Latest Articles and News - Jul 24, 2025
post on 24 Jul 2025
Serotonin Syndrome Without Overdose: Polypharmacy-Induced Toxicity in a Medically Stable Young Adult.
Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin activity in the central and peripheral nervous systems that can lead to symptoms such as altered mental status, autonomic instability (e.g., hyperthermia and hypertensive tachycardia), and neuromuscular abnormalities (e.g., clonus and tremor). We present the case of a 29-year-old male healthcare worker with a history of major depressive disorder (MDD), temporal lobe epilepsy, and suspected obsessive-compulsive disorder (OCD) who presented with sudden-onset agitation, confusion, and abnormal limb movements after his third consecutive 12-hour overnight shift. He had been on stable outpatient doses of escitalopram 20 mg and bupropion XL 150 mg daily for over six months, with naltrexone 50 mg added three months earlier for off-label psychiatric use. In the emergency department, he was treated for presumed seizure or psychosis with multiple sedatives and antipsychotics and subsequently intubated. EEG showed no epileptiform activity, and lumbar puncture was unremarkable. Neurologic findings, including hyperreflexia, clonus, and rigidity, along with rapid clinical improvement following cyproheptadine and benzodiazepines, supported a diagnosis of serotonin syndrome. The patient denied overdose or substance use, and toxicology review concluded that polypharmacy with serotonergic and modulating agents was the likely trigger. We present a young adult who developed serotonin syndrome without overdose, likely due to the cumulative serotonergic effect of multiple prescribed medications at therapeutic doses. This case emphasizes the importance of clinical vigilance in patients with neuropsychiatric comorbidities on centrally acting agents, even in the absence of recent medication changes. It illustrates that even therapeutic combinations of serotonergic and modulating agents can precipitate life-threatening toxicity.
https://pubmed.ncbi.nlm.nih.gov/40704237/Catastrophic Outcomes: Rapid Multi-Organ Failure from Paraquat Poisoning- A Case Report.
Paraquat dichloride, a potent herbicide widely used in agriculture, poses a severe health risk due to its high toxicity. Ingesting even small amounts can cause fatal multi-organ failure. We report a case of a 19-year-old male who ingested approximately 5 ml of 24% paraquat dichloride. He presented with stable vital signs, but initial laboratory results showed elevated urea (26mg/dL), creatinine (0.97 mg/dL), and hypokalemia (3.2 mEq/L). Despite interventions including gastric lavage, N-Acetyl cysteine, methylprednisolone, and supportive care, he developed severe metabolic acidosis (HCO3- 22.8 to 16.3 mEq/L), acute renal failure (creatinine 0.97 to 4.62 mg/dL, urea 26 to 99 mg/dL, serum potassium 3.2 to 2.62 mEq/L), and multi-organ dysfunction. The unavailability of hemoperfusion has impacted the outcome. The patient's rapid deterioration highlights paraquat's aggressive nature and underscores the necessity for better therapeutic strategies and regulatory measures to prevent such poisoning.
https://pubmed.ncbi.nlm.nih.gov/40703903/A chain of survival for drug overdose.
Drug overdose is a leading global cause of preventable morbidity and mortality and is closely associated with out-of-hospital cardiac arrest. While the American Heart Association's "chain of survival" has improved outcomes in traditional cardiac arrest, it does not address the unique characteristics and challenges of overdose-related emergencies. In this article, we propose a novel "overdose chain of survival" to emphasize the importance of linking acute care with long-term prevention. This six-link framework includes: (1) prevention, (2) recognition and activation of emergency services, (3) basic first aid, (4) emergency treatment, (5) post-overdose care, and (6) recovery and secondary prevention. Each link highlights opportunities for intervention and coordination across systems of care. The framework is intended to guide clinical care, policy development, education, and research. By viewing overdose through a structured and holistic lens, the overdose chain of survival seeks to improve outcomes in the immediate aftermath of an overdose and also to address systemic barriers to sustained recovery. This conceptual model is adaptable to evolving drug trends and highlights the need for integrated, patient-centered approaches to overdose response and prevention.
https://pubmed.ncbi.nlm.nih.gov/40703815/Overdose Toxicological Effect of Methanol Extract of Popular Edible Colocasia esculenta Linn. Flowers: Biochemical, Hematological, and Behavioral Study on Swiss Albino Mice.
Colocasia esculenta Linn., an annual herbaceous plant from the Araceae family, has long been utilized in traditional medicine throughout tropical and subtropical regions for the treatment of diverse health conditions. This research explored the impact of the methanolic extract derived from C. esculenta flowers (CEF-ME) on mice, examining various physiological, biochemical, hematological, and behavioral responses. Behavioral assessments for anxiolytic activity included the Elevated Plus Maze, Hole-Board Test, and Light-Dark Box Test. Sedative properties were evaluated using the Open-Field Test and Hole-Cross Test, while potential antidepressant effects were analyzed via the Tail-Suspension Test and Forced-Swimming Test. The administration of CEF-ME led to observable changes in organ-to-body weight ratios, most notably a significant increase in liver size, which may indicate an upregulation of metabolic or detoxification functions. Biochemical tests revealed a hepatoprotective trend, characterized by decreased levels of ALT, ALP, bilirubin, cholesterol, and triglycerides. Yet, elevations in AST and creatinine at higher doses suggested potential hepatic and renal strain. Hematological profiles showed enhanced immune activity and red blood cell production, though the drop in platelet counts raised concern for thrombocytopenia. Behavioral evaluations revealed the extract's anxiolytic, sedative, and antidepressant properties, with effects comparable to diazepam and fluoxetine. The therapeutic potential of CEF-ME was evident; however, its administration at high doses triggered toxicity concerns, particularly impacting the hepatic and renal systems. These observations highlight a pressing need for further studies to investigate its prolonged safety, pharmacological mechanisms, and optimal therapeutic range.
https://pubmed.ncbi.nlm.nih.gov/40703613/Principles of environmental medicine: an educational case study of lead poisoning in Beethoven.
Understanding the nature and consequences of widespread lead poisoning is critical to protecting people from harm. We review the historical example of hypothesized lead poisoning in the famous composer Beethoven as an educational vector to illustrate principles of environmental medicine. We discuss what would happen if a hypothetical present-day Mr. B with comparable health complaints, clinical symptoms, or test results were to visit a doctor today. Human biomonitoring - with population reference values and health-based guidance values - is discussed as an important diagnostic tool. This practical outlook on lead poisoning for readers with non-environmental medicine backgrounds contributes to an understanding of principles of environmental medicine.
https://pubmed.ncbi.nlm.nih.gov/40703155/Metallophosphide poisoning, a rising public health problem in Ethiopia: a systematic review and meta-analysis.
Metallophosphide poisoning, mainly due to aluminum phosphide and zinc phosphide, is a growing public health problem in developing countries associated with a high mortality rate, including in Ethiopia, where it is used a fumigant for stored grains and agricultural commodities. Ethiopia lacks a well-organized poison control center, making it difficult to obtain primary data on metallophosphide poisoning cases and outcomes. This systematic review and meta-analysis aim to determine the pooled prevalence and mortality rate from metallophosphide poisoning in Ethiopia. As of August 2024, PUBMED, EMBASE, SCOPUS, and GOOGLE SCHOLAR were inclusively searched. Two independent reviewers extracted the data. Quality was assessed using the Modified Newcastle-Ottawa Scale adapted for cross-sectional studies. A random effects model was used to obtain the pooled estimate of the prevalence of and mortality rate from metallophosphide poisoning. Fourteen studies with a sample size of 3218 were included in the final estimate. The pooled prevalence of metallophosphide poisoning in this systematic review and meta-analysis was 38% (95% CI: 0.14-0.71, I2 = 96.6%, p < 0.0001). In the teen-included studies for the pooled mortality analysis, the sample size was 677 and the pooled mortality rate was 37% (95 % CI: 0.22, 0.55, I2 = 87.8%, P < 0.0001). We found a high pooled prevalence of metallophosphide poisoning in Ethiopia. This highlights the urgent need for regulatory actions to restrict the sales and distribution of these substances. This is supported by international experiences from similar low-resource settings. We recommend safer alternatives to control insects and rodents, such as mechanical rodent controls and integrated pest management. Public awareness creation and enhancing local management protocols to reduce the burden and improve the outcome of metallophosphide poisoning.
https://pubmed.ncbi.nlm.nih.gov/40702417/Personally-tailored opioid-overdose and medication for opioid use disorder (MOUD) education (TOME) significantly increases MOUD and overdose knowledge in peripartum individuals: Results from a randomized controlled pilot trial.
Overdose is a leading cause of pregnancy-associated mortality in the US. Our personally-tailored opioid-overdose (OOD) and medication for opioid use disorder (MOUD) education intervention has been shown to significantly improve MOUD/OOD knowledge in out-of-treatment persons using illicit opioids. We evaluated the ability of the intervention modified for peripartum (pregnant or within one year postpartum) individuals, the personally-tailored OOD and MOUD education (TOME) intervention, to increase MOUD (primary) and OOD (key secondary) knowledge. A six-site, two-arm, open-label, trial with 131 peripartum individuals receiving MOUD (methadone or buprenorphine) randomized to TOME, a 15-minute, computer-facilitated, individually-tailored intervention, or Control. TOME participants received education on MOUD and OOD questions they missed in a pre-test. Control participants received SAMHSA handouts on OOD and MOUD. All participants were scheduled for a 3-week post-test. Participants were enrolled in MOUD for an average of 15.6 months (SD=20.4) at baseline, with 30.5 % enrolled in methadone and 69.5 % enrolled in buprenorphine treatment. On the pre-test, participants answered 66.7 % of the MOUD and 82.1 % of the OOD questions correctly on average. Linear regressions indicated that participants' MOUD (X2=33.96, p < 0.001) and OOD (X2=45.78, p < 0.001) knowledge increased significantly more in the TOME, relative to Control, group. In a sample of peripartum patients enrolled in MOUD for a substantial length of time, TOME significantly increased MOUD and OOD knowledge. Taken together with past research, these findings suggest that there are gaps in MOUD and OOD knowledge in individuals with opioid use disorder that can be addressed with brief personally-tailored education.
https://pubmed.ncbi.nlm.nih.gov/40700987/
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