MedTox 2019 LLSA Reading List


Acute Liver Failure Study Group. Unrecognized acetaminophen toxicity as a cause of indeterminate acute liver failure. Hepatology 2011 Feb;53(2):567-76.
  • In this study, occult acetaminophen intoxication was identified using analysis of ___________________ in serum.
  • In the population of 110 cases of liver failure of indeterminate cause, analysis suggested occult acetaminophen toxicity in ___________________ cases or ___________________%.  In known acetaminophen-induced hepatic failure the assay was positive in approximately ___________________% of cases.


Ma WW, Saif MW, El-Rayes BF, Fakih MG, Cartwright TH, Posey JA, et al. Emergency use of uridine triacetate for the prevention and treatment of life-threatening 5-fluorouracil and capecitabine toxicity. Cancer 2017 Jan;123(2):345-356.

  • In addition to intentional or accidental overdose, ___________________ in capecitabine metabolism to 5-FU and in susceptibility to 5-FU can result in severe toxicity with properly planned dosing.
  • Uridine triacetate serves as an effective precursor to uridine, which cannot be given orally due to ___________________.


Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid hyperemesis syndrome: diagnosis, pathophysiology, and treatment—a systematic review. J Med Toxicol 2017 Mar;13(1):71-87.

  • Prior to onset of hyperemesis, cannabis use pattern was daily or greater in approximately ___________________% of patients and reported use less than ___________________ was rare (2.4%).
  • In addition to discontinuation of cannabis, hyperemesis often responds clinically to ___________________, which may be initiated by the patient and may contribute to dehydration and renal failure.

Household Products

Hatten BW, French LK, Horowitz BZ, Hendrickson RG. Outcomes after high-concentration peroxide ingestions. Ann Emerge Med 2017 Jun;69(6):726-36.

  • The typical 4-6 hour observation period appears ___________________ for cases of symptomatic hydrogen peroxide exposure.
  • ___________________ therapy should be initiated as soon as possible once neurologic symptoms occur.


  • Increased blood lead levels at age ___________________ were correlated with ___________________ in full scale IQ and socioeconomic status at age 38.
  • Deficits in verbal comprehension and processing speed were ___________________.


Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med 2017 Feb;376(7):663-73.

  • Within the hospital studied, the authors found substantial ___________________ in the opioid prescribing patterns of emergency physicians.
  • There was a ___________________ association between the intensity of a physician’s opioid prescribing and long-term use of opioids over the subsequent 12 months.

Poisoning Epidemiology

Mazer-Amirshahi M, Sun C, Mullins P, Perrone J, Nelson L, Pines JM. Trends in emergency department resource utilization for poisoning-related visits, 2003–2011. J Med Toxicol 2016 Sep;12(3):248-54.

  • Comparing 2003-4 and 2010-11 visits, the mean length of ED stay for a poison related case ___________________ by approximately 36%. 
  • While use of any diagnostic or therapeutic procedure remained relatively stable (-3.3%), rates of ___________________ decreased dramatically (-55.7%) while the use of ___________________ more than doubled (+163%). 


Shively RM, Hoffman RS, Manini AF. Acute salicylate poisoning: risk factors for severe outcome. Clin Toxicol (Phila) 2017 Mar;55(3):175-80.

  • The strongest predictor of severe outcome in salicylate poisoning was initial ___________________ elevation.
  • ___________________ age was an early predictor of severe outcome in acute salicylate poisoning.


Levine M, Ruha AM. North American scorpion envenomations. In: Brent J, Burkhart K, Dargan P, Hatten B, Megarbane B, Palmer R, et al., editors. Critical care toxicology: diagnosis and management of the critically poisoned patient. Springer International Publishing, 2017: 2269-75.

  • The bark scorpion in the United States is found in Arizona, ___________________, ___________________, and ___________________.
  • Scorpion venom targets voltage-gated sodium or ___________________ channels.


Soyka M. Treatment of benzodiazepine dependence. N Engl J Med 2017 Mar 23;376(12):1147-57.

  • Benzodiazepine dependence develops in approximately ___________________ of patients who use them for longer than one month.
  • A special characteristic of benzodiazepines is that ___________________ and ___________________ dependence can develop in the absence of tolerance.


Greenwood-Ericksen MB, Poon SJ, Nelson LS, Weiner SG, Schuur JD. Best practices for prescription drug monitoring programs in the emergency department setting: results of an expert panel. Ann Emerg Med 2016 Jun;67(6):755-64.

  • One significant challenge facing prescription drug monitoring programs has been ___________________ enrollment by prescribers.  Enrollment rates are well below ___________________% in most states with a median registration rate of ___________________%.
  • One policy recommendation includes ___________________ lookup for selected patients who meet objective data regarding their opioid prescription.

Synthetic Cannabinoids

Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R. “Zombie” outbreak caused by the synthetic cannabinoid AMB-FUBINACA in New York. N Engl J Med 2017 Jan 19;376(3):235-42.

  • Identification of AMB-FUBINACA required ___________________ among clinical laboratories, health professionals, law enforcement agencies, and organic chemists.
  • Synthetic cannabinoids shifted from research tools to drugs of abuse in ___________________.

Toxic Outbreaks

Shrivastava A, Kumar A, Thomas JD, Laserson KF, Bhushan G, Carter MD, et al. Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study. Lancet Glob Health 2017 Apr;5(4):e458-66.

  • Clinical features characterizing patients included ___________________ and ___________________.
  • Children seriously affected commonly had ___________________ blood glucose and ___________________ of an evening meal.

Zakharov S, Pelclova D, Urban P, Navratil T, Nurieva O, Kotikova K, et al. Use of out-of-hospital ethanol administration to improve outcome in mass methanol outbreaks. Ann Emerg Med 2016 Jul;68(1):52-61.

  • Field administration of ethanol (1.8-2.0 mL/kg body weight) prior to referral hospital arrival in patients with suspected methanol intoxication resulted in survival without visual or CNS complications for ___________________% in treated versus ___________________% in those not treated.
  • One serious limitation of the study is that treatment was not ___________________.

Withdrawal Syndrome Management

Kraft WK, Adeniyi-Jones SC, Chervoneva I, Greenspan JS, Abatemarco D, Kaltenbach K, et al. Buprenorphine for the treatment of the neonatal abstinence syndrome. N Engl J Med 2017 Jun 15;376(24):2341-8.

  • The median duration of treatment of neonatal opiate withdrawal and length of hospital stay were shorter when sublingual ___________________ was employed in place of oral ___________________.
  • The percentage of infants requiring supplemental treatment with ___________________ was similar in the two groups and adverse effect rates with buprenorphine were ___________________ those observed with morphine.