The following is an overview of the current week's literature (Jan 1 through Jan 7, 2026) that includes articles and case studies published in Clinical Toxicology; Adverse Drug Reactions and Medication Misadventures; Overdose Medicine. The articles cover a wide spectrum of topics, including carbon monoxide poisoning in burn patients, opioid overdose risk factors during pregnancy, severe drug toxicities from antidepressants, colchicine, cesium, and 2,4-dinitrophenol, as well as rare poisonings such as fluoroacetate exposure. These investigations demonstrate the importance of identifying, managing, and preventing intentional and accidental exposure to toxic substances, and the significance of immediate and appropriate clinical interventions.

Incidence and Outcome of CO Poisoning in Burn Patients with Inhalation Injury

This prospective study evaluated 68 adult burn patients with inhalation injury to compare those with and without carbon monoxide (CO) poisoning. CO poisoning was present in 35.3% of patients at admission, despite similar prehospital respiratory support and normal oxygen saturation in both groups. Patients with CO poisoning had a significantly higher rate of severe inhalation injury, higher arterial lactate levels, and more frequent hypocapnia with lower PaCO₂ values. There were no statistically significant differences between the two groups in the following: duration of mechanical ventilation; length of stay in the hospital; or mortality. Conclusively, CO poisoning has been associated with increased severity of inhalation injury and metabolic disturbance. Further studies will clarify the predictive ability of admission SpCO in burn patients.

https://pubmed.ncbi.nlm.nih.gov/41479630/

Factors Associated With Opioid-Involved Overdose: Descriptive Data From a Randomized Controlled Trial Evaluating Extended-Release Buprenorphine for Perinatal Opioid Use Disorder

This research examined factors associated with lifetime opioid-involved overdose among pregnant individuals receiving buprenorphine treatment for opioid use disorder. Using the baseline data (n=140) from participants in a randomized multi-site study, the researchers applied Random Forest modelling to identify important characteristics associated with having previously overdosed, including: ever having used heroin; ever experiencing trauma; being financially reliant upon their partner or parent; having a history of depression; and ever having used cocaine. More than half of the participants had reported having previously overdosed at least once. The findings of this study suggest that aspects of substance use history, mental well-being, and socio-economic status are critical determinants of overdose risk for pregnant women. Therefore, comprehensive and targeted approaches are needed to provide robust improvements in outcomes related to peripartum care.

https://pubmed.ncbi.nlm.nih.gov/41482623/

Survival after multiple in-hospital cardiac arrests due to severe amitriptyline poisoning- a case report

A 25-year-old male developed severe life-threatening arrhythmias and two instances of cardiac arrest after swallowing a large amount of amitriptyline. The situation was saved by quickly identifying tricyclic antidepressant toxicity (TCAD) and applying supportive care combined with the bicarbonate therapy. Consequently, both resuscitation and survival occurred without any impute from neurological deficits. The case demonstrates that favorable outcomes are possible despite severe cardiotoxicity when early diagnosis, persistent resuscitative efforts, and appropriate antidotal treatment are implemented, and it highlights concerns regarding the accessibility and misuse of tricyclic antidepressants.

https://pubmed.ncbi.nlm.nih.gov/41484815/

Runaway uncoupling in 2,4-dinitrophenol poisoning: Clinical and mitochondrial observations from two cases

This report illustrates two cases of poisoning from 2,4-dinitrophenol (DNP) in Sweden: one death from intentional ingestion and another that was not fatal but resulted from the administration of DNP for the purpose of weight loss. Both cases demonstrated profound hypermetabolic states resulting from the uncoupling of mitochondrial respiration. The fatal case progressed rapidly to hyperthermia, respiratory acidosis, hyperkalemia, and rigidity in the peri-mortem rigidity, whereas the non-fatal case had the same risk of hypermetabolism but with a prolonged and reversible metabolic disturbance. Physiological and mitochondrial evaluations suggested the presence of an uncontrolled feedback loop. In this loop, acidosis and an increase in CO₂ production resulted in increased uptake of DNP and potentially, catastrophic "runaway uncoupling." The report concludes that DNP toxicity cannot be predicted and is frequently fatal. DNP should be classified as unsuitable for human consumption.

https://pubmed.ncbi.nlm.nih.gov/41487961/

Late Onset of Entrectinib-Related ST Elevation in the Setting of Alcohol Intoxication in a Patient With Metastatic Non-small Cell Lung Cancer: A Case Report and Literature Review

This case report describes a 56-year-old man with non–small cell lung cancer who was receiving entrectinib therapy continuously for five years developed acute chest pain with transient ST-segment elevation and troponin. The patient underwent a complete cardiac evaluation, including coronary angiography, echocardiography and cardiac MRI. No signs of myocardial ischemia were found, nor were any abnormalities detected. Furthermore, after the patient was taken off of entrectinib and the ECG changes were resolved after temporarily discontinuing entrectinib. There is no evidence to suggest any other cause for these findings, suggesting that entrectinib therapy may have caused the events described or was implicated as a potential cause. The patient continued to benefit from entrectinib as an oncologic agent, and the initiating dose of entrectinib had to be lowered before being reinstituted. This case draws attention to the potential association between chronic entrectinib therapy and the development of reversible cardiac toxicity (due to an unknown mechanism), suggests the possibility of an interaction between entrectinib and alcohol, and stresses the importance of further research to determine the delayed cardiovascular effects of targeted agents.

https://pubmed.ncbi.nlm.nih.gov/41487784/

Intoxication by Self-administered Cesium Salts, the Clinical Impact of Questionable Research Output

The review looks at 20 case reports regarding the use of Cesium Chloride (CsCl) as an alternative to treat cancer. Most of the subjects were female between the ages of 40-49, many of whom used CsCl as a form of Self-Care for cancer via oral administration. The observed clinical effects of cesium chloride affected multiple systems of the body, however, the most serious effects appeared to have been from cardiovascular toxicities. QT interval prolongation, sinus bradycardia, and Torsades de Pointes were the most common ECG abnormalities recorded among the patients in the case reports. The toxicity of cesium chloride largely is to block potassium ion channels, which disturbs the proper function of cardiac electrophysiology and increases the risk for potentially fatal arrhythmias. The treatment protocols used in the presented cases varied widely, and 5 of the 20 reported cases resulted in the death of an individual from the effects of cesium. The findings of the review emphasize the significant and potentially fatal health risks associated with the use of cesium for cancer treatment and highlight the need to better educate patients and providers about the use of unsubstantiated claims of alternative cancer treatments based on false and misleading information.

https://pubmed.ncbi.nlm.nih.gov/41489700/

Treatment of colchicine intoxication, including the management of drug interactions

The following case study details the medical treatment of a 70-year-old man who had an unintentional overdose of 11 mg of colchicine over the course of two days. This resulted in multiple organ failures including renal failure, respiratory failure, cytopenias, cardiac arrhythmia, and gastrointestinal paresis. The patient received care from the Intensive Care Unit (ICU) and was treated initially with activated charcoal to minimize the absorption of the medication, as well as provide intensive supportive care. While undergoing treatment in the ICU, the patient was not given any medications that would inhibit the elimination of the colchicine from his system.

Fifty-eight days after the overdose, the patient was transferred to an appropriate acute rehabilitation facility for further recovery from the ICU-acquired weakness caused by the overdose.

This case illustrates the narrow therapeutic range of colchicine and the need for continued careful monitoring and supportive care for patients who are acutely ill due to a colchicine overdose.

https://pubmed.ncbi.nlm.nih.gov/41494721/

Human fluoroacetate poisoning: A case series of 36 patients in Vietnam

The retrospective study included 36 cases of fluoroacetate poisoning treated at Bach Mai Hospital, Hanoi, Vietnam over a two-year period from 2023-2024. Of these patients, 27 were male and their mean age was 35.4 years. The majority of the patients presented early on in their illness and had no symptoms. A small number of cases presented with seizures or a decrease in level of consciousness. All patients received supportive treatment (gastric lavage and activated charcoal) and 6 of the patients required intensive care unit admission. None of the patients died, and the outcomes were generally favorable, demonstrating that early identification and supportive care result in excellent short-term recovery from fluoroacetate poisoning.

https://pubmed.ncbi.nlm.nih.gov/41498051/

Summary

Collectively, the reports from this week reinforce the need for vigilant monitoring, early recognition, and evidence-based management of toxic exposures. The information presented also highlights the continuing threat from many different types of both traditional toxic agents and newly emerging toxic agents, the complexities involved with diagnosing and managing patients who exhibit overlapping toxidromes, and lastly, the necessity of continued research and education to ultimately enhance patient safety and reduce both morbidity and mortality from toxic exposure.