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

October 2017

CONTENTS General Toxicology 11 Metals 31 Management 17 Pesticides 33 Drugs 19 Chemical Warfare 34 Chemical Incidents & 27 Plants 34 Pollution Chemicals 28 Animals 35

CURRENT AWARENESS PAPERS OF THE MONTH

The interpretation of hair analysis for drugs and drug metabolites Cuypers E, Flanagan RJ. Clin Toxicol 2017; online early: doi: 10.1080/ 15563650.2017.1379603: Introduction Head hair analysis for drugs and drug metabolites has been used widely with the aim of detecting exposure in the weeks or months prior to sample collection. However, inappropriate interpretation of results has likely led to serious miscarriages of justice, especially in child custody cases. Objective The aim of this review is to assess critically what can, and perhaps more importantly, what cannot be claimed as regards the interpretation of hair test results in a given set of circumstances in order to inform future testing. Methods We searched the PubMed database for papers published 2010-2016 using the terms "hair" and "drug" and "decontamination", the terms "hair" and "drug" and "contamination", the terms "hair" and "drug-facilitated crime", the terms "hair" and "ethyl glucuronide", and the

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

terms "hair", "drug testing" and "analysis". Study of the reference lists of the 46 relevant papers identified 25 further relevant citations, giving a total of 71 citations. Hair samples Drugs, drug metabolites and/or decomposition products may arise not only from deliberate drug administration, but also via deposition from a contaminated atmosphere if drug(s) have been smoked or otherwise vaporized in a confined area, transfer from contaminated surfaces via food/fingers, etc., and transfer from sweat and other secretions after a single large exposure, which could include anesthesia. Excretion in sweat of endogenous analytes such as gamma-hydroxybutyric acid is a potential confounder if its use is to be investigated. Cosmetic procedures such as bleaching or heat treatment of hair may remove analytes prior to sample collection. Hair color and texture, the area of the head the sample is taken from, the growth rate of individual hairs, and how the sample has been stored, may also affect the interpretation of results. Toxicological analysis Immunoassay results alone do not provide reliable evidence on which to base judicial decisions. Gas or liquid chromatography with mass spectrometric detection (GC- or LC-MS), if used with due caution, can give accurate analyte identification and high sensitivity, but many problems remain. Firstly, it is not possible to prepare assay calibrators or quality control material except by soaking "blank" hair in solutions of appropriate analytes, drying, and then subjecting the dried material to an analysis. The fact that solvents can be used to add analytes to hair points to the fact that analytes can arrive not only on, but also in hair from exogenous sources. A range of solvent-washing procedures have been advocated to "decontaminate" hair by removing adsorbed analytes, but these carry the risk of transporting adsorbed analytes into the medulla of the hair therefore confounding the whole procedure. This is especially true if segmental analysis is being undertaken in order to provide a "time course" of drug exposure. Proposed clinical applications of hair analysis There have been a number of reports where drugs seemingly administered during the perpetration of a crime have been detected in head hair. However, detailed evaluation of these reports is difficult without full understanding of the possible effects of any "decontamination" procedures used and of other variables such as hair color or cosmetic hair treatment. Similarly, in child custody cases and where the aim is to demonstrate abstinence from drug or alcohol use, the issues of possible exogenous sources of analyte, and of the large variations in analyte concentrations reported in known users, continue to confound the interpretation of results in individual cases. Conclusions Interpretation of results of head hair analysis must take into account all the available circumstantial and other evidence especially as regards the methodology employed and the possibility of surface contamination of the hair prior to collection. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1379603

Acute lamotrigine overdose: a systematic review of published adult and pediatric cases Alyahya B, Friesen M, Nauche B, Laliberté M. Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1370096: Context Lamotrigine is a broad-spectrum anticonvulsant commonly used to treat seizure and bipolar mood disorders. Evidence from case series and retrospective studies indicate that

lamotrigine overdose is usually benign. However, there are reported cases of cardiac arrest and mortality following lamotrigine overdose. We undertook a systematic review of the literature on lamotrigine overdoses to better understand the clinical severity, the relevance of serum concentrations, and therapeutic interventions for overdose. Objectives To characterize manifestations of acute lamotrigine overdose, determine if serum concentrations predict poisoning severity, and evaluate the effectiveness of overdose management interventions. Methods We performed a literature search across eight databases, including Medline, EMBASE, and the Cochrane Library, from database inception to April 2014. Major bibliographic databases were updated on 31 May 2017. Articles were eligible if they described acute or acute on chronic lamotrigine overdose. At least one serum lamotrigine concentration had to be reported for inclusion. Reports on chronic poisoning, studies describing adverse effects of therapeutic use, and animal studies were excluded. Results We retrieved 6238 records; 48 (51 cases) met the inclusion criteria. Cases primarily involved adults (70.6%). Potentially life-threatening symptoms of overdose included seizures (55%), Glasgow Coma Scale ≤8 (20%), hypotension (12%), and wide complex tachycardia (WCT) and cardiac arrest (6%). Among the 25 cases exposed to lamotrigine alone (13 adult; 12 pediatric), 2 adult fatalities occurred (4 g and 7.5 g ingested) and 8 pediatric cases experienced seizures (all children ≤3.5-years-old, 75% without an underlying seizure disorder, ≥ 525 mg ingested). The lowest seizure-associated serum concentration was 3.8 mg/L and 25.6 mg/L for pediatric and adult patients, respectively, suggesting children may be more susceptible to CNS toxicity. Cardiovascular toxicities occurred primarily in adult patients (threshold >25 mg/L). Overdose interventions included benzodiazepines (53%), propofol or barbiturates (14%), NaHCO3 (20%), lipid therapy (12%), and extracorporeal elimination (10%). NaHCO3 yielded no response in four of nine cases with conduction delays; however, two of the four cases subsequently responded with lipid therapy. Conclusions Most cases reporting lamotrigine exposures observed mild or no toxicity; however, large exposures were associated with severe CNS depression, seizures, cardiac conduction delays, wide complex tachycardia, and death. In adults with a serum concentration >25 mg/L, severe toxicity may occur. In patients ≤3.5 years of age, ingestions of ≥525 mg may produce severe CNS depression and seizures. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1370096

Comparison of low dose and standard dose abdominal CT scan in body stuffers Bahrami-Motlagh H, Mahboubi-Fooladi Z, Salevatipour B, Hassanian- Moghaddam H, Mirhashemi SH. Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1377220: Purpose Detection of body stuffers is challenging in emergency departments. Because of the small size of baggies, plain radiograph is of little value in most suspects. On the other hand, abdomen CT scan is burdened by high cost and radiation dose. This study was performed to compare the image quality, radiation dose and accuracy of low-dose CT scan in comparison with standard dose.

Material and methods In this prospective study, suspected body stuffers who were referred to the radiology department underwent two different protocols of abdominal non-contrast CT scan simultaneously: low-dose (with equivalent dose to conventional abdominal x-ray) and standard dose. Standard dose CT scan was considered as the reference. Low-dose CT scans were evaluated for detection of baggies by two radiologists blinded to the result of standard dose CT. Image quality, noise, dose-length product (DLP) and effective dose (ED) compared between two groups. Results The study consisted of 40 patients (33.38 ± 7.4 years). Standard dose CT evaluation was positive in 22 patients (55%). In comparison with standard dose CT scan, low-dose group had a sensitivity of 86%, specificity of 100%, PPV and NPV of 100% and 86%. The accuracy of low-dose CT scan for detection of baggies larger than 1 cm was 100%. However, from the 3 cases that could not be detected with low dose protocol, one had CT features suspected for baggies rupture which was intubated and later deceased. Noise average of low-dose protocol, was approximately 7 times greater than standard dose group, while DLP and ED were 9.7 times less. Conclusion Low dose CT scan appears to be an appropriate screening method for body stuffers, especially when the baggies are larger than one centimeter. However, in the presence of severe clinical symptoms, a standard dose CT scan will be more helpful due to better image quality especially in suspected ruptured baggies. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1377220

Suicidal bupropion ingestions in adolescents: increased morbidity compared with other antidepressants Sheridan DC, Lin A, Zane Horowitz B. Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1377839: Objective Bupropion is often categorized as a newer generation antidepressant and assessed with serotonin reuptake inhibitors as a lower risk than older tricyclic antidepressants (TCAs). The objective of this study was to compare outcomes in adolescent suicide from ingestions between bupropion and TCA medications. Study design An analysis of the National Poison Data System for exposures coded "suspected suicide" in adolescents (age: 13–19) was undertaken for the years 2013–2016 and included TCAs or bupropion. We compared clinical effects, therapies and medical outcomes. Results Over the four-year period there were 2253 bupropion and 1496 TCA adolescent suspected suicide calls. There was a significant linear increase in bupropion ingestions over the four years. Across all years, there were on average 189.2 (95% CI: 58.1–320.4; p = .01) more ingestions of bupropion than TCA. When comparing bupropion to a TCA, ingestions of bupropion were significantly more likely to be accompanied by seizure (30.7% vs 3.9%; p < .01), to be admitted (74.8% vs 61.6%; p < .01) and medical outcomes to be coded as a major outcome (19.3% vs 10.0%; p < .01). The number of cases with death or major clinical outcome for both increased over the four-year period. Ingestions of bupropion were less likely to have hypotension (2.7% vs 8.0%; p < .01) and less likely to be intubated (5.6% vs 16.4%; p < .01) as compared to ingestions of TCA.

Conclusions Adolescents who overdose on a single medication in a suicide attempt with bupropion have a statistically significant higher incidence of major outcomes and seizures. The risks of bupropion as a potential means of suicidal gesture by overdose must be considered, and weighed against its benefits and side effect profile when choosing an appropriate agent for the treatment of depression in adolescents. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1377839

DMTS is an effective treatment in both inhalation and injection models for cyanide poisoning using unanesthetized mice DeLeon SM, Downey JD, Hildenberger DM, Rhoomes MO, Booker L, Rockwood GA, Basi KA. Clin Toxicol 2017; online early: doi: 10.1080/ 15563650.2017.1376749: Context Cyanide (CN) is a metabolic poison, halting ATP synthesis by inhibiting complex IV of the electron transport chain. If exposed at high enough concentrations, humans and most animals can die within minutes. Because time is a crucial factor in survival of CN poisoning, a rapidly bioavailable, nontoxic, easy to administer CN medical countermeasure could improve morbidity/mortality in a mass CN exposure scenario. The most likely route of exposure to CN is via inhalation. Objective This study examined the efficacy of a new formulation for dimethyl trisulfide (DMTS), a countermeasure which has shown promise as a treatment for CN poisoning, using both inhalation and injection models of CN exposure. Methods We developed a model of acute CN inhalation intoxication, using the highly toxic agent system from CH Technologies for nose-only exposure. Both continuous and discontinuous HCN exposure paradigms were implemented. For comparison, we also utilized a potassium cyanide (KCN) injection model. In all experiments, DMTS was administered as a cyanide countermeasure via intramuscular injection in unanesthetized mice. Results We found DMTS administration to be highly protective against both subcutaneous KCN and HCN inhalation toxicity. In the KCN injection model, DMTS afforded protection against 3.73 times the LD50 dose of KCN. In our HCN inhalation exposure model, mice challenged with LC50 HCN doses for the duration of either 10- or 40-minute exposure paradigms demonstrated improved survival in the presence of DMTS treatment (87.5% and 90.0% survival, respectively). Animals in the DMTS treatment groups of both lethal exposure models similarly exhibited improvement in observed toxic signs. Conclusion We show that a newly developed formulation of DMTS is efficacious within two lethal CN exposure mouse models (inhalation and injection) and is highly effective by intramuscular injection. Within these HCN studies, we demonstrate efficacy of DMTS in both continuous and discontinuous inhalation exposure models. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1376749

Synthetic cannabinoid "Black Mamba" infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort Brandehoff N, Adams A, McDaniel K, Banister SD, Gerona R, Monte AA. Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1357826: Background Use of new psychoactive substances (NPS) has increased over the last decade. During this period, variability of both clinical presentations and chemical compositions of these compounds has increased. Synthetic cannabinoids (SCs) are the most commonly used NPS and there are more than 100 documented unique molecules in this class. "Black Mamba", often associated to ADB-FUBINACA, is the most commonly used SC in Colorado. It has been linked to kidney injury, myocardial toxicity, seizures, and death. Objectives We aim to identify the chemical constituents and quantification of eight cases of reported "Black Mamba" use in order to further understand the clinical variability in patients presenting for emergency stabilization. Methods We report data from eight cases of reported "Black Mamba" use prospectively captured through the Colorado site of the Psychoactive Surveilance Consortium and Analysis Network (P SCAN). P SCAN is a geographically representative group of academic hospitals that capture clinical presentation, outcome, and biologic samples from patients that present for emergency stabilization following NPS use. Serum and urine samples were analyzed and quantified by liquid chromatography-quadrupole time-of-flight mass spectrometry after a qualitative screen for over 600 unique NPS compounds. Results In the reported eight cases, the median age was 28 years old. There were four male and four females. Four patients had agitation/delirium and four patients had chest pain. Normal saline, benzodiazepines and ondansetron were the common treatment provided in the emergency department (ED). Two patients were discharged from the ED and six patients being admitted for emergency observation with a median length of stay (LOS) of six hours. No deaths were reported. Confirmatory testing revealed that only five patients (62.5%) had SCs found in blood or urine samples. Cocaine, NRG-3, 3-methoxyphencyclidine hydrochloride (MeO-PCP), and methamfetamine were identified in other presentations. Conclusions The wide range of clinical presentations from "Black Mamba" use may be explained by the wide variability of chemical constituents found by laboratory analysis. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1357826

Intoxications in the STRIDA project involving a panorama of psychostimulant pyrovalerone derivatives, MDPV copycats Beck O, Bäckberg M, Signell P, Helander A. Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1370097: 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 intoxications involving 11 stimulant pyrovalerone NPS derivatives over a 5-year period.

Study design Case series of consecutive patients with admitted or suspected intake of NPS presenting to Swedish hospitals for emergency treatment from January 2011 to March 2016. Patients and method Blood and urine samples were collected from intoxicated patients presenting to hospitals all over Sweden. Analyses of NPS and other drugs of abuse were performed by immunochemical and liquid chromatography-mass spectrometry multi-component methods. Clinical data were collected during consultation with the Swedish Poisons Information Centre (PIC), and retrieved from medical records. The study involved analytically confirmed cases with 11 pyrovalerone drugs. Results During the study period, 114 intoxications were detected that involved any of 11 new pyrovalerone drugs. In addition to these new pyrovalerone derivatives, 3,4- methylenedioxypyrovalerone (MDPV) was detected in 17 of the cases and alpha- pyrrolidinovalerophenone (α-PVP) in 45 cases. Identification was made according to forensic standards and comprised the following substances: 4F- α-PVP, α-PHP, PV8, 4Me-PPP, α-PBP, 4F-PV8, α-PPP, MDPHP, α-PVT, 4Cl- α-PVP, and 4F- α-PHP. The three most frequently detected drugs were α-PBP, MDPHP, and 4F- α-PVP. The age range of patients was 16–66 (median 30) years and 84% were males. The substance concentrations in urine and serum were highly variable, ranging from 1 ng/mL to 300 µ/mL. Poly-drug use was common with only 8 of 114 cases (7%) involving one pyrovalerone drug. The additional substances comprised other NPS and classical psychoactive drugs. The patients showed a variety of clinical signs; agitation, delirium, hallucinations, excessive motor activity, seizures, tachycardia, hypertension, and/or hyperthermia. Conclusions In analytically confirmed NPS-related intoxications, 11 new pyrovalerone derivatives in addition to MDPV and α-PVP were found. The clinical features were consistent with a sympathomimetic toxidrome, but the urine and serum concentrations were highly variable. The results demonstrated that many novel pyrovalerone stimulants were introduced on the recreational NPS drugs market. Analytical investigations were necessary to obtain this information. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1370097

Clinical predictors of tissue necrosis following rattlesnake envenomation Heise CW, Ruha A-M, Padilla-Jones A, Truitt Hayek C, Gerkin RD. Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1371311: Background Rattlesnake envenomation (RSE) causes edema, hemotoxicity and tissue necrosis. Necrosis may result in permanent disability. Objective To study patient-related factors associated with tissue necrosis after Crotalus envenomation. Methods Prospective cohort study of patients admitted to the Medical Toxicology service with diagnosis of RSE between April 2011 and November 2014. Inclusion criteria were age ≥18 years and upper extremity (UE) envenomation site. Primary outcome was tissue necrosis, including dermonecrosis, manifesting as bullae. Secondary outcome was amputation.

Results 77 subjects, age 18 to 88 years, met inclusion criteria. Rattlesnake species was unknown in most cases. All received Fab antivenom. 62 (82%) had a digital envenomation. 31 (40.3%) had necrosis. Necrotic area ranged from 0.1 cm2 to 14 cm2. Procedural interventions, (superficial debridement, dermotomy, surgical exploration, and operative debridement of devitalized tissue) occurred in 25 (32.5%). Five (6.5%) underwent dermotomy and 6 (7.8%) operative debridement. No amputations were performed. Patients with cyanosis on presentation had increased risk of developing necrosis (11/12; RR 2.98 95% CI 1.99–4.46). Ecchymosis on presentation was also associated with increased risk of necrosis (24/32; RR 4.04 95% CI 2.08–7.86). Patients with social or regular ethanol use were more likely to develop necrosis than those without (28/53; RR 4.23 95% CI 1.42–12.6). Regular cocaine use was associated with increased risk of operative debridement (4/6; RR 9.13 95% CI 2.33–35.8). A nonsignificant risk of operative debridement occurred with tobacco use (RR 1.14 95%CI 0.99-1.31 p = 0.09). Time to antivenom did not correlate with risk of necrosis. Conclusion UE RSE patients who presented with cyanosis, ecchymosis or history of ethanol use were at increased risk of developing necrosis. Cocaine use was associated with increased risk of operative debridement. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1371311

Carbon monoxide poisoning from waterpipe smoking: a retrospective cohort study Eichhorn L, Michaelis D, Kemmerer M, Jüttner B, Tetzlaff K. Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1375115: Objective Waterpipe smoking may increasingly account for unintentional carbon monoxide poisoning, a serious health hazard with high morbidity and mortality. We aimed at identifying waterpipe smoking as a cause for carbon monoxide poisoning in a large critical care database of a specialty care referral center. Methods This retrospective cohort study included patients with a history of exposure to waterpipe smoking and carbon monoxide blood gas levels >10% or presence of clinical symptoms compatible with CO poisoning admitted between January 2013 and December 2016. Patients' initial symptoms and carbon monoxide blood levels were retrieved from records and neurologic status was assessed before and after hyperbaric oxygen treatment. Results Sixty-one subjects with carbon monoxide poisoning were included [41 males, 20 females; mean age 23 (SD ± 6) years; range 13–45] with an initial mean carboxyhemoglobin of 26.93% (SD ± 9.72). Most common symptoms included syncope, dizziness, headache, and nausea; 75% had temporary syncope. Symptoms were not closely associated with blood COHb levels. Conclusion CO poisoning after waterpipe smoking may present in young adults with a wide variability of symptoms from none to unconsciousness. Therefore diagnosis should be suspected even in the absence of symptoms. Full text available from: http://dx.doi.org/10.1080/15563650.2017.1375115

Metal-on-metal hip joint prostheses: a retrospective case series investigating the association of systemic toxicity with serum cobalt and chromium concentrations Ho JH, Leikin JB, Dargan PI, Archer JRH, Wood DM, Brent J. J Med Toxicol 2017; online early: doi: 10.1007/s13181-017-0629-1: Abstract and full text available from: http://dx.doi.org/10.1007/s13181-017-0629-1

Overdoses with aripiprazole: signs, symptoms and outcomes in 239 exposures reported to the Danish Poison Information Center Christensen AP, Boegevig S, Christensen MB, Petersen KM, Dalhoff KP, Petersen TS. Basic Clin Pharmacol Toxicol 2017; online early: doi: 10.1111/bcpt.12902: Abstract and full text available from: http://dx.doi.org/10.1111/bcpt.12902

Extracorporeal life support and digoxin-specific Fab fragments for successful management of Taxus baccata intoxication with low output and ventricular arrhythmia Farag M, Badowski D, Koschny R, Skopp G, Brcic A, Szabo GB. Am J Emerg Med 2017; online early: doi: 10.1016/j.ajem.2017.09.031: Abstract and full text available from: http://dx.doi.org/10.1016/j.ajem.2017.09.031

Post-mortem findings in 22 fatal Taxus baccata intoxications and a possible solution to its detection Reijnen G, Bethlehem C, van Remmen JMBL, Smit HJM, Van Luin M, Reijnders UJL. J Forensic Leg Med 2017; 52: 56-61. Abstract and full text available from: http://dx.doi.org/10.1016/j.jflm.2017.08.016

Reversal of dabigatran-associated bleeding using idarucizumab: review of the current evidence Giustozzi M, Verso M, Agnelli G, Becattini C. J Thromb Thrombolysis 2017; online early: doi: 10.1007/s11239-017-1555-4: Abstract and full text available from: http://dx.doi.org/10.1007/s11239-017-1555-4

Detection of tetrodotoxin shellfish poisoning (TSP) toxins and causative factors in bivalve molluscs from the UK Turner AD, Dhanji-Rapkova M, Coates L, Bickerstaff L, Milligan S, O'Neill A, Faulkner D, McEneny H, Baker-Austin C, Lees DN, Algoet M. Mar Drugs 2017; 15: 277.

Abstract and full text available from: http://dx.doi.org/10.3390/md15090277

Epidemiologic features and outcomes of caustic ingestions; a 10-year cross-sectional study Alipour Faz A, Arsan F, Peyvandi H, Oroei M, Shafagh O, Peyvandi M, Yousefi M. Emerg (Tehran) 2017; 5: e56. Abstract and full text available from: https://www.ncbi.nlm.nih.gov/pubmed/28894772

TOXICOLOGY Wozniak MK, Wiergowski M, Aszyk J, Kubica P, Namiesnik J, Biziuk M. Analytical toxicology Application of gas chromatography–tandem mass spec- Boumba VA, Di Rago M, Peka M, Drummer OH, trometry for the determination of amphetamine-type Gerostamoulos D. stimulants in blood and urine. The analysis of 132 novel psychoactive substances in J Pharm Biomed Anal 2017; 148: 58-64. human hair using a single step extraction by tandem LC/MS. Forensic Sci Int 2017; 279: 192-202. Biomarkers Chen L, Smith JD, Mikl J, Fryer R, Pack F, Williams BJ, Caspar AT, Kollas AB, Maurer HH, Meyer MR. Phillips J, Papov V. Development of a quantitative approach in blood plasma Multi-platform approach for the discovery of novel drug- for low-dosed hallucinogens and opioids using LC-high induced kidney injury biomarkers. resolution mass spectrometry. Chem Res Toxicol 2017; online early: Talanta 2018; 176: 635-45. doi: 10.1021/acs.chemrestox.7b00159:

Cuypers E, Flanagan RJ. El Rahman HAA, Salama M, Gad El-Hak SA, El-Harouny The interpretation of hair analysis for drugs and drug MA, ElKafrawy P, Abou-Donia MB. metabolites. A panel of autoantibodies against neural proteins as Clin Toxicol 2017; online early: peripheral biomarker for pesticide-induced neurotoxicity. doi: 10.1080/15563650.2017.1379603: Neurotox Res 2017; online early: doi: 10.1007/s12640-017- 9793-y: Henkel K, Altenburger MJ, Auwärter V, Neukamm MA. Full validation of a method for the determination of drugs of Ismail AA, Wang K, Olson JR, Bonner MR, Hendy O, abuse in non-mineralized dental biofilm using liquid chro- Rasoul GA, Rohlman DS. matography-tandem mass spectrometry and application to The impact of repeated organophosphorus pesticide postmortem samples. exposure on biomarkers and neurobehavioral outcomes Talanta 2018; 176: 360-6. among adolescent pesticide applicators. J Toxicol Environ Health A 2017; online early: Lehmann S, Kieliba T, Beike J, Thevis M, Mercer- doi: 10.1080/15287394.2017.1362612: Chalmers-Bender K. Determination of 74 new psychoactive substances in Body packers serum using automated in-line solid-phase extraction- Bahrami-Motlagh H, Mahboubi-Fooladi Z, Salevatipour B, liquid chromatography-tandem mass spectrometry. Hassanian-Moghaddam H, Mirhashemi SH. J Chromatogr B Biomed Sci Appl 2017; 1064: 124-38. Comparison of low dose and standard dose abdominal CT scan in body stuffers. Li S, Chen D. Clin Toxicol 2017; online early: Rapid determination of aconitum alkaloids from human doi: 10.1080/15563650.2017.1377220: urine by UHPLC-HRMS. J Anal Toxicol 2017; 41: 611-7. Heymann-Maier L, Trueb L, Schmidt S, Carron P-N, Hugli O, Heymann E, Yersin B. Maas A, Maier C, Iwersen-Bergmann S, Madea B, Hess C. Emergency department management of body packers and Simultaneous extraction of propofol and propofol glucuronide body stuffers. from hair followed by validated LC-MS/MS analyses. Swiss Med Wkly 2017; 147: w14499. J Pharm Biomed Anal 2017; 146: 236-43. Visentin S, Bevilacqua G, Giraudo C, Dengo C, Nalesso A, Magalhães P, Alves G, Llerena A, Falcão A. Montisci M. Therapeutic drug monitoring of fluoxetine, norfluoxetine Death by heroin intoxication in a body pusher with an and paroxetine: a new tool based on microextraction by innovative packaging technique: case report and review of packed sorbent coupled to liquid chromatography. the literature. J Anal Toxicol 2017; 41: 631-8. Forensic Sci Int 2017; 280: 8-14.

Murphy CM, Devlin JJ, Beuhler MC, Cheifetz P, Maynard S, Cardiotoxicity Schwartz MD, Kacinko S. Abroug F, Ouanes I, Maatouk M, Golli M, Ouanes-Besbes L. Detection of ingested nitromethane and reliable creatinine Inverted Takotsubo syndrome in Androctonus australis assessment using multiple common analytical methods. scorpion envenomation. Clin Toxicol 2017; online early: Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1360497: doi: 10.1080/15563650.2017.1377221:

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Fragrance chemicals Disinfectant byproducts Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, Chiu SK, Burton NC, Dunn KH, de Perio MA. Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, Respiratory and ocular symptoms among employees of an Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler indoor waterpark resort — Ohio, 2016. DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, MMWR Morb Mortal Wkly Rep 2017; 66: 986-9. Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Theophilus EH, Tiethof AK, Tokura Y. Disinfectants RIFM fragrance ingredient safety assessment, ethyl 2-tert- Kim W-Y, Hong S-B. butylcyclohexyl carbonate, CAS registry number 67801-64-3. Humidifier disinfectant-associated lung injury: six years Food Chem Toxicol 2017; online early: after the tragic event. doi: 10.1016/j.fct.2017.09.033:

Tuberc Respir Dis (Seoul) 2017; 80: e2. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, E-cigarettes and e-liquids Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Farsalinos KE, Voudris V, Spyrou A, Poulas K. DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, E-cigarettes emit very high formaldehyde levels only in Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, conditions that are aversive to users: a replication study Theophilus EH, Tiethof AK, Tokura Y. under verified realistic use conditions. RIFM fragrance ingredient safety assessment, propyl Food Chem Toxicol 2017; 109: 90-4. phenethyl acetal, CAS Registry Number 7493-57-4. Food Chem Toxicol 2017; online early: Polosa R, Russell C, Nitzkin J, Farsalinos KE. doi: 10.1016/j.fct.2017.09.030:

Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, 3,12- Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, Tridecadienenitrile CAS Registry Number 134769-33-8. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.09.041: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, 3-methyl-2- Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, pentylcyclopentan-1-one, CAS Registry Number 13074-63-0. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.08.035: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, acetaldehyde Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, ethyl phenylethyl acetal, CAS Registry Number 2556-10-7. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.09.040: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, phenyl- Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, acetaldehyde diethyl acetal, CAS Registry Number 6314-97-2. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.08.039: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, 2-isopropyl-4- Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, methylanisole, CAS Registry Number 31574-44-4. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.09.039: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, menthyl Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, isovalerate CAS registry number 16409-46-4. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.09.035: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment 2-heptyl- Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, cyclopentanone, CAS Registry Number 137-03-1. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.09.034: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y,

Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, benzene- Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, propanol, a,ß-dimethyl-, CAS Registry Number 56836-93-2. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.09.009: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y,

Theophilus EH, Tiethof AK, Tokura Y. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, RIFM fragrance ingredient safety assessment, p-(2,2- Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, dimethoxyethyl)toluene, CAS Registry Number 42866-91-1. Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler Food Chem Toxicol 2017; online early: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, doi: 10.1016/j.fct.2017.08.034: Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y,

Theophilus EH, Tiethof AK, Tokura Y. RIFM fragrance ingredient safety assessment, 4-isopropyl-2- Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, methoxy-1-methylbenzene, CAS Registry Number 6379-73-3. Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, Food Chem Toxicol 2017; online early: Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler doi: 10.1016/j.fct.2017.09.008: DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, Theophilus EH, Tiethof AK, Tokura Y. Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, RIFM fragrance ingredient safety assessment, 1-methyl-3- Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler DC, methoxy-4-isopropylbenzene, CAS Registry Number 1076- O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, 56-8. Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Tokura Food Chem Toxicol 2017; online early: Y, Tsang S, Wahler J. doi: 10.1016/j.fct.2017.08.042:

RIFM fragrance ingredient safety assessment, alcohols, C8- 10-iso-, C9-rich, CAS Registry Number 68526-84-1. Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, Food Chem Toxicol 2017; online early: Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, doi: 10.1016/j.fct.2017.09.028: Francis M, Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler DC, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, Api AM, Belsito D, Botelho D, Browne D, Bruze M, Burton GA, Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Jr., Buschmann J, Dagli ML, Date M, Dekant W, Deodhar C, Theophilus EH, Tiethof AK, Tokura Y. Fryer AD, Joshi K, La Cava S, Lapczynski A, Liebler DC, RIFM fragrance ingredient safety assessment, acetaldehyde, O'Brien D, Parakhia R, Patel A, Penning TM, Ritacco G, diphenethyl acetal, CAS Registry Number 122-71-4. Romine J, Salvito D, Schultz TW, Sipes IG, Thakkar Y, Tokura Food Chem Toxicol 2017; online early: Y, Tsang S, Wahler J. doi: 10.1016/j.fct.2017.08.036:

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Hoang VAT, Do HTT, Agusa T, Koriyama C, Akiba S, Zarn JA, O'Brien CD. Ishibashi Y, Sakamoto M, Yamamoto M. Current pesticide dietary risk assessment in light of Hair mercury levels in relation to fish consumption among comparable animal study NOAELs after chronic and short- Vietnamese in Hanoi. termed exposure durations. J Toxicol Sci 2017; 42: 651-62. Arch Toxicol 2017; online early: doi: 10.1007/s00204-017-

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Linde SJL, Franken A, Du Plessis JL. Occupational respiratory exposure to platinum group Biocides metals: a review and recommendations. Schettgen T, Kraus T. Chem Res Toxicol 2017; online early: Urinary excretion kinetics of the metabolite N- doi: 10.1021/acs.chemrestox.7b00184: methylmalonamic acid (NMMA) after oral dosage of chloromethylisothiazolinone and methylisothiazolinone in human volunteers. Thallium Arch Toxicol 2017; online early: doi: 10.1007/s00204-017- Osorio-Rico L, Santamaria A, Galván-Arzate S. 2051-5: Thallium toxicity: general issues, neurological symptoms, and neurotoxic mechanisms. Adv Neurobiol 2017; 18: 345-53. Organochlorine pesticides General Titanium Sharma N, Garg D, Deb R, Samtani R. Hong F, Zhou Y, Zhao X, Sheng L, Wang L. Toxicological profile of organochlorines aldrin and dieldrin: Maternal exposure to nanosized titanium dioxide an Indian perspective. suppresses embryonic development in mice. Rev Environ Health 2017; online early: Int J Nanomedicine 2017; 12: 6197-204. doi: 10.1515/reveh-2017-0013:

Toichuev RM, Zhilova LV, Makambaeva GB, Payzildaev TR, Vanadium Pronk W, Bouwknegt M, Weber R. Ngwa HA, Ay M, Jin H, Anantharam V, Kanthasamy A, Assessment and review of organochlorine pesticide Kanthasamy AG. pollution in Kyrgyzstan. Neurotoxicity of vanadium. Environ Sci Pollut Res Int 2017; online early: in Neurotoxicity of metals, ed. by M Aschner & LG Costa. doi: 10.1007/s11356-017-0001-7: 287-301. 2017. Organophosphorus insecticides PESTICIDES General General Ismail AA, Wang K, Olson JR, Bonner MR, Hendy O, El Rahman HAA, Salama M, Gad El-Hak SA, El-Harouny Rasoul GA, Rohlman DS. MA, ElKafrawy P, Abou-Donia MB. The impact of repeated organophosphorus pesticide A panel of autoantibodies against neural proteins as exposure on biomarkers and neurobehavioral outcomes peripheral biomarker for pesticide-induced neurotoxicity. among adolescent pesticide applicators. Neurotox Res 2017; online early: doi: 10.1007/s12640- J Toxicol Environ Health A 2017; online early: 017-9793-y: doi: 10.1080/15287394.2017.1362612:

Terekhov SS, Palikov VA, Palikova YA, Dyachenko IA, Anthrax lethal toxin (LeTx) neutralization by PA domain Shamborant OG, Smirnov IV, Masson P, Gabibov AG. specific antisera. Application of tetrameric recombinant human butyryl- Toxicon 2017; online early: cholinesterase as a biopharmaceutical for amelioration of doi: 10.1016/j.toxicon.2017.09.008: symptoms of acute organophosphate poisoning. Bull Exp Biol Med 2017; 163: 430-5. Ricin Barnewall RE, Riffle CG, Jones RL, Guistino DJ, Chou RM, Zafar R, Munawar K, Nasrullah A, Haq S, Ghazanfar H, Anderson MS, Vassar ML, Howland CA. Sheikh AB, Khan AY. Biochemical and aerosol characterization of ricin for use in Acute renal failure due to organophosphate poisoning: a non-clinical efficacy studies. case report. J Biochem Mol Toxicol 2017; online early: Cureus 2017; 9: e1523. doi: 10.1002/jbt.21980:

Dichlorvos Taubenschmid J, Stadlmann J, Jost M, Klokk TI, Rillahan Akande MG, Ahmed US. CD, Leibbrandt A, Mechtler K, Paulson JC, Jude J, Zuber J, Taurine abated subacute dichlorvos toxicity. Sandvig K, Elling U, Marquardt T, Thiel C, Koerner C, Toxicol Rep 2017; 4: 463-6. Penninger JM. A vital sugar code for ricin toxicity. Fenitrothion Cell Res 2017; online early: doi: 10.1038/cr.2017.116:

Park JT, Choi KH. Polyneuropathy following acute fenitrothion poisoning. Chemical warfare Clin Toxicol 2017; online early: Mustard gas doi: 10.1080/15563650.2017.1378354: Florent M, Giannakoudakis DA, Bandosz TJ. Mustard gas surrogate interactions with modified porous Monocrotophos carbon fabrics: effect of oxidative treatment. Hou Y, Liu S-W, Wang L, Wu S-H. Langmuir 2017; online early: Physiopathology of multiple organ dysfunction in severely doi: 10.1021/acs.langmuir.7b02047: monocrotophos-poisoned rabbits. Chem Biol Interact 2017; online early: Jiang A, Maibach H. doi: 10.1016/j.cbi.2017.08.016: Dermatotoxicology of sulfur mustard: historical perspectives from World War I. Paraoxon J Appl Toxicol 2017; online early: doi: 10.1002/jat.3524: de Koning MC, van Grol M, Breijaert T. Degradation of paraoxon and the chemical warfare agents Nerve agents VX, tabun, and soman by the metal-organic frameworks de Koning MC, van Grol M, Breijaert T. UiO-66-NH2, MOF-808, NU-1000, and PCN-777. Degradation of paraoxon and the chemical warfare agents Inorg Chem 2017; online early: VX, tabun, and soman by the metal-organic frameworks doi: 10.1021/acs.inorgchem.7b01809: UiO-66-NH2, MOF-808, NU-1000, and PCN-777. Inorg Chem 2017; online early: Rodenticides doi: 10.1021/acs.inorgchem.7b01809:

Bromadiolone Golime R, Palit M, Acharya J, Dubey DK. Wang M, Yang Y, Hou Y, Ma W, Jia R, Chen J. Neuroprotective effects of galantamine on nerve agent- Effects of bromadiolone poisoning on the central nervous induced neuroglial and biochemical changes. system. Neurotox Res 2017; online early: doi: 10.1007/s12640- Neuropsychiatr Dis Treat 2017; 13: 2297-300. 017-9815-9:

Tetramethylenedisulfotetramine Vucinic S, Antonijevic B, Tsatsakis AM, Vassilopoulou L, Rice NC, Rauscher NA, Langston JL, Myers TM. Docea AO, Nosyrev AE, Izotov BN, Thiermann H, Drakoulis Behavioral intoxication following voluntary oral ingestion N, Brkic D. of tetramethylenedisulfotetramine: dose-dependent onset, Environmental exposure to organophosphorus nerve agents. severity, survival, and recovery. Environ Toxicol Pharmacol 2017; 56: 163-71. Neurotoxicology 2017; 63: 21-32. PLANTS Thallium Osorio-Rico L, Santamaria A, Galván-Arzate S. Aconitum spp. Thallium toxicity: general issues, neurological symptoms, Li S, Chen D. and neurotoxic mechanisms. Rapid determination of aconitum alkaloids from human Adv Neurobiol 2017; 18: 345-53. urine by UHPLC-HRMS. J Anal Toxicol 2017; 41: 611-7.

CHEMICAL WARFARE, Annona reticulata (Custard Apple) BIOLOGICAL WARFARE AND Devi Nivean P, Malarkodi S, Nishanth M, Nivean M. Custard apple seed induced keratitis: a harmful traditional RIOT CONTROL AGENTS practice in South India. Biological warfare GMS Ophthalmol Cases 2017; 7: Doc23. Anthrax Verma M, Suryanarayana N, Tuteja U, Thavachelvam K, Cerbera odollam (Suicide tree) Rao MK, Bhargawa R, Shukla S. Fok H, Victor P, Bradberry S, Eddleston M.

Novel methods of self-poisoning: repeated cardenolide Reijnen G, Bethlehem C, van Remmen JMBL, Smit HJM, poisoning after accessing Cerbera odollam seeds via the Van Luin M, Reijnders UJL. internet. Post-mortem findings in 22 fatal Taxus baccata Clin Toxicol 2017; online early: intoxications and a possible solution to its detection. doi: 10.1080/15563650.2017.1369543: J Forensic Leg Med 2017; 52: 56-61.

Cynara cardunculus (Artichoke) Thevetia spp. (Yellow oleander) Campos MG, Machado J, Costa ML, Lino S, Correia F, Anandhi D, Raju KP, Basha MH, Pandit VR. Maltez F. Acute myocardial infarction in yellow oleander poisoning. Case report: Severe hematological, muscle and liver J Postgrad Med 2017; online early: toxicity caused by drugs and artichoke infusion interaction doi: 10.4103/jpgm.JPGM_141_17: in an elderly polymedicated patient. Curr Drug Saf 2017; online early: González-Stuart A, Rivera JO. doi: 10.2174/1574886312666170912163746: Yellow oleander seed, or "Codo de Fraile" (Thevetia spp.): a review of its potential toxicity as a purported weight-loss Datura stramonium (Jimsonweed) supplement. Tranca SD, Szabo R, Cocis M. J Diet Suppl 2017; online early: Acute poisoning due to ingestion of Datura stramonium - a doi: 10.1080/19390211.2017.1353565: case report. Rom J Anaesth Intensive Care 2017; 24: 65-8. ANIMALS

Fish/marine poisoning Euphorbia Chang C-H, Lu C-W, Chung W-H, Ho H-C. McVeigh K. Acute fish liver intoxication induced blisters formation and Ubiquitous euphorbia is anything but euphoria for the eye: generalized skin peeling. a reminder to get any area of contact with the toxic sap Clin Toxicol 2017; online early: under the tap. doi: 10.1080/15563650.2017.1341634: Eye (Lond) 2017; online early: doi: 10.1038/eye.2017.204:

Sovann K. Hypericum perforatum (St John's Acute kidney injury due to fish gallbladder ingestion: a wort) case report from Cambodia. Soleymani S, Bahramsoltani R, Rahimi R, Abdollahi M. Blood Purif 2017; 44 Suppl 1: 22-5. Clinical risks of St John's Wort (Hypericum perforatum) co- administration. Vidal F, Sedan D, D'Agostino D, Cavalieri ML, Mullen E, Expert Opin Drug Metab Toxicol 2017; online early: doi: Parot Varela MM, Flores C, Caixach J, Andrinolo D. 10.1080/17425255.2017.1378342: Recreational exposure during algal bloom in Carrasco beach, Uruguay: a liver failure case report. Toxins (Basel) 2017; 9: 267. Mitragyna speciosa (Kratom) Griffin OH, Webb ME. The scheduling of Kratom and selective use of data. Tetrodotoxin J Psychoactive Drugs 2017; online early: Turner AD, Dhanji-Rapkova M, Coates L, Bickerstaff L, doi: 10.1080/02791072.2017: Milligan S, O'Neill A, Faulkner D, McEneny H, Baker-Austin C, Lees DN, Algoet M. Detection of tetrodotoxin shellfish poisoning (TSP) toxins Mushrooms and causative factors in bivalve molluscs from the UK. Cervellin G, Comelli I, Rastelli G, Sanchis-Gomar F, Negri Mar Drugs 2017; 15: 277. F, De LC, Lippi G. Epidemiology and clinics of mushroom poisoning in Northern Italy: a 21-year retrospective analysis. Frogs Hum Exp Toxicol 2017; online early: Aquila I, Gratteri S, Sacco MA, Fineschi V, Magi S, doi: 10.1177/0960327117730882: Castaldo P, Viscomi G, Amoroso S, Ricci P. The biological effects of Kambo: is there a relationship Diaz JH. between its administration and sudden death? Colorful mushroom ingestion. J Forensic Sci 2017; online early: doi: 10.1111/1556- Wilderness Environ Med 2017; online early: 4029.13641: doi: 10.1016/j.wem.2017.07.006: Hymenoptera Woloszyn A, Kotlowski R. Cross B, Choudhury TR, Hindle M, Galasko G. A universal method for the identification of genes encoding Wasp sting induced STEMI with complete coronary artery amatoxins and phallotoxins in poisonous mushrooms. occlusion: a case of Kounis syndrome. Rocz Panstw Zakl Hig 2017; 68: 247-51. BMJ Case Rep 2017; doi: 10.1136/bcr-2017-221256:

Taxus baccata (Yew) Scorpions Farag M, Badowski D, Koschny R, Skopp G, Brcic A, Abroug F, Ouanes I, Maatouk M, Golli M, Ouanes-Besbes L. Szabo GB. Inverted Takotsubo syndrome in Androctonus australis Extracorporeal life support and digoxin-specific Fab scorpion envenomation. fragments for successful management of Taxus baccata Clin Toxicol 2017; online early: intoxication with low output and ventricular arrhythmia. doi: 10.1080/15563650.2017.1377221: Am J Emerg Med 2017; online early: doi: 10.1016/j.ajem.2017.09.031: Al-Asmari A, Manthiri RA, Abdo N, Al-Duaiji FA, Khan HA.

Saudi medicinal plants for the treatment of scorpion sting Neuromuscular paralysis by the basic phospholipase A2 envenomation. subunit of crotoxin from Crotalus durissus terrificus snake Saudi J Biol Sci 2017; 24: 1204-11. venom needs its acid chaperone to concurrently inhibit acetylcholine release and produce muscle blockage. Hauke TJ, Herzig V. Toxicol Appl Pharmacol 2017; 334: 8-17. Dangerous arachnids-fake news or reality? Toxicon 2017; 138: 173-83. Heise CW, Ruha A-M, Padilla-Jones A, Truitt Hayek C, Gerkin RD. Hurst NB, Lipe DN, Karpen SR, Patanwala AE, Taylor AM, Clinical predictors of tissue necrosis following rattlesnake Boesen KJ, Shirazi FM. envenomation. Centruroides sculpturatus envenomation in three adult Clin Toxicol 2017; online early: patients requiring treatment with antivenom. doi: 10.1080/15563650.2017.1371311: Clin Toxicol 2017; online early: doi: 10.1080/15563650.2017.1371310: Rivas E, Neri-Castro E, Benard-Valle M, Hernanez-Davila AI, Zamudio F, Alagon A. Snake bites General characterization of the venoms from two species Gutiérrez JM, Calvete JJ, Habib AG, Harrison RA, Williams of rattlesnakes and an intergrade population (C. lepidus x DJ, Warrell DA. aquilus) from Aguascalientes and Zacatecas, Mexico. Snakebite envenoming. Toxicon 2017; 138: 191-5. Nat Rev Dis Primers 2017; 3: 17063. Elapidae Rahim S. Padula AM, Leister E. Haemoperitoneum secondary to snake bite. Severe neurotoxicity requiring mechanical ventilation in a S Afr J Surg 2017; 55: 67. dog envenomed by a red-bellied black snake (Pseudechis porphyriacus) and successful treatment with an Rizer J, King J, Charlton N. experimental bivalent whole equine IgG antivenom. In response to "Are changes necessary in the medical Toxicon 2017; 138: 159-64. management of a patient with snakebite regarding the incidence of hypersensitivity reaction to antivenom Spiders polyvalent immune Fab?". Hauke TJ, Herzig V. Clin Toxicol 2017; online early: Dangerous arachnids-fake news or reality? doi: 10.1080/15563650.2017.1376750: Toxicon 2017; 138: 173-83.

Crotalinae (Pit vipers) Sanaei-Zadeh H. Cavalcante WLG, Noronha-Matos JB, Timóteo MA, de Spider bite in Iran. Mattos Fontes MR, Gallacci M, Correia-de-Sá P. Electron Physician 2017; 9: 4703-7.

INDEX

Acetaminophen ...... 26 Apixaban ...... 21 Acetylcysteine ...... 18 Aripiprazole ...... 22 Aconitum spp...... 34 Arsenic ...... 31 Air pollution ...... 27 Artichoke ...... 35 Alcohol ...... 28 Baclofen...... 19, 22 Aldehydes ...... 28 Batteries ...... 28 Aluminium ...... 31 Benzene ...... 28 Aluminium phosphide ...... 33 Benzocaine ...... 21 Amfetamines ...... 20 Benzodiazepines ...... 22 Amygdalin ...... 21 Benzylpiperazine...... 22 Anaesthetics ...... 21 Beta-blockers ...... 19 Analytical toxicology ...... 11 Bevacizumab ...... 22 Animals, general ...... 35 Biocides ...... 33 Annona reticulata ...... 34 Biological warfare ...... 34 Anthrax ...... 34 Biomarkers ...... 11 Antiarrhythmic drugs ...... 21 Bisoprolol ...... 22 Anticoagulants ...... 21 Bisphenol S ...... 28 Anticonvulsants ...... 21 Bleomycin ...... 22 Antidepressants ...... 22 Body packers ...... 11 Antidotes ...... 18 Bromadiolone ...... 34 Antihistamines ...... 22 Buprenorphine ...... 19 Antimalarial drugs ...... 22 Bupropion ...... 22 Antineoplastic drugs ...... 22 Butyrylcholinesterase ...... 19 Antipsychotics ...... 22 Cadmium ...... 31 Antipyretic drugs ...... 22 Caffeine ...... 23 Antivenom ...... 18 Cannabidiol ...... 23 Antiviral drugs ...... 22 Cannabis ...... 23

Carbon monoxide ...... 28 Idarucizumab ...... 18 Cardiotoxicity ...... 11 Immunosuppressants ...... 24 Cerbera odollam ...... 34 Infusion fluid therapy...... 24 Chemical incidents ...... 27 Inhalation toxicity ...... 14 Chemical warfare, general ...... 34 Ivermectin ...... 24 Chemicals, general ...... 28 Jimsonweed ...... 35 Chromium ...... 32 Kambo ...... 24 Clozapine...... 22 Kerosene ...... 31 Cobalt ...... 32 Kinetics ...... 14 Colchicine ...... 23 Kratom ...... 24, 35 Contrast media ...... 28 Lamotrigine ...... 21 Copper ...... 32 Lead ...... 32 Copper sulphate ...... 28 Leucovorin ...... 24 Corrosives ...... 28 Lipid emulsion therapy ...... 18 Cosmetics ...... 28 Lithium ...... 24, 32 Crotalinae ...... 36 LSD ...... 24 Custard Apple ...... 34 Management, general ...... 17 Cyanide ...... 29 Manganese ...... 32 Cyclosporine ...... 24 Marijuana ...... 23 Cynara cardunculus ...... 35 MDMA ...... 20 Dabigatran ...... 21 Medication errors ...... 14 Datura stramonium ...... 35 Mercury ...... 33 Dermal toxicity...... 12 Metabolism ...... 14 Developmental toxicology ...... 12 Metals, general ...... 31 Diacetylmorphine ...... 23 Methadone ...... 19, 26 Dichlorvos ...... 34 Methotrexate ...... 24 Dietary supplements ...... 23 Mitragyna speciosa ...... 35 Digoxin ...... 23 Monocrotophos...... 34 Dioxins ...... 29 Morphine ...... 26 Diphenhydramine ...... 22 Mushrooms ...... 35 Disinfectant byproducts ...... 29 Mustard gas ...... 34 Disinfectants ...... 29 Naloxone ...... 18, 24 DMTS ...... 19 Nanoparticles ...... 31 Doxorubicin ...... 22 Nephrotoxicity ...... 14 Driving under the influence ...... 13 Nerve agents ...... 34 Drugs, general ...... 19 Neurotoxicity ...... 15 E-cigarettes and e-liquids ...... 29 Nicotine ...... 24 Ecstasy ...... 20 Nitrobenzene ...... 31 Elapidae ...... 36 Nitromethane ...... 31 Epidemiology ...... 13 Novel psychoactive substances ...... 24 Epinephrine ...... 23 Occupational toxicology ...... 15 Eslicarbazepine ...... 21 Ocular toxicity ...... 16 Essential oils ...... 29 Opioid maintenance therapy ...... 19 Ethanol...... 28 Opioids ...... 25 Ethnic remedies ...... 23 Opium ...... 26 Ethylene dibromide ...... 29 Organochlorine pesticides, general ...... 33 Eucalyptus oil ...... 29 Organophosphorus insecticides, general ...... 33 Euphorbia ...... 35 Oxycodone ...... 26 Extracorporeal treatments ...... 19 Paediatric toxicology ...... 16 Fab fragments ...... 18 Paracetamol ...... 26 Fenitrothion ...... 34 Paraffins ...... 31 Fentanyl ...... 26 Paraoxon ...... 34 Fish/marine poisoning ...... 35 Paroxetine...... 27 Flecainide ...... 21 Pesticides, general ...... 33 Fluoxetine ...... 27 Phenethylamines ...... 24 Foreign body ingestion ...... 13 Pit vipers ...... 36 Forensic toxicology ...... 13 Plants, general ...... 34 Formaldehyde ...... 29 Platinum ...... 33 Fragrance chemicals ...... 29 Poison information centres ...... 17 Frogs ...... 35 Poisons information ...... 17 Galantamine ...... 19 Polybrominated diphenyl ethers ...... 31 Gamma hydroxybutyrate ...... 23 Polytetrafluoroethylene ...... 31 Genotoxicity ...... 14 Pregabalin ...... 21 Glycine ...... 19 Propofol ...... 21 Hallucinogenic drugs ...... 23 Proton pump inhibitors...... 26 Hepatotoxicity ...... 14 Psychiatric aspects ...... 17 Herbal medicines ...... 19, 23 Psychoactive drugs ...... 26 Heroin ...... 23 Reprotoxicity ...... 17 Hydroxocobalamin ...... 18, 24 Ricin ...... 34 Hydroxychloroquine ...... 22 Risk assessment ...... 17 Hymenoptera ...... 35 Rodenticides ...... 34 Hypericum perforatum ...... 35 Salicylates ...... 27

Scorpions ...... 35 Tetrodotoxin ...... 35 Simvastatin ...... 27 Thallium...... 33, 34 Snake bites ...... 36 Thevetia spp...... 35 Sodium bicarbonate ...... 19 Ticagrelor ...... 27 Sodium thiosulfate ...... 19 Titanium ...... 33 Spiders ...... 36 Tobacco ...... 31 SSRIs and SNRIs ...... 27 Toxicology, general ...... 11 St John's wort ...... 35 Tramadol ...... 26 Statins ...... 27 Trazodone ...... 22 Substance abuse ...... 27 Triclosan ...... 31 Suicide ...... 17 U-47700...... 26 Suicide tree ...... 34 Valproate ...... 21 Synthetic cannabinoids ...... 25 Vanadium ...... 33 Synthetic cathinones ...... 25 Venlafaxine ...... 27 Synthetic opioids ...... 25 Water pollution ...... 27 Taurine ...... 19 Waterproofing aerosols ...... 31 Taxus baccata...... 35 Yellow oleander ...... 35 Tenofovir ...... 22 Yew) ...... 35 Tetramethylenedisulfotetramine ...... 34

The NPIS is commissioned by Public Health England