This summary features recently released research concerning various aspects of poisonings including toxicity from different sources, use and abuse of drugs, occupational exposure and effects along with how healthcare providers treat patients who have been poisoned. The articles selected are meant for use by clinical professionals, toxicology experts, industry professionals and regulators. Each selected article presents current data based on the findings of these studies in relation to the issues associated with the care and prevention of poisoning.

Investigation of Amanita molliuscula poisoning outbreaks in Heilongjiang province, China

There were three cases of mushroom poisoning from the mushroom Amanita molliuscula in Heilongjiang Province, People’s Republic of China. In total, there were eight incidents in late August 2024 with a total of 19 people affected, resulting in two deaths, and one person requiring a liver transplant because of liver failure caused by amanita poisoning. Most patients who were affected presented with gastro-intestinal symptoms; however, 12 patients experienced severe liver injury. The mushroom and biological samples were both positive for α-amanitin and β-amanitin. To our knowledge, these are the first reported cases of Amanita molliuscula poisoning, and they show the high potential of Amanita molliuscula to cause severe liver toxicity and the leading cause of death from fulminant liver failure. In one case, liver transplant was successful.

https://pubmed.ncbi.nlm.nih.gov/41411678/

Nonfatal Drug Overdose in a National Sample of Adolescents by Intent and Substance, Medicaid 2016-2020

To determine the prevalence and patterns of drug overdose among adolescents (12–18 years) presenting to emergency department and inpatient settings, this study reviewed national Medicaid data between 2016 and 2020. The average yearly rate of a treated drug overdose was 0.41%, with only minor fluctuations over time.

The rate of drug overdose differed depending on the intent (i.e., intentional drug overdose = 0.28%; unintentional drug overdose = 0.17%; undetermined drug overdose = 0.04%) as well as by demographic groups that included sex, age, race/ethnicity, and whether the individual was in foster care.

Most intentional overdoses were attributed to non-opioid analgesics, antidepressants, antipsychotics, and benzodiazepines. On the other hand, unintentional overdoses typically involved cannabis, benzodiazepines, opioids, and stimulants. Over time, there was a slight increase in the number of unintentional overdoses that were due to opioids and cannabis. The results show that there are specific patterns of substance use, based on the intent (intentional vs. unintentional) to overdose, which provide information when creating a strategy to reduce the incidence of overdose-related morbidity and mortality in adolescents.

https://pubmed.ncbi.nlm.nih.gov/41418933/

Development of a novel risk score reflecting the relative harm potential of synthetic cannabinoids based on prevalence estimates, well-documented intoxication cases and basic pharmacological data

To determine the risk level of synthetic cannabinoid receptor agonists (SCRAs) in Germany between 2013 and 2021, a risk score was created, combining clinical intoxication and forensic prevalence. Researchers tested nearly 10,000 blood and 45,000 urine samples for SCRAs during this period and found that 16-18% were positive for SCRAs; additionally, there were 48 reported cases of non-fatal intoxication where clinical symptoms were noted. 

The risk score revealed that SCRA harm does not correlate with in vitro receptor potency. The risk score demonstrated that SCRAs with the highest level of risk (5F-PB-22) were not necessarily the most potent based on in vitro testing, while 5F-Cumyl-PEGACLONE was the least hazardous. Further findings from this study indicate that SCRA prevalence, clinical severity of observed symptoms, and contribution to the symptom's appearance, are key aspects for determining SCRA toxicity. The study demonstrates the importance of this framework for assessing potential abuse liability of emerging synthetic cannabinoids.

https://pubmed.ncbi.nlm.nih.gov/41423817/

Drowning during methamphetamine intoxication precipitated by improper fluid administration: medico-legal case analysis

An 18-year-old male was fatally drowned and subsequently died due to an acute methamphetamine intoxication. Details of the circumstances surrounding the drowning indicated the young man may have aspirated the fluid while he was deep unconscious without airway reflexes to protect him.

The forensic toxicology analysis showed a high methamphetamine concentration in the victim's blood (4818 ng/mL). The results of the autopsy were consistent with typical findings in cases of drowning and diatom analysis also supported the cause of death. This case is important in illustrating how acute neurological and cardiovascular impairment from drug effects can result in passive drowning, as well as reinforcing the need to integrate toxicology, autopsy, and scene investigation and diatom examination in forensic assessments.

https://pubmed.ncbi.nlm.nih.gov/41428191/

Early Recognition and Management of Severe Sodium Nitrite Intoxication: A Case Report Emphasizing Prehospital Administration of Methylene Blue

A case report of an 18-year-old man with methemoglobinemia is presented. The patient was in shock and had severe cyanosis, which were identified by first responders at the time of presentation. The patient received methylene blue as an antidote within the first hour by ambulance service, and again in the Emergency Department, which resulted in a significant decrease in methemoglobin level and complete recovery. The case illustrates the vital need for emergency providers to have timely access to antidotes, and demonstrates the ongoing requirement for training of healthcare professionals and emergency responders in recognition and treatment of acute toxicological emergencies.

https://pubmed.ncbi.nlm.nih.gov/41427746/

Pesticide Poisoning Linked to PPE Usage Among Pesticide Sprayers in Northeastern Thailand

This study examined the health impacts of pesticide exposure and use of PPE among 421 pesticide applicators working in Northeast Thailand. Researchers found that 37.5% of the pesticide applicators had reported experiencing adverse health effects, including dizziness, nasal irritation, and tachycardia. Women, individuals who worked with certain types of plants, and those who utilized hand-held knapsack sprayers were more likely to suffer from these health issues. Although the majority of the pesticide applicators reported no health effects, it has been found that using protective footwear decreases the risk of blurred vision. The results of this study demonstrate that current PPE practices may not be adequate for the comprehensive safety of workers who are constantly exposed to pesticides and that targeted, gender- and equipment-specific programs are necessary to improve occupational safety.

https://pubmed.ncbi.nlm.nih.gov/41429439/

The Association Between Rapid Opioid Dose Tapering and Polydrug Overdose Deaths Among High-Dose, Long-Term Opioid Therapy Recipients

In this study of over 21,000 North Carolina residents on long-term, high-dose opioid therapy, researchers looked at what happens when opioid doses are reduced rapidly. They found that patients who experienced rapid tapering had more than three times the risk of dying from a polydrug overdose in four years compared to those whose doses were reduced gradually or maintained. These results underscore the potential dangers of rapid tapering and emphasize the need for careful, patient-focused approaches when adjusting opioid therapy to protect patients from serious harm.

https://pubmed.ncbi.nlm.nih.gov/41430020/

Effect of hyperbaric oxygen therapy on early features of carbon monoxide poisoning focusing on neurological symptoms

Between 2020 - 2023, a total of 288 CO-poisoned patients treated from Hyperbaric Oxygen (HBO) therapy in Korea were reviewed. The study concluded that patients who arrive unconscious required more aggressive HBO treatment and had higher rates of heart damage, shock, and ventilator use  compared to alert patients. Most symptoms improved quickly during the early phase of treatment, but delayed neurological complications can still occur, even in those who initially appeared alert. The data show the importance of adequately monitoring these patients, especially those who present to the treatment facility with neurologic deficits; those who exhibit the potential for cardiovascular injury and patients presenting with abnormal muscle enzymes require continuous monitoring with an appropriate HBO regimen.

https://pubmed.ncbi.nlm.nih.gov/41436924/

Too much of a good thing: OTC calcium carbonate overdose causing milk-alkali syndrome in a psychiatric patient

A retrospective study across four pediatric hospitals located in Italy and the UK was conducted to evaluate the frequency of adolescent emergency department (ED) visits for intoxication resulting from alcohol or substance use. ED visits were limited to patients from ages 10–to 17 years old that occurred between the years 2016 and 2024 (2020-21)—a significant increase in ED visits associated with alcohol and substance use by adolescents occurred during the COVID-19 pandemic. In fact, during this period of time, the rate of adolescent ED visits for intoxication increased from 4.6 to 6.7 per 1,000 pediatric ED visits, fully 58% of the total number of cases being reported occurred during the pandemic. All hospitals reported an increase in cases of intoxication where there were suicidal intentions and the majority of these cases reported the use of substances(s) other than alcohol in combination with alcohol, while the majority of non-suicidal cases still indicate alcohol as the main substance used in combination with other substances(s). Therefore, the increase in adolescent substance related injuries during the COVID-19 pandemic is indicative of substantial adverse effects on adolescents’ substance-related behaviors, as they relate to suicidal actions, and that there is an urgent need to strengthen prevention and mental health supports for this population.

https://pubmed.ncbi.nlm.nih.gov/41441985/

Can Albumin Trap Salicylate? An In Vitro Exploration of Salicylate Overdose Scenarios

Salicylate toxicity remains a significant cause of morbidity and mortality. At therapeutic levels, most salicylic acid (SA) is albumin-bound, but in overdose, the free fraction rises, driving toxicity.

In the context of this in vitro study, the purpose was to determine whether supplementation with human serum albumin could decrease the concentration of free salicylate in overdose levels of salicylate (high concentration of salicylate).

Increasing the amount of human serum albumin decreased the amount of free salicylate in all samples, however the biggest decrease in the amount of free salicylate was found when using increased amounts of albumin in conjunction with increased acid pH levels. The reduction in the amount of free salicylate resulting from correcting the low level of human serum albumin was significantly greater than if the amount of albumin had been at a normal level. When the amount of albumin was greater than what would typically be found in the body (supraphysiologic level), the amount of free salicylate continued to decrease.

This study demonstrates that human serum albumin can function as a "sink" for salicylate during an overdose and recommend further studies be conducted to evaluate the efficacy and safety of administering human serum albumin during salicylate toxicity.

https://pubmed.ncbi.nlm.nih.gov/41413367/

Evaluating Radiological Awareness of Carbon Monoxide Poisoning Among Physicians in Saudi Arabia

This cross-sectional survey assessed the knowledge of Saudi doctors about the radiological signs of carbon monoxide (CO) poisoning. This study found that even though CO poisoning is a significant public health issue, the radiologic signs of CO poisoning were poorly known by 86.5% of the survey participants, and only one-third of the respondents reported receiving any training or clinical experience regarding CO poisoning prior to this survey. A greater level of understanding of the radiological signs was significantly linked to longer clinical experience, with senior physicians having a greater familiarity with them. The results revealed that there is a significant gap in the education of Saudi physicians regarding CO poisoning and indicate the need for improved education and training programs aimed at improving the early recognition of CO poisoning.

https://pubmed.ncbi.nlm.nih.gov/41416303/

Conclusion

This week’s studies highlight the severity and diversity of poisoning-related harms, ranging from fatal toxic exposures to emerging risks linked to substance use, inadequate protection, and gaps in clinical recognition. Collectively, the findings emphasize the need for early detection, targeted prevention, and improved training to reduce poisoning-related morbidity and mortality.