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2019 Annual Scientific Meeting Abstracts—San Francisco, CA Journal of Medical Toxicology https://doi.org/10.1007/s13181-019-00699-x ANNUAL MEETING ABSTRACTS ACMT 2019 Annual Scientific Meeting Abstracts—San Francisco, CA Abstract: These are the abstracts of the 2019AmericanCollegeofMedical of Medicine, Elk Grove, CA. 3Banner-University Medical Center, Toxicology (ACMT) Annual Scientific Meeting. Included here are 162 ab- Phoenix, Phoenix, AZ. 4University of Arizona College of Medicine, stracts that will be presented in April 2019 in San Francisco, California, Phoenix, AZ. 5Weill Cornell College of Medicine in Qatar and Hamad including research studies from around the globe and the ToxIC collabora- Medical Corporation, Doha, Qatar. 6University of Southern California, tion, clinically significant case reports describing new toxicologic phenome- Los Angeles, CA na, and encore research presentations from other scientific meetings. Background: Patients with bupropion overdose are routinely observed Keywords: Abstracts—Annual Scientific Meeting—Toxicology for prolonged periods due to concerns for delayed seizures. The study Investigators Consortium—Medical Toxicology Foundation—Pediatric sought to evaluate characteristics of bupropion ingestions and attempt to Environmental Health Specialty Units determine an appropriate observation period. Hypothesis: Patients with bupropion toxicity will have antecedent altered Correspondence: American College of Medical Toxicology (ACMT) mental status (AMS) and/or tachycardia before seizure. 10645 N. Tatum Blvd Phoenix, AZ; [email protected] Methods: This multicenter, retrospective study, utilized standard- ized data abstraction methods, included all patients who presented Introduction: The American College of Medical Toxicology (ACMT) with a bupropion ingestion to 1 health system (20 hospitals), 1 received 212 eligible research abstracts for consideration for presentation toxicology practice (5 hospitals), and toxicology referral center. at the 2019 Annual Scientific Meeting (ASM), including 96 research stud- Data collected included demographics, ingestion history (time, ies and 116 case reports. Each abstract was reviewed in a blinded fashion dose, preparation), clinical characteristics (vital signs, seizures, by at least four Research Committee members. Each abstract was indepen- AMS) length of stay, and treatment. Medians (IQR) were utilized dently scored based on the clinical question, data source, analytic method, for descriptive statistics, Chi-square, and/or Fisher’s exact for cat- results/conclusion, and clarity of presentation. A total of 162 abstracts from egorical variables. Logistic regression was performed to assess for a competitive pool were accepted for presentation to this year's Annual confounders. The following definitions were used: delayed seizure Scientific Meeting. This work would not be possible without the hard work (first seizure > 8 h post arrival); persistent tachycardia (tachycardia and diligence of our abstract reviewers: Ann Arens, Justin Arnold, Katie lasting > 2 h). Boyle, Nick Brandehoff, Jeffrey Brent, Stephanie Carreiro, James Results: Four hundred thirty-seven encounters were identified. The Chenoweth, Neeraj Chhabra, Jon Cole, Nick Connors, Kirk Cumpston, median (IQR) age was 28 (18–43) years; 275 (63%) were female. Rob Hendrickson, David Jang, David Juurlink, Louise Kao, Ken Katz, Seventy-eight percent of cases involved intentional exposures. Katherine Katzung, Russ Kerns, Andrew King, Kathy Kopec, JoAn Accidental double-dose ingestions accounted for 39 (8.9%) cases. Laes, Eric Lavonas, Michael Levine, Heather Long, Joe Maddry, Kevin Seizures occurred in 122 (27.9%) subjects (68 pre-hospital seizures, Maskell, Maryann Mazer-Amirshahi, William Meggs, Elissa Moore, Mark 75 in-hospital seizures). The median (IQR) length of stay was 36 Mycyk, Matt Noble, Travis Olives, Renee Petzel Gimbar, Evan Schwarz, (12–72) hours. Using logistic regression, the tachycardia or AMS at Daniel Sessions, Sam Stellpflug, Mark Su, Manoj Tyagi, Shawn Varney, arrival were each associated with an increased odds of seizure (OR Steven Walsh, Richard Wang, Tim Wiegand, Sage Wiener, Brandon Wills, 3.98 [95% CI 2.2–7.3] for tachycardia; OR 2.65, [95% CI 2.18–7.26] and Luke Yip. Equally significant is the contribution of the ACMT staff for altered mental status). Only 1 of 143 subjects who arrived without (Lizzy Nguyen and Adrienne Dunavin) who led the process. tachycardia or AMS had a delayed seizure (0.7%; 95% CI 0.02– Congratulations to all the contributors whose work will be presented in 3.9%). Of eight cases with delayed seizures, all had persistent tachy- San Francisco. cardia prior to the seizure. Conclusion: Seizures are common following bupropion overdose and We look forward to seeing you there. are predicted by tachycardia or AMS. Seizures beyond 8 h of obser- vation are unusual and were accompanied by antecedent tachycardia Shawn M. Varney, MD, FACMT, Abstract Review Chair; Jon B. Cole, and/or AMS. MD, FACMT, Abstract Review Co-Chair, Maryann Mazer-Amirshahi, PharmD, MD, MPH, Chair, ACMT Research Committee 002. Fentanyl Analog Exposures Among Living Patients in a Large Urban Healthcare System Neeraj Chhabra1,2, Lum Rizvanolli1, Arkady Rasin1,2,Granger Day 1: Platforms, Abstracts 001-004 Marsden1,KeikiHinami1, Steven E Aks1,2 1Cook County Health, Chicago, IL, USA. 2Toxikon Consortium, 001. Bupropion-Associated Seizures Following an Acute Overdose Chicago, IL, USA Steve Offerman1, Jasmin Goshen2, Angela Padilla-Jones3,Anne- Background: Fentanyl contamination of illicit drugs is a growing Michelle Ruha3,4, Stephen Thomas5, Michael Levine6 concern in the USA with an increasing mortality rate resulting 1Medical Toxicology Consultation Service. Kaiser Permanente Northern from synthetic opioid exposures. The extent to which such con- California, Sacramento, CA. 2California North State University College tamination is driven by potentially more potent fentanyl analogs J. Med. Toxicol. remains unclear. The majority of data regarding fentanyl analog Conclusion: In this preliminary review of samples, no false-positive exposure has originated from medical examiner offices and law readings were discovered. Thus, the current study failed to find any evi- enforcement seizures, with little information regarding exposures dence that lidocaine, or MEGX specifically, causes false-positive results in living patients. on an immunoassay for BE. Research Question: For patients screening positive for illicit opioids or fentanyl, are there also detectable fentanyl analogs on a reference fentanyl 004. Challenges in the Implementation of a Urine Immunoassay for analog panel? Buprenorphine at a Children’s Hospital Methods: This is a retrospective analysis of urine opioid testing results from patients in an urban public healthcare system from Kristen McCabe, Tracey Polsky, Kevin Osterhoudt May through July 2018. A convenience sample of patients’ urine The Children's Hospital of Philadelphia, Philadelphia, PA, USA samples which screened positive for opioids or fentanyl on ELISA assay was referred to a reference laboratory (NMS Labs, Willow Background: Failure to detect opioid poisoning among children may Grove PA) for identification of fentanyl analogs by high- negatively affect child health, and our hospital’s commercial urine drug performance liquid chromatography/tandem mass spectroscopy immunoassay (Vitros5.1 Chemistry System®, Ortho Clinical (HPLC/MS). HPLC/MS was performed on specimens for the iden- Diagnostics) may fail to detect the synthetic opioid buprenorphine. We tification of 20 Bdesigner opioids^ including carfentanil, acryl fen- implemented an additional specific immunoassay (CEDIA tanyl, and 4-ANPP. Buprenorphine II®, Thermo Scientific) for buprenorphine and tracked Results: A total of 142 urine samples were referred for fentanyl its clinical performance. analog testing. Sixty-two samples were referred due to detection of Methods: Patients with positive urine buprenorphine immunoas- both opioids and fentanyl, 31 for opioids alone, and 49 for fentanyl says from a single tertiary care children’s hospital were identified alone. Fentanyl analogs were detected in 86 samples (60.6%). The prospectively during the first 28 days of test implementation median number of analogs detected per sample was 1 (range 0–5). (October 9–November 5, 2018). Patient characteristics were col- The most common analogs detected were 4-ANPP, 78; 2- lected prospectively as part of quality assurance. Each positive furanylfentanyl, 18; cyclopropylfentanyl, 14; acryl fentanyl, 13; sample was sent for confirmation by mass spectrometry. This and carfentanil, 10. dataset was de-identified then abstracted by a single, blinded Conclusion: BFentanyl contamination^ is not restricted strictly to fenta- investigator. nyl but also its analogs which may be more potent. Testing samples from Results: One hundred ninety-eight patients had a urine drug im- living patients provides a useful mechanism to detect exposure patterns as munoassay during the study period, and 12/129 screened positive well as identify patients at risk of overdose death and target resources for for buprenorphine. Ages ranged 5 to 17 years (median 14); three evidence-based interventions such as prescription-naloxone and were male and nine were female. Eleven of 12 subjects had no medication-assisted therapy. history of suspected pre-hospital opioid exposure, and none was administered opioids. Three of 12 urine drugs screens were per- 003. Preliminary Findings of False-Positive Interferences of Lidocaine formed as part of
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