The Poison Lab

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**The Poison Lab**

Dive into the captivating world of poisons with The Poison Lab! Hosted by Clinical Toxicologist Ryan Feldman (@EMPoisonPharmD), who has over a decade of managing poisoning and drug overdose via poison centers and in the emergency department. Also occasional co-hosted by his robo cohost Toxo! (@LabPoison). This show unpacks the fascinating history, cutting-edge science, and life-saving medical management of toxins from around the globe. From stories of those impacted to expert insights from pioneers in poisoning treatment, each episode brings you closer to understanding the poisons that lurk in plain sight. Explore episodes, med videos, games, and more at thepoisonlab.com—every poison has a story to tell!

Latest Episodes:

Mini Episode: Bridging the Gap- Bupropion's not your average wide QRS with Dr. Travis Olives Feb 15, 2023

Show notes

Rohr 2004- Gap junction blockade can cause a wide QRS
Vink 2004 Connexin 43 is the most important protein for connexon formation and cardiac signal transmission
Callier 2012- Bupropion does not block sodium channels, and does exhibit similar effects on the cardiac action potential as known gap junction
Burnham 2014 Bupropion has an IC50 for connexin 43 >50 uMol, larger than other drugs such as fluoextine and lamotrigine
Shaikh Quereshi 2014 Bupropion interferes with connexin43 production and localization in chicken cardiac myoctes at concentration >50 uMol

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Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

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Mini Episode: Who Seizes in Bupropion Overdose with Dr Ari Filip MD Feb 15, 2023

Show notes

Seizure Risk: Patients can seize 8–24 hours post-ingestion. Neurologic symptoms and tachycardia often precede seizures.
Delayed Symptoms: Co-ingestions may mask tachycardia, and symptoms can be significantly delayed.
Key Management Advice:
Do not discharge patients without consulting a toxicologist or poison center about observation times.
Do not dismiss tachycardia and anxiety as situational in cases of bupropion overdose.

Key Studies

Spiller 1994: Review of instant-release bupropion overdoses.
Shepherd 2004: Seizures predominantly occur with sustained-release products. Most cases had prodromal neuropsychiatric symptoms.
Starr 2009: Analysis of XL products:
Symptoms predicting seizures: Tachycardia, tremor, and agitation.
Tachycardia may be masked by coingestions and symptoms may be very delayed
Seizures occurred as late as 24 hours, with 25% occurring after 8 hours.
Offerman 2020: Study of sustained/extended-release products:
Tachycardia (duration and rate >120 bpm) predicts seizures.
Hypotension and neuropsychiatric symptoms also predictive.
Prehospital seizures associated with cardiac arrest—indicative of poor outcomes.
Rianprakaisang 2021: ToxIC database review of seizure risk factors:
QTc prolongation and HR >140 bpm are predictive of seizures.

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Review the show where ever your listening

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Join as a supporting member

Ad free episodes
Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

More Show Resources

2022 North American Congress of Clinical Toxicology (NACCT) High Yield Abstract Review Dec 29, 2022

Show notes

All published abstracts can be found here

Abstracts

Category 1: Amlodipine Vasoplegia

Abstract 1: Vasodilation in patients with calcium channel blocker poisoning treated with high dose insulin: a comparison of amlodipine versus non-dihydropyridines
Study of HDI on propranolol poisoned pigs
Study of Minnesota HDI protocol
Abstract 2: Amlodipine anxiety: a 10-year review of amlodipine associated fatalities
Abstract 3: Extracorporeal membrane oxygenation utilization for vasoplegic shock due to pediatric toxic ingestions
Data of ECMO in poisoning

Category 2: Xylazine

Abstract 4: “Tranq dope” opioid overdose: clinical outcomes for emergency department patients with illicit opioid overdose adulterated with xylazine

Category 3: Case Reports with Terrifying Clinical Implications

Abstract 5: Recovery after poly-drug overdose despite blood flow imaging demonstrating no brain perfusion
Abstract 6: Challenges in diagnosing an environmental cause of recurrent methemoglobinemia
Abstract 7: Acute thiamine deficiency as a complication of insulin euglycemic therapy for an amlodipine overdose

Category 4: Comparative evidence, Prognostication, and Triage

Abstract 8: Utility of pre four-hour iron concentration in predicting toxicology
Abstract 9: Andexanet alfa vs 4-factor prothrombin complex concentrate for intracranial hemorrhage at a level I trauma hospital

Category 5: Rapid Review

Abstract 10: Fentanyl and fentanyl analogue exposure among emergency personnel and first responders: a systematic review
Abstract 11: Significance of falsely low creatinine values in diagnosing massive acetaminophen ingestion
Abstract 12: Large dose intentional ciprofloxacin ingestion associated with false-positive urine immunoassay for oxycodone and fentanyl
Abstract 13: Don’t make it a double?: a 20- year review of supratherapeutic amlodipine ingestions while on chronic therapy
Abstract 14: Evaluation of pediatric lisdexamfetamine exposures reported to a statewide poison control system
Abstract 15: An assessment of the reliability of stated quantity in acute acetaminophen overdoses reported to a regional poison center

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Review the show where ever your listening

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Join as a supporting member

Ad free episodes
Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

More Show Resources

Episode 19 Mystery Case Dec 09, 2022

Show notes

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 19

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Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

Ad free episodes
Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

More Show Resources

Toxicologists vs the Internet (#7) With Guest Dr Emily Kiernan DO Nov 09, 2022

Show notes

Dr. Emily Kiernan, DO (@em2kiernan) an emergency medicine physician and medical toxicologist with Emory university school of medicine joins the show to solve toxic cases, opine on recent healthcare related poisoning, and dive head first into the bongwater on this episode. (Remember friends, don't drink the bong water).

A Morel Dilemma

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Review the show where ever your listening

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Join as a supporting member

Ad free episodes
Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

More Show Resources

Phenibut. The emerging drug you don’t know about (yet) Sep 12, 2022

Show notes

Phenibut is an emerging and unfamiliar drug taking hold in the US that is readily available online and legal to obtain. It acts as a GABA-B agonist and carries risks of dependency and withdrawal. In this episode Ryan interviews phenibut users as well as experts involved in phenibut treatment. They explore the history, current trends, toxicity, and management of phenibut, a novel GABA-B agonist. He is joined by guest Dr. Matthew Stanton PharmD and Dr. Benjamin Weston MD who listen in to an audio documentary by that includes clips from Dr. Janessa Graves PhD and Dr. Erica Liebelt MD who wrote a recent report on increasing phenibut exposures, Dr. Dan McCabe MD who is the author of the largest published phenibut case series, and Elliot, a recovered phenibut user who we would like to sincerely thank for sharing his story of use and recovery.

+Update- a systematic review of phenibut withdrawal treatment strategies authored by the poison lab host himeself, Ryan!+

A Morel Dilemma

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

Ad free episodes
Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

More Show Resources

Episode 16 Mystery Case Aug 03, 2022

Show notes

Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in episode 16

A Morel Dilemma

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

Ad free episodes
Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

More Show Resources

Toxicologists vs the Internet (#6) With Guest Dr Joshua Trebach MD Jul 06, 2022

Show notes

Dr. Joshua Trebach, MD (@jtrebach) joins the show for some toxic sleuthing of fishy poisonings and answers questions from reddit.com/r/askdrugs.

Case report Ryan Feldman wrote about himself
Stump the Tox cases
Case #1
Case #2
case series from Dr Jillian Theobald
Case #3
Case #4
Ask drugs
Fanconi syndrome in expired tetracycline

A Morel Dilemma

Support the show

Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

Ad free episodes
Bonus content and early access
Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

Reach the show

Email: Toxtalk1@gmail.com

More Show Resources

Fast and Fatalurious May 04, 2022

Show notes

In this episode Ryan and Toxo dive into a widely available prescription poison with a frightening ability to cause rapid neurologic and cardiovascular decline, and the best part, it looks like candy!