Weekly news summary: December 25-31,2025

This week’s reports highlight a range of studies and case reports on drug- and toxin-related poisonings, as well as their neurological, renal, and psychiatric consequences. Covered topics include acute kidney injury from anticoagulant rodenticide poisoning, rising adolescent emergency visits for alcohol and substance intoxication during the COVID-19 pandemic, severe neurological and cardiac complications from drug overdoses, and the potential benefits of targeted therapies such as neuroprotective antioxidants, vitamin K, and safer opioid supply programs.

Acetaminophen poisoning: contemporary intravenous acetylcysteine regimens and early discharge pathways

This interesting review article outlines the main IV NAC regimens used worldwide from 2000–Aug 2025: the classic 21-hour “3-bag” protocol, the 20-hour FDA-labeled “2-bag” regimen, and the 12-hour SNAP protocol. The key practical takeaway is that they work about the same for preventing hepatotoxicity, but the simplified regimens (2-bag and SNAP) tend to cause fewer non-IgE (“anaphylactoid”) reactions and fewer dosing/infusion errors, which is not a small thing in real hospitals staffed by real humans.

The SNAP approach is essentially “treat fast, then decide intelligently”: it delivers 300 mg/kg over 12 hours, and you continue NAC only if the patient fails the stopping criteria. Early-stop pathways like NACSTOP/SARPO go even further but are intended for carefully selected low-risk patients, not everyone who wanders in with “maybe APAP?”

Across regimens, the review emphasizes a practical, lab-anchored way to decide when you’re done: in most acute overdoses, you can stop NAC once APAP is <10 mg/L, AST/ALT are stable or falling, and INR is acceptable. If those boxes are not checked, you extend therapy rather than just hoping the liver “feels better soon.”

The “expert opinion” punchline is that the biggest improvement isn’t picking the “perfect” regimen; it’s establishing a standardized NAC pathway with explicit stop/extend rules so clinicians stop guessing and start following a plan. More aggressive escalation (higher or prolonged dosing, early hepatology/transplant involvement, and consideration of extracorporeal removal in select scenarios) should be reserved for high-risk cases, not used as reflexive overkill.

Finally, in LMIC settings where APAP levels may be delayed or unavailable, the review supports starting empiric NAC based on dose and timing history rather than waiting. And yes, biomarkers and AI may help, but they’re framed as adjuncts, not replacements, for the basic lab-driven decision-making that keeps patients alive.

Acetaminophen poisoning: contemporary intravenous acetylcysteine regimens and early discharge pathways - PubMed

Acute kidney injury induced by mixed poisoning with brodifacoum and bromadiolone: a case report

A 37-year-old man was found to be experiencing severe bleeding and coagulation issues after being poisoned by a combination of brodifacoum and bromadiolone. He also developed urinary tract obstruction from the presence of blood in his urine (hematuria), which resulted in acute kidney injury. Diagnostic evaluation confirmed anticoagulant rodenticide poisoning, and a multidisciplinary treatment approach led to recovery of kidney function. The case concludes that anticoagulant rodenticide poisoning can induce acute kidney injury through combined anticoagulation-related and obstructive mechanisms, and that early recognition and management are essential for renal recovery.

https://pubmed.ncbi.nlm.nih.gov/41446851/

Trend of emergency department attendances for alcohol and substances intoxication in adolescents across the COVID-19 pandemic: a multicenter international study

The retrospective multicenter study evaluated data from emergency department presentations for alcohol and substance intoxication among adolescents aged 10 years to 17 years old across four different children's hospitals located in Italy and the United Kingdom., and span of 2016-2024. Comparison between pre-COVID-19 and during the COVID-19 pandemic was done. Using the data collected over this time, the study identified a total of 1818 cases. Comparison of the number of cases before (41.5%) and during (58.5%) COVID-19 revealed a greater rate of increase in the number of intoxication cases  and a significant increase in prevalence from 4.6 to 6.7 per 1000 pediatric ED attendances. The study found an overall rise in intoxications during the pandemic, with a notable increasing trend in cases involving suicidal intent, which were more commonly associated with substances other than alcohol, while alcohol remained the most frequent substance in non–suicidal intoxications. The study concludes that the COVID-19 pandemic was associated with a substantial increase in adolescent alcohol- and substance-related intoxications, particularly those linked to suicidal intent, highlighting the need for strengthened preventive and mental health interventions.

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

Clinico-Epidemiological Prediction of Adverse Outcomes in Acute Pediatric Poisoning: A Risk Prediction Nomogram Approach

This three-year retrospective study analyzed 1,328 pediatric poisoning cases to identify risk factors for PICU admission and mortality. Unintentional exposure dominated among infants and preschoolers, while intentional exposure was most common among adolescents. Non-pharmaceutical poisonings (e.g., aluminum phosphide) had more severe outcomes  and they accounted for all of the fatalities. The study indicated that prehospital interventions, as well as the speed of admission and an elevated white blood cell count, were strong predictive factors for mortality and the need for a PICU admission. The results suggest that additional work is needed in terms of family education, community awareness, and mental health support to reduce severe pediatric poisonings, particularly when looking at factors related to age and type of exposure.

https://pubmed.ncbi.nlm.nih.gov/41458941/

Clinical Indicators of Hemodialysis and Mortality in Methanol Poisoning: A Retrospective Analysis

The study is a retrospective study of 64 adults suffering from methanol poisoning to identify the predictors of mortality and requirement of hemodialysis. The mortality rate was found to be 29.7%, and Laboratory indicators strongly correlated with death or dialysis requirement were a serum pH of ≤7.08, bicarbonate, elevated lactate concentration of ≥3.67mmol/L and elevated anion gap of ≥27.25. The findings of the study indicate that the early identification of these critical indicators can greatly enhance the efficacy of treatment and improve outcomes for patients with methanol poisoning.

https://pubmed.ncbi.nlm.nih.gov/41459893/

Mercury Poisoning and the Wider Implications

This case report describes a patient who ingested and inhaled elemental mercury resulting in the deposition of mercury in the patient's pulmonary and gastrointestinal systems. The patient required monitoring in an intensive care unit but did not require any organ support. The patient's mercury poisoning was treated using chelation therapy in accordance with the guidance of the UK National Poisons Information Service. A prophylactic appendicectomy was performed as a result of mercury deposition within the body. This case report is indicative of the clinical and logistical difficulties associated with the management of mercury poisoning, including compliance with protective protocols as well as safe disposal methods of contaminated waste.

https://pubmed.ncbi.nlm.nih.gov/41459053/

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

This retrospective study tested whether rapid tapering of high-dose long-term opioid therapy among commercially insured adults (aged ≥18 years) in North Carolina was associated with an increased risk of Polydrug Overdose Death from 2006-2018. Among the subjects, 21,478 patients were followed in this analysis for an average period of 4 years. Rapid tapering occurred during nearly half of the patient-months evaluated. A total of 26 cases of polydrug overdose death occurred. The analysis revealed that the risk of polydrug overdose death at 4 years was significantly greater when compared to those not receiving rapid tapering. This finding indicates that rapid tapering of high-dose long-term opioid therapy may pose an increased risk of overdose death over time. Accordingly, providers need to consider these findings carefully when making treatment decisions about managing patient pain with respect to opioid use.

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

Comprehensive Clinical Profile of Amanita exitialis Poisoning: Integrating Toxin Detection and Autopsy Pathology

The purpose of this retrospective study was to describe the cases of poisoning due to Amanita exitialis mushroom from 2019 through 2024 in Southern China. The study focused on the detection of toxins, clinical features, and pathological findings associated with this type of mushroom poisoning. Ten poisoning events involving 27 patients, including five deaths, were identified, with amatoxins detected mainly in urine samples and rarely in blood.There was a direct correlation between the increase in the time-weighted cumulative exposure to urinary amatoxins and an increase in severity of laboratory parameters reflecting damage to the liver, kidneys, heart, and coagulation system.

The initial clinical presentation of the patients included gastrointestinal symptoms, which were followed by the progressive development of multiple organ dysfunction, with severe liver injury being the most prominent; however, there were also renal, myocardial, intestinal injuries, and autopsy-confirmed evidence of multiorgan bleeding. Based on these findings, the authors conclude that Amanita exitialis mushroom poisoning is characterized by prominent hepatic damage, with systemic manifestations, and that the early detection of urinary toxins is useful for diagnosing and managing patients with this type of mushroom poisoning.

https://pubmed.ncbi.nlm.nih.gov/41441612/

Alcohol Intoxication, Sexual Misperception, and Sexual Assault Perpetration: The Role of Sexual Drive-Related Alcohol Expectancies

This study examined how alcohol intoxication and related expectancies influence sexual misperception and intentions to perpetrate sexual assault in 96 cisgender men. all completed measures for their expectancies of sexual drive due to having consumed alcohol. Participants were randomly assigned to drink either alcohol or a control beverage, and were then assessed for sexual assault behaviours and their perceptions of sexual interest from hypothetical female partners. The research shows that, among intoxicated individuals, the higher the expectation of sexual drive from using alcohol, the more likely they are to have an incorrect perception about women’s sexual interest (Sexual Misperception) and the higher their intention to commit a sexual assault (Sexual Assault). The study suggests that prevention programs may benefit from cognitive strategies addressing beliefs about alcohol and sexuality.

https://pubmed.ncbi.nlm.nih.gov/41451123/

Reduced risk of overdose among clients of a safer opioid supply program in Southwestern Ontario: A pre-post observational cohort study

The evaluation of a safer opioid supply (SOS) program for 100 high-risk individuals over six months in Kitchener-Waterloo, Canada, measured its effect on non-fatal overdoses. At baseline, there was a prevalence of 60% for overdose; however, at follow-up, only 15% of participants reported non-fatal overdose experiences. Incidence rates decreased from 48.5 per 100 person months  to 3.3. After adjusting for confounders, participants had 83% lower odds of overdose during follow-up. Therefore, SOS programs have the ability to reduce significantly the number of non-fatal overdoses in high risk populations and thus should be included in the overall overdose prevention strategy.

https://pubmed.ncbi.nlm.nih.gov/41456366/

Delayed-onset parkinsonism after carbon monoxide poisoning: neuropsychological perspectives from a case report

This article describes a patient who was diagnosed with parkinsonism and cognitive impairment approximately one month after suffering from carbon monoxide poisoning. The patient experienced increasing neurological and cognitive deficits that impacted his daily living and job performance. Treatment consisted of medication, hyperbaric oxygen therapy, and individualized neuropsychological rehabilitation. The patient's sequential evaluations indicated improvements in attention, memory, and executive functioning, but some residual deficits were still present. This case emphasizes the need for individualized neuropsychological intervention in conjunction with medication to help facilitate functional restoration following delayed neurological consequences of carbon monoxide poisoning.

https://pubmed.ncbi.nlm.nih.gov/41460512/

Mixed planned and unplanned complex suicide by cut-throat and poisoning in a hemiplegic person - case report

This case is a prime example of how difficult it can be to differentiate between premeditated and non-premeditated complex suicides, especially since there are elements of both present within the report. Furthermore, there is also the possibility that such complex suicides could raise concern regarding the potential for being homicides. Many factors are at play, and therefore, documentation of all aspects related to these atypical events is critical and imperative, as complex suicides that use multiple modalities are quite uncommon; the combination of use of pesticides in conjunction with cutthroat self-infliction presents as an extreme rarity among complex suicides.

https://pubmed.ncbi.nlm.nih.gov/41456507/

Neuroprotective Effects of N-Acetylcysteine-Amide (AD4) in a Survival Mouse Model of Paraoxon Intoxication: Targeting Oxidative Stress, Neuroinflammation and Memory Impairments

N-acetylcysteine-amide (AD4) is a blood-brain barrier permeable antioxidant that was evaluated for its effects in a murine model of acute paraoxon (POX) intoxication. Following standard emergency treatment for poisoning, mice were administered AD4, which resulted in decreased oxidative damage; restored levels of major antioxidants enzymes  in the hippocampus and prefrontal cortex; and reduced neuroinflammation in specific areas of the hippocampus. Furthermore, treatment with AD4 also restored object recognition memory deficits as measured by the Novel Object Recognition Test. The findings indicate that AD4 reduces the oxidative damage and neuroinflammatory response associated with the acute toxic effects of POX. Thus, AD4 may serve as an adjunctive treatment for acute organophosphate poisoning to protect against secondary neurotoxicity.

https://pubmed.ncbi.nlm.nih.gov/41462663/

Severe Bupropion Overdose Resulting in Cardiac Arrest, Delayed Rhabdomyolysis, and Persistent Neurological Sequelae in an Adolescent

This case report describes a 16-year-old girl who ingested a massive dose of extended-release bupropion (4.2 g, 90.3 mg/kg) and presented with seizures and out-of-hospital cardiac arrest. however, the reanimation took place over the next several hours. Eventually, she was admitted  with a metabolic acidosis, abnormal ECG results, and significant elevation of Bupropion levels. During hospitalization, she developed delayed rhabdomyolysis, hypoxic encephalopathy, and persistent neurological sequelae including Parkinsonism and cognitive deficits Through supportive treatments, the patient was able to completely recover her cardiac function and rid her system of Bupropion by day 20 after presenting to the hospital; however, there remained permanent deficits at the time of discharge after being in the hospital for seven weeks. This case emphasizes the potential seriousness of complications of an overdose of Bupropion and reinforces the need for vigilance regarding subsequent effects of overdose.

https://pubmed.ncbi.nlm.nih.gov/41465856/

Overlapping Hepatic and Neurological Toxicity Following Intentional Multidrug Poisoning with Acetaminophen, Metoclopramide, and Metronidazole: A Case Report

This case report describes a young adult male who intentionally ingested 12 g of acetaminophen, 170 mg of metoclopramide, and 8 g of metronidazole, presenting 24 hours later with vomiting, tremor, rigidity, dysarthria, gait ataxia, and transient confusion.Diagnostic tests revealed that the patient had sustained minor liver damage and blood clotting problems (coagulopathy). Treatment options for this patient's condition included N-acetylcysteine (acetaminophen antidote), diphenhydramine (antihistamine), and diazepam (benzodiazepine) for the treatment of the patient's extrapyramidal symptoms (EPS). Other treatments included intensive supportive care and psychiatric support. After 72 hours of treatment, all neurological and hepatic findings returned to baseline levels, and the patient made a complete recovery. This case illustrates the diagnostic and therapeutic difficulties associated with poly-drug overdose involving multiple chemical entities that create similar toxidrome/overdose symptoms and demonstrates that prompt, agent-specific treatment can result in complete recovery without long-term sequelae.

https://pubmed.ncbi.nlm.nih.gov/41467082/

Summary

The week’s findings emphasize that prompt diagnosis, multidisciplinary management, and preventive interventions can reduce the risk of severe complications and mortality from poisonings, while supporting functional recovery and mental health in affected individuals.