oximes ...... 15 Haemodialysis ...... 15 Oxymorphone ...... 23 Haemoperfusion...... 15 Ozone ...... 28 Hazardous waste ...... 25 Paediatric toxicology ...... 12 Heparin ...... 17 Parabens...... 28 Hepatotoxicity ...... 9 Paracetamol ...... 23 Herbal medicines ...... 21 Paralytic shellfish poisoning ...... 34 Herbicides ...... 32 Paraquat ...... 32 Heroin ...... 22 Parathion ...... 32 Hydrocarbons ...... 28 Perchlorate ...... 28 Hydromorphone ...... 23 Perfluorinated compounds ...... 28 Hydroxyethyl starch ...... 15 Pesticides, general ...... 31 Hyperbaric oxygen therapy ...... 14 Pharmacological excipients ...... 23 Hypnotics ...... 22 Phenethylamines ...... 20 Hypoglycaemic drugs ...... 22 Phenobarbital ...... 18 Ibogaine ...... 15 Phenytoin...... 18 Idarucizumab ...... 15 Phthalate esters ...... 29 Inhalation toxicity ...... 10 Plants, general ...... 34 Insecticides (general) ...... 32 Plasma exchange ...... 15 Insulin ...... 15 Plasma perfusion ...... 15 Ipecac syrup ...... 15 Plasticisers ...... 29 Iron ...... 22, 30 Platinum ...... 31 Ivermectin ...... 22 Poison information centres ...... 12 Ketamine ...... 22 Poisons information ...... 12 Ketoconazole ...... 18 Pollution ...... 25 Kinetics ...... 10 Polybrominated diphenyl ethers ...... 29 Lead...... 31 Polychlorinated biphenyls ...... 29 Levobupivacaine ...... 17 Polycyclic aromatic hydrocarbons ...... 29 Levocetirizine ...... 18 Protamine ...... 16 Lidocaine ...... 17 Psychiatric aspects ...... 12 Lipid emulsion therapy ...... 14 Pyrethroid insecticides, general ...... 33 Lithium ...... 22, 31 Quinine ...... 24 Loperamide ...... 22 Radiation ...... 29 Management, general ...... 14 Reprotoxicity ...... 12 Manganese ...... 31 Risk assessment ...... 13 Marijuana ...... 20 Risperidone ...... 19 MDMA ...... 17 Rizatriptan ...... 24 Medication errors ...... 10 Rodenticides ...... 33 Melatonin ...... 15 S,S-dimethyl cyanoimidodithiocarbonate ...... 29 Menadione ...... 16 Salicylate ...... 24 Mercury ...... 31 Scorpions ...... 34 Metabolism ...... 10 Sertaconazole ...... 18

Silica ...... 29 Tobacco ...... 29 Silver...... 31 Toxicology, general ...... 6 Snake bites ...... 34 Triamcinolone ...... 20 Sodium metabisulphite ...... 29 Tricyclic antidepressants ...... 24 Sodium zirconium cyclosilicate ...... 16 Trifluoroacetic acid ...... 30 Spiders ...... 35 Trihexyphenidyl ...... 24 SSRIs and SNRIs ...... 24 True vipers...... 35 Substance abuse ...... 24 Tyrosine kinase inhibitors ...... 24 Suicide ...... 13 Vaccines ...... 24 Sulfuryl fluoride ...... 32 Vanadium ...... 31 Synthetic cannabinoids ...... 21 Venlafaxine ...... 24 Synthetic cathinones ...... 21 Vigabatrin ...... 18 Synthetic opioids ...... 21 Viperinae ...... 35 Taxus baccata...... 34 VX ...... 33 Tenofovir ...... 19 Water pollution ...... 25 Tetramethylenedisulfotetramine ...... 33 Welding fumes ...... 30 Thiophosphate pesticides ...... 33 Yellow phosphorus ...... 30 Thymoquinone ...... 16 Yew ...... 34 Toads ...... 35 Zinc phosphide ...... 33

The NPIS is commissioned by Public Health England